Pregnancy
Having hepatitis C does not rule out having children. Many women with hepatitis C experience a trouble-free pregnancy and delivery and deliver healthy, hepatitis C-negative babies. The risk of transmitting the virus from mother to child is approximately 5%.
Mothers with very low viral loads are much less likely to transmit the virus to their infant. However, if the mother is also HIV positive, the risk increases significantly to up to 36%.
Relationship between pregnancy and hepatitis C
Pregnancy does not appear to hasten liver disease in women with hepatitis C nor does the presence of hepatitis C increase the risk of complications during pregnancy, unless there is severe liver damage.
Breastfeeding
Although hepatitis C has been detected in breast milk, the levels are much lower than those found in blood and the general advice to mothers considering breastfeeding is that the virus is present, but the risk of transmission via breastfeeding is very low. However, mothers need to be aware of the increased risk in the presence of cracked and bleeding nipples, which exposes the infant to infected blood. For mothers who are HIV positive as well, breastfeeding is not recommended as breastfeeding is a recognised transmission route for HIV.
Delivery
There has for some time been debate about whether the risk of transmission from mother to child is reduced if a caesarean section delivery is performed. There appears to be no conclusive evidence to suggest that it makes any difference to the 5-7% incidence of transmission. However, if the mother is co-infected with HIV then the risk of transmitting either virus is significantly higher in normal vaginal deliveries.
Treatment while pregnant
At present no data is available that illustrates the benefits or risks of interferon treatment during pregnancy, including the impact it may have on reducing the risk of mother to child transmission.
Ribavirin, used in hepatitis C combination therapy should not be used during pregnancy. Ribavirin is known to cause severe birth defects and any woman of child bearing age or man with a female partner of child-bearing age undergoing treatment with ribarivin will be required to use two methods of birth control.
Determining mother to child transmission
In order to ensure any infected child receives appropriate and effective medical care it is important to determine whether viral transmission has occurred. Because of the presence of maternal antibodies up until the age of 10 months, the only accurate test to determine infection is the HCV-RNA test (to determine the presence of hepatitis C virus). All hepatitis C infected children will have a positive RNA test at 3 months. In the absence of RNA testing, diagnosis of infection can be established by antibody testing after the child is 12 months old.
Babies born to hepatitis C mothers usually receive hepatitis B vaccine starting within the first 4 weeks of their life. This is becuase they may be at higher risk of hepatitis B infection which can be more severe if they are infected with hepatitis C. Hepatitis A vaccine is usually given to hepatitis C infected children after their second birthday.
IVF Treatment
Women with hepatitis C may encounter problems getting IVF treatment.
The Human Fertilisation and Embryology Authority's code of practice states in its section on 'Welfare Of The Child '
3.12 Those seeking treatment are entitled to a fair assessment. Treatment centres are expected to conduct the assessment with skill and care, and have regard to the wishes and sensitivities of all those involved. This assessment is expected to take into account the following factors relating to patients:
(i) The commitment to raise children
(ii) The ability to provide a stable and supportive envirnoment for a child/children
(iii) Immediate and family medical histories
(iv) The age, health and ability to provide for the needs of child/children
(V) The risk of harm to children including:
a inherited disorders or transmissible disease
(The risk of transmitting the virus from mother to child is approximately 5%. Mothers with very low viral loads are much less likely to transmit the virus to their infant. However, if the mother is also HIV positive, the risk increases significantly to up to 36%. ) see pregnancy
and also
9.2 All patients placing gametes, embryos and ovarian or testicular tissue in storage which falls under an HFEA licence are expected to be screened for Hepatitis B, Hepatitis C and HIV,as outlined in Section 9.4 of the Association for Clinical Embryologists' Guidelines.
This procedure is necessary to reduce the potential risk of cross contamination between stored samples.
If you are having difficulties getting treatment this clinic treats women with hepatitis C both on the NHS and privately.
Chelsea & Westminster Hospital
Assisted Conception Unit
369 Fulham Road
London SW10 9NH
Tel: 0208 746 8922
Email: acu@chelwest.nhs.uk
They are currently licenced for:-
Intra Cytoplasmic Sperm Injection with donor sperm - IVF - DI - Storage of Sperm - Storage of Embryos - ICSI - ZIFT - IVF with donor eggs - IVF with donor sperm - PZD - Egg sharing - Chemical Assisted Hatching - Mechanical Assisted Hatching
Human Fertilisation and Embryology Authority
Tel: 0207 291 8200
Website: www.hfea.gov.uk
HCV and menstruation
Little is known about the impact hepatitis C has on menstruation or what impact menstruation has on hepatitis C. However, some evidence exists to suggest that women with hepatitis C experience more absent or irregular periods than their hepatitis C negative counterparts, more abdominal cramps and a greater incidence of pre-menstrual syndrome (PMS) or more severe PMS.
Much more attention is paid to sexual transmission during menstruation and risk of infection from improper disposal of sanitary protection. This is because the hepatitis C virus is present in menstrual blood and is thought to survive outside the body in dried blood for up to two weeks or more. Used tampons and sanitary towels should be put in a sealed bag and then disposed of in the usual way.
Hepatitis C and the menopause
Progression to liver fibrosis in Hepatitis C infected people is faster in men than women. Some studies have illustrated that one of the major reasons for this is the presence of the female hormones oestrogen and/or progesterone which may have an antifibrotic effect. As a consequence women who are post-menopausal have a higher risk of fibrosis, with a faster progression rate than pre-menopausal women. This effect may be countered with hormone replacement therapy and should be discussed with your physician.
In addition pre-menopausal women appear to have an improved response to treatment than post-menopausal women or men. Once again oestrogen and/or progesterone seem to play a significant role in this difference.
