Hepatitis C in Pregnancy: Causes, Risks, Diagnosis, Treatment & Prevention:
Pregnancy-associated hepatitis C (HCV) correlates with the Hepatitis C virus (blood-borne) and approximately 1 - 3.6% of women giving birth worldwide are known to have positive tests for this infection while pregnant.
Most pregnancies where the mother is positive for HCV can proceed without too many complications. However, the risk of transmitting the virus from mother to child in an active (original) case is 5.8 - 7.2%. This risk can be further increased (10.8 - 12.1%) if the mother is HIV positive as well.
The CDC and AASLD now recommend universally screening all pregnant women for HCV during every pregnancy. Currently there are no medicines that are FDA approved for treating HCV using Direct Acting Antivirals (DAAs) in pregnant women, but the 2025 fetal guidelines will allow for medications to be given to pregnant women based on mutual clinical decision making. The Cesarean Section route of delivery will not necessarily lessen the risk of transmission from mother to child. Breast feeding will not pose any additional risks.
Author!
Dr. Humaira Latif MBBS · Obstetrician & Gynaecologist · 14 Years Clinical Experience · Private Clinic, Pakistan
✔ Clinician-Authored.
Published:October 2025.
Updated on:June 2026.
Medical Disclaimer!
This article is for educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider regarding any health concerns, medical conditions, or pregnancy-related questions.
📋 Table of Contents:
- What Is Hepatitis C?
- How Common Is HCV in Pregnancy?
- Causes & Risk Factors
- Symptoms During Pregnancy
- Risks for the Mother
- Risks for the Baby
- Vertical Transmission: The Full Picture
- Screening & Diagnosis
- Treatment Options in 2025
- Labour, Delivery & Intrapartum Care
- Breastfeeding With HCV
- Testing the Baby After Birth
- Postpartum Care for the Mother
- Prevention Strategies
- Frequently Asked Questions.
- References
- Medical Disclaimer.
- Free Link for pdf checklist "Hep c in pregnancy symptoms checkList".
1. What Is Hepatitis C?:
Cases of Hepatitis C result from the Hepatitis C virus (HCV)-a single-stranded RNA virus which infects the liver is not protected by either a vaccine or any natural immunity so therefore this is why only counteracting (i.e., vaccines) nor any natural immunity would have prevented.
Furthermore, such viruses will spread primarily through blood (i.e., person-to-person) contact thus allowing it to go undetected for a prolonged period of time thus progressing substantially without an individual knowing until diagnosed if any indication appears through conventional testing methods).
Due to these factors, HCV has 6 (six) main genotypes (i.e., genotypes 1 through 6). According to the data published by World Health Organization (WHO), it would appear that most individuals both within the USA and Canada are infected with Genotype 1 HCV whereas Genotype 3 is dominant both in South;
Asia, specifically Pakistan and India, so some genotypes may yield different levels of success based upon each patients’ individual genetic makeup as well as their respective geographic area/region where they got infected (by HCV).
In conjunction with how it was acquired, genotype designation (i.e., genotype) will have an impact on patient treatment because there may also be a difference in treatment periods and medications that may be used.
As a rule of thumb, since new medications called pangenotypic (i.e., such as Sofosbuvir/Velpatasvir), work against all 6 genotypes of HCV, patients needing treatment should be using such medications as those not having been diagnosed would benefit from their use as soon as possible be it for acute, chronic or post-transplant HCV infections., or women that can potentially carry the HCV virus while pregnant due to the pregnancy related hormonal and physical changes their bodies will experience and are likely to have if they are infected with it (will have a larger percentage of both cases along with those infected with the virus that will conceive) and may need long-term follow-up care. .
2. How Common Is HCV in Pregnancy?:
There is a large burden of HCV infection in pregnant women globally; many may not be aware of this issue. According to Lancet Gastroenterology & Hepatology modeling done on this topic, there are approximately 1.3 million pregnant women with HCV each year worldwide.
In the United States, the rate of HCV- positive births among infants has also been increasing rapidly over the last ten years, primarily due to our current opioid crisis. The rate of HCV infection among pregnant women increased from 2012 to 2018 by 100%; this was especially true in rural Appalachian states where there were sharp increases in the rates of infections. For example, West Virginia now has an estimated incidence of 22.4 HCV-positive deliveries per 1,000 live births, one of the highest incidences in all developed nations.
In Pakistan and South Asia, estimating the number of pregnant women with HCV is difficult because of unavailability of reliable national data. Injection drug use, unscreened blood transfusions and reuse of improperly sterilized medical instruments are very important factors contributing to the HCV infection rate among women of reproductive age.
3. Risk Factors and Causes of HCV in Pregnancy:
Who has a higher risk of having HCV in Pregnancy?
1. A history of drug use (historically, including a single use), injection (IV or otherwise)
2. Someone who has received a blood transfusion, or an organ transplant prior to 1992 (when blood screening began in most countries).
3. Women who are on dialysis (haemodialysis), or have chronic kidney disease
4. Woman with HIV (HCV and HIV together is a higher risk)
5. Women who had (had raised) ALT/AST (abnormal liver function tests) at some time during pregnancy
6. Women with a history of incarceration (jail or prison)
7. Women who are in a sexual relationship with someone with HCV
8. Someone whose mother (HCV Positive) has never been tested.
9. Health care workers with a needle stick injury to HCV+
10. Important note:
Also, up to 50% of people that get diagnosed with (HCV) have no way to determine that they had a risk factor at the time of diagnosis. This is the best argument for universal (no risk factor) screening for HCV during pregnancy instead of only screening on risks.
4. Symptoms During Pregnancy:
The confusion regarding HCV is its deceptive nature. Most people who are infected with chronic HCV do not show symptoms at any time until they have a blood test showing the presence of HCV; meaning most women with chronic HCV infection feel completely normal throughout their entire pregnancy.
When the Symptoms are Present:
In the case of acute HCV infection (a new infection contracted while pregnant or shortly before), the person may experience mild nonspecific symptoms 2 to 12 weeks after exposure to HCV, some of which can resemble morning sickness:
- Fatigue and generalised weakness
- Loss of appetite (nausea/vomiting that resembles morning sickness)
- Mild upper right quadrant abdominal discomfort
- Muscle/joint pain
- Mild fever
- Jaundice (yellow skin/eyes) – occurs about 20-30% of the time in acute cases
- Dark urine/pale stools.
Pregnancy-Specific Symptoms of Advanced Disease
When a woman with HCV has progressed to cirrhosis, her symptoms become more severe and there is increased risk during pregnancy:
- legs and abdominal swelling due to portal hypertension
- increased tendency to bruise and bleed
- spider nevi (small clusters of blood vessels that are spider-like)
- pruritus (very itchy) is more likely to occur due to developing intrahepatic cholestasis (which is 5.89 times more likely to occur in HCV-positive pregnancies)
- confusion or altered level of consciousness due to extreme liver failure.
5. Risks for the Mother:
Pregnant women often experience itchy skin, and although it is usually a normal and harmless symptom of pregnancy, when a pregnant woman who is also positive for HCV has generalized itching, especially on the palms and soles, it is vital that the health care provider rule out the diagnosis of intrahepatic cholestasis of pregnancy (ICP). The combination of HCV and ICP puts the woman at a 1.5-fold greater risk for severe maternal morbidity than if neither HCV nor ICP was present.
A common phrase seen in older literature is "Hepatitis C is usually not a problem during pregnancy." While this is generally true for women without cirrhosis, more recent and larger data sets indicate that the relationship between hepatitis C infection and complications during pregnancy is more complex than had previously been thought
6. The Mother Risks: The Latest Data:
Obstetrical Complications of Hepatitis C That Are Currently Being Reported
An Article’s Vending Table Shows Information on HCV That Most Articles Have Not
Notice That HCV Viremia (Having a Detectable Viral Load in Pregnancy) is Associated with Poorer Outcomes than Being Infected with HCV and Clearing the Virus Before Pregnancy. Active Viral Replication During Gestation is Likely the Driver of the Preterm Labour and Cholestasis-Related Inflammatory Cascade, as Opposed to Confirmation of Antibody Positivity. This Is Clinically Significant.
Risk of HCV in Pregnancy is Greatest with Cirrhosis.
For Women Who Have Developed Cirrhosis, their Risk Profile Is Different. Portal Hypertension Due to Cirrhosis Can Worsen Dramatically in Pregnancy Due to 40-50% Increase in Blood Volume. Some Cirrhosis-Specific Risks Are:
• Variceal Bleeding—Rupture of Oesophageal and Gastric Varices
• Hepatic Decompensation (Acute Liver Failure)
• Spontaneous Bacterial Peritonitis
• Higher Maternal Mortality Rate Compared to Non-Cirrhotic HCV Pregnancies
All Pregnant Women with HCV and Documented Advanced Fibrosis or Cirrhosis Should Be Referred to Maternal Fetal Medicine and Hepatology Specialists.
6. Risks To The Baby:
Babies of mothers who are infected with Hepatitis C (HCV) also have to be considered at various risk factors, as previously mentioned regarding the risk of vertical transmission in Section 7. According to a study published in Obstetrics & Gynecology in 2024, even after adjusting for confounding factors in the study, researchers found the following results:
Neonates born to HCV positive mothers were 2.6 times more likely to require admission to the NICU
Neonates born to HCV positive were 2.9 times more likely to be born with a low birth weight (below the 5th percentile) (severe SGA)
In a multi-state CDC-affiliated study of 1,418 births, 20% of births were to mothers with Hepatitis C; and
an additional 13% of those babies were considered small-for-gestational-age
34% of those neonates who were born at term were admitted to the NICU
Both hyperbilirubinemia (jaundice) and neonatal HCV infection rates were not statistically significantly increased among HCV infected mothers as compared to non-infected mothers; meaning that many of the negative outcomes seen in this study may actually be accounted for by social / substance use comorbidity issues that are prevalent in HCV infected patient populations, but are not attributed directly to HCV. Therefore, continued monitoring of neonatal infants is warranted.
The Focus of HCV Management During Pregnancy: Vertical Transmission
The Focus of HCV Management During Pregnancy: Vertical Transmission
Vertical transmission of HCV, the mother to the foetus, is the primary focus of HCV management while pregnant. Below is the most complete breakdown of vertical transmission statistics and vertical transmission data that has not been previously represented.
7. Vertical Transmission Statistics:
The following are the estimated transmission rates for each combination of an HCV+ mother and her baby based on the mother's HIV status and HCV RNA level prior to pregnancy.
HCV- & HIV- Mother:
Transmission Rate = ~5.8% - ~7.2% Low
HCV+ & HIV+ or HCV+ & HIV- Mother: Transmission Rate = ~10.8 - ~12.1% Moderate
HCV+ Mother:
HCV RNA > 6 log 10 IU/ml: Transmission Rate = ? High HCV RNA
HCV- Mother:
No detectable HCV RNA: Transmission Rate = 0% Negligible HCV RNA
Critical Point:
There has never been a report of vertical transmission of HCV when the mother has no detectable HCV RNA level. A woman who has received successful treatment for her HCV and has achieved a sustained virological response (SVR) before becoming pregnant represents an almost zero risk of transmitting HCV to her baby. This represents the most significant justification for treating HCV for all pregnant women prior to pregnancy.
When Does Transmission Occur? The New Timing Data:
Most existing guidelines reference HCV vertical transmission but do not necessarily characterize the timing of transmission. A 2022 systematic review in Clinical Infectious Diseases has provided new timing estimates for vertical transmission:
1. Early In Utero (~24.8% of total transmissions)
Vertical transmission through the placenta early in the first trimester. The mechanism of early in utero transmission is not fully understood. There is a possibility that the HIV virus crosses over early due to changes in the immune system associated with the placenta or due to micro haemorrhages.
2. Late In Utero (~66% of total transmissions):
Most vertical HCV transmissions occur in the last trimester (3 months) of pregnancy. This represents the relatively high proportion of vertical HCV transmissions in the late in utero and is therefore a crucial aspect of diagnosing and treating HCV in pregnant women.
3. What this means medically:
3. What this means medically:
Most vertical transmission occurs before delivery (90.7%), so planned Caesarean delivery does not significantly reduce vertical transmission of HCV.
Multiple cohort studies have shown that there is no statistically significant difference in the transmission rates of HCV following vaginal delivery (4.2%) compared to planned Caesarean delivery (3.0%; p = NS).
Vertical transmission (risk factors).
1. High maternal viral load;
HCV RNA ≥6.0 log₁₀ IU/ml is independently associated with 3.4 times greater odds of transmission.
2. Co-infection with HIV;
results in 2 times higher transmission rate.
Prolonged rupture of membranes; increases fetal to maternal blood exposure time.
3. Fetal scalp electrodes placed for invasive fetal monitoring;
disrupt the fetal skin barrier; should be avoided whenever possible in HCV positive mothers.
4. Amniocentesis;
increases the theoretical risk for transmission, but data are inconsistent for this route.
5. Maternal illicit drug use;
confounds the risk of vertical transmission due to the presence of factors such as immune suppression and social factors.
Vertical transmission does NOT increase the following:
1. Breastfeeding (with un cracked, intact nipples).
2. Mode of delivery (caesarean section/vaginal), based on current evidence.
3. Genotype of HCV.
Routine use of epidural anaesthesia.
8. Screening for hepatitis C (HCV) in pregnancy:
1.Transitioning to Universal Screening:
Previously, women were screened for HCV during pregnancy only if they were considered to be "high risk." However, this system hasn't proven to be effective — various studies indicate that the number of pregnant women who are undiagnosed with HCV can be as high as 50% because many of them will not disclose or share their risk factors, or providers will fail to apply the risk criteria consistently.
Because of this history of failure, the Centers for Disease Control and Prevention (CDC), United States Preventive Services Task Force (USPSTF), American Association for the Study of Liver Diseases (AASLD), and American College of Obstetricians and Gynecologists (ACOG), all recommend universal screening for HCV at the beginning of all pregnancies, regardless of previous risk assessment and/or possible risk factors. These guidelines have been updated over 2018-2020 and will continue to remain unchanged through 2025.
2. Stepwise Diagnostic Algorithm:
An important consideration for diagnosis is that having only a positive HCV antibody test does not indicate that the patient has active infection. Antibodies will remain forever after exposure even for women who have cleared the HCV naturally. The only definitive way to identify the presence of active (current) infection is through a HCV RNA test; active (current) HCV infection has the potential to transmit vertically.
1. Lab Interpretation Simplified:
On the Lab Report: Anti-HCV positive + HCV RNA positive = active infection requiring further management
1.On the Lab Report:
Anti-HCV positive + HCV RNA negative = past resolved infection with no vertical transmission risk.
2. On the Lab Report:
Anti-HCV negative = not infected (unless with very recent exposure and require retest for new exposures during third trimester).
2. Retesting During Late Pregnancy:
Current guidelines suggest screening in the third trimester for pregnant females who have continued to have high-risk behaviors (active drug use, partners who are incarcerated, new sexual partners).
A negative screening result at the first trimester;
however, if the pregnant female were to acquire HCV late in her pregnancy, she would have the potential to transmit HCV to her newborn.
9. Updates on Hepatitis C Treatment in Pregnant Individuals after 2025:
The greatest change in the treatment of hepatitis C (HCV) in pregnant people is how the decision to treat has transitioned from being an absolute contraindication (meaning no treatment would be given due to the significant negative effects of treatment for mother and baby) to a conversation that is shared (with many stakeholders) and complex.
1. The historical basis of withholding treatment: (ribavirin) for HCV positive pregnant people was due to ribavirin being classified as definitely teratogenic (meaning it caused severe fetal malformations in animal studies) and because ribavirin is still considered a contraindicated treatment for all pregnant people as of 2025.
However, ribavirin is no longer a frequently used therapy for HCV due to the emergence of DAAs (Direct Acting Antivirals).
2. This new generation of medication can be taken orally as a once-daily pill;
1. Offer very different safety profiles than ribavirin;
2. And separate HCV treatment from pregnant individuals and the use of ribavirin.
3. Regarding the use of DAAs during pregnancy,
as of 2025, the safety of using DAAs during pregnancy has not been previously established by any labelled/ FDA approved.
What the Clinical Trials Tell Us:
DAA treatment regimen; however, based upon early clinical studies of DAAs in pregnant individuals, much of the data obtained indicates sufficient safety.
The latest AASLD and IDSA clinical guidelines also include information supporting the recommendation to treat HCV positive pregnant individuals with DAAs and that this should occur with an emphasis on shared decision-making and a personalized approach to treatment based on individual preference.
While these numbers would be considered large for most studies based on the number of patients treated for hepatitis c during pregnancy, they offer some meaningful consistency due to the lack of any anomalies discovered in the fetus, as well as the 100% cure rate among those who were treated for hepatitis c with anti-retroviral drugs prior to and during their pregnancy.
In addition to the small data set, the Center for Disease Control (CDC) and Coalition for Global Hepatitis Elimination (CGHCE) have launched a registry that collects real-life data from the thousands of patients using direct-acting antiviral agents (DAAs) to treat hepatitis c during pregnancy.
1.As for "Treat Before Pregnancy" remains the Most Definitive Evidence-Based Approach.
Currently there is no doubt, based on the currently available evidence-based research, that treating hepatitis c before getting pregnant is still the most supported evidence based approach for women who are planning to become pregnant if clinical circumstances allow for it.
A woman with sustained virological response (meaning essentially cure from hepatitis c virus) before becoming pregnant has:
- A zero percent chance of transmitting hepatitis c to her baby
- No liver based obstetric complications from active hepatitis c virus infection
- No drug safety concerns while pregnant
- Decreased chance of developing a future liver related disease herself
Current direct-acting antiviral agents used to treat hepatitis c are highly efficacious with treatment and a cure typically achieved within 8 to 12 weeks and cure rate to that point has been over 95%.
Every reproductive aged woman who is known to be infected with hepatitis c should have been treated prior to becoming pregnant and ideally treated years prior.
2. The "Treat After Delivery" Approach Has Limitations:
Prior to the widespread use of DAAs for hepatitis c, traditional guidelines recommended delaying treatment until after giving birth.
However, there is significant concern, supported by data,
That the majority of women will not continue with their hepatitis c care after delivery as currently there are so many additional demands on their time related to newborn care, breast feeding, being exhausted, and getting their lives back.
The Clinical Framework for Decision-Making
When Diagnosed Prior to Pregnancy:
• DAA should be treated immediately and conception may not occur until after SVR has been verified (12 weeks post-treatment).
When Diagnosed During First Trimester:
• Emerging data and risks should be discussed with the patient. The majority of guidelines indicate that monitoring is preferred unless there are significant issues with the liver.
When Diagnosed During Second or Third Trimester:
• The decision regarding the initiation of DAA during the pregnancy as opposed to postpartum should be made collaboratively with the patient and documented thoroughly.
In Cases of Cirrhosis:
• Discuss the initiation of treatment at any point prior to delivery with a physician who specializes in hepatology.
10. Delivery, Labour and Intrapartum Care:
Understanding interventions that should occur as well as those that should not occur during the labour of an HCV positive female can alleviate unnecessary interventions and mitigate the low risk of viral transmission during delivery.
1.Mode of Delivery:
Currently, there is no evidence to recommend the planned caesarean section as a means to avoid vertical transmission of HCV.
Multiple large studies (including a large retrospective study of 559 mothers with their babies) show no difference in Hepatitis C transmission rates between vaginal delivery (4.2%) and a planned caesarean (3.0%).
This p-value is NS. The risks associated with caesarean delivery include, but are not limited to;
- Blood loss,
- Incision infection,
- And extended times to return to normal - especially in women with pre-existing liver disease.
2. Intrapartum Precautions for Women with HCV:
- Avoid fetal scalp electrodes unless clinically necessary. The placement of these instruments breaches the fetal skin barrier and creates potential maternal blood exposure.
- Avoid fetal scalp blood sampling unless absolutely necessary for clinical management.
- Limit time spent with ruptured membranes as much as possible; the fetus should not stay in ruptured membranes for long periods of time.
- Use of episiotomy should be strictly limited to situations where it is clearly indicated (the evidence supporting the risk of transmission through an episiotomy is weak).
- All healthcare workers must use standard precautions during the delivery of babies.
3. What Will Not Be Changed at the Time Of Delivery Due To HCV:
- Choice of pain management options (Epidural, spinal, nitrous oxide.)
- Oxytocin use for labor augmentation or to induce labor
- Delaying the clamping of umbilical cord (no evidence supports this increasing mother to child transmission of HCV
- Immediate skin to skin after delivery.
11. Breastfeeding With Hepatitis C: The Evidence:
The most commonly asked question of mothers in my clinic who have been infected with Hepatitis C is "Is breastfeeding safe for my baby?"
All major guidelines from the
- WHO,
- CDC,
- ACOG, and
- AASLD
Recommend that breastfeeding is safe and does not increase the risk of transmitting Hepatitis C to the baby through breastfeeding. Therefore, mothers are encouraged to breastfeed.
The Reasons Why Breastfeeding Is Considered Safe:
There are only small amounts of Hepatitis C found in breast milk if any at all
Because the virus is not intact when it reaches the baby's digestive system, it cannot be transmitted through breastfeeding.
There are studies that show no differences in HCV contractions of breast-fed infants vs. formula-fed infants born to HCV positive mothers.
One Situation to Stop Breastfeeding Temporarily.
🛑 Do Not Breastfeed Temporarily:
- If the nipples are cracked open,
- Bleeding, or have any open wounds,
- Do not continue breastfeeding as there could be a theoretical risk of Hepatitis C transmission from the blood.
- Return to breastfeeding when the nipples have completely healed.
- Also, women on DAA (direct-acting antiviral) Therapy should not breastfeed because there is no evidence to support that sofosbuvir and other DAA medications are safe while breastfeeding.
This is an additional reason why it is advisable for women to complete HCV treatment prior to conception.
12.Complete Protocol for Testing a Newborn Immediately After Birth:
New research has identified a major gap in care in that only 29-34% of at risk infants will have received appropriate follow-up tests. Research shows that this is a failure of the system and not of the parents.
The Difficulty of Testing Infants:
From birth until 18 months, all children born to mothers who are positive for HCV will be antibody positive; this is due to maternal antibodies crossing the placenta and does NOT indicate whether the child has the virus. The antibody test cannot differentiate whether or not the child has produced its own antibodies in response to the virus or has passively received the mother's antibodies.
13. Summary of the timeline for testing:
To obtain a quick answer regarding the presence of infection:
1. HCV-RNA testing at the 2-month mark (this is an "interim timeline" test).
2. Comprehensive ruling out of infection:
3. Negative test for HCV antibodies at 18 months (the definitive test).
Both timelines have clinical validity and must be documented.
1. What happens if the baby is positive?
Around 20-30% of HCV positive babies clear HCV by the time they’re 3 years old without treatment.
Those who have not cleared the virus, clinical management of pediatrics with hepatitis C has been revolutionized due to the approval of DAA therapy available for paediatric age groups.
Effective treatments now are available with glecaprevir/pibrentasvir and sofosbuvir based regimens approved down to the age of 3 based on weight criteria.
Referred to a paediatric gastroenterologist/hepatologist for the diagnosis would be appropriate for all infants with a positive status regarding hepatitis C.
13. Postpartum Care for Mothers with HCV:
The postpartum period is a unique opportunity to engage HCV positive mothers with the health care system. Many mothers who were previously disengaged from their liver specialists will now have access to the health care system. It is essential that health care professionals be proactive within the postpartum time frame.
Postpartum HCV Care Checklist:
✓ If the mother of a child born with hepatitis C did not receive DAA treatment during pregnancy, initiate DAA therapy as soon as possible (ideally within the first 6 weeks).
✓ Repeat tests of liver function, particularly if the mother has experienced a flare up of HCV activity after giving birth and/or as her immune suppression has ended.
✓ Stage the liver with liver fibrosis assessment (using FIB-4 calculation or Fibroscan assessment).
✓ Refer to hepatology.
💡Treatment After Giving Birth:
Studies have shown that women suffering from HCV will start a treatment regimen before having a baby rather than getting started on treatment three-six months after giving birth.
This means a large amount of women that tested positive for HCV will lose the opportunity to begin a treatment program to help eliminate the disease.
Therefore, it is critical that health care providers and/or systems pre-schedule an appointment for postpartum HCV treatment prior to a mother leaving the maternity unit instead of relying on the mother to refer herself to treatment.
14. Prevention: Protecting Yourself & Your Baby:
Before You Get Pregnant:
1.The Best Method of Prevention
If you have any risk factors, get tested for HCV prior to becoming pregnant
Meet all requirements for DAA therapy and achieve SVR prior to conception (this will eliminate all risk of transmission).
2. Test your partner for HCV, again, while sexual transmission is very low, it is not zero. The chance of transmission increases when co-infecting with STIs
During Your Pregnancy
3.Make sure you attend all of your doctor/obstetrician appointments and complete all of the recommended prenatal screening tests
4. Avoid alcohol entirely (even small amounts will increase the rate of fibrosis in the liver caused by HCV)
5. Be honest with your obstetrician regarding your HCV status;
this will assist your health care provider to appropriately develop your treatment plan while you are pregnant with your child
- If you are on an opioid replacement program (methadone/buprenorphine) remain on it;
- If you discontinue the medication abruptly, it will put you and your baby at a much higher risk than remaining on the medication
- Do not share any needles/syringes or anything that may be contaminated with blood (razors/nail clippers) with anyone.
- Community Health and Public Health Prevention
- Harm Reduction, e.g. needle exchange programs.
Hepatitis C can be cured:
these antibiotics do the job very well! If you remember to stop taking your medications two weeks before trying to conceive (or you’ve had your baby with an HCV-free status), then you can pass HCV-free on to your child. This represents one of the most significant breakthroughs in medicine to date, starting with a standard blood test.
15. Commonly Asked Questions:
Q'1' Can hepatitis C be passed from a pregnant mother to her child?
Yes, but the likelihood of this happening is small. If the mother has HCV RNA detectable in her blood, the chance of passing the HCV to their child is about 5.8-7.2%. If the mother also has HIV, this chance increases to 10.8-12.1%. Mothers with undetectable HCV RNA have effectively no chance of passing HCV to their child.
Q'2'Is it safe for pregnant women to receive HCV therapy?
As of 2025, no direct-acting antiviral (DAA) has been approved for use in pregnancy by the FDA. However, a few smaller studies of both ledipasvir/sofosbuvir and sofosbuvir/Velpatasvir have found minimal safety concerns, either to the mother or the infant. According to the current AASLD/IDSA practice guidelines, it is permissible to treat pregnant women with hepatitis C on a case-by-case basis and after extensive discussion with the treating physician. Ribavirin should not be given to pregnant women at any time.
Q'3'. Since a mother has hepatitis C, does she have to deliver by cesarean section?
No. Present literature does not support recommending that patients with hepatitis C deliver by cesarean section to decrease the risk of vertical transmission. There are no statistically significant differences between the vaginal delivery and planned cesarean delivery in regards to vertically transmitting the HCV. Therefore, there are no contraindications to vaginal delivery in asymptomatic women with hepatitis C, unless other obstetric indications exist.
Q'4'Can a mother who has Hepatitis C breast feed her baby?
Absolutely! Breast milk is not a way to transmit the Hepatitis C virus and all major health organizations strongly endorse breastfeeding! The only exceptions would be if the mother has cracked or bleeding nipples - in this case, she will want to pause breastfeeding until her nipples heal completely. If the mother is taking antiviral treatment she should also not breast feed during her treatment course.
Q'5'When does my child born to a parent with Hepatitis C get tested?
The first test for Hepatitis C in children should be performed via HCV RNA testing at age 2 months or older; however, the second test must also be performed for confirmatory reasons. The use of laboratory tests for the detection of antibodies is not recommended before age 18; maternal antibodies may continue to be present long after the mother has recovered from Hepatitis C. If there are any antibodies detected at age 18, that would indicate the child was not infected with Hepatitis C. If either of the two RNA tests performed on the child is positive, the child should be referred on to a pediatric gastroenterologist.
Q'6'Can I get pregnant with Hepatitis C?
Yes! HCV does not cause infertility. Ideally, you would complete the course of antiviral (DAA) treatment and achieve "sustained viral response" or cure before getting pregnant. This completely eliminates your risk of transmitting Hepatitis C to your child. Pregnant women who discover they have Hepatitis C can continue their pregnancy safely with close monitoring and mutual agreements with their healthcare providers regarding treatment options.
Q'7'What happens if my child has a positive Hepatitis C test?
Approximately 20-30% of infants infected with HCV will clear the virus without any treatment by three years of age. The children that remain positive can now be cured (over 95% success rates) using modern Pediatric DAA therapies (For example: glecaprevir/pibrentasvir is approved for children aged three to 18 years). Your child should be referred for care to a Pediatric Hepatologist. Today, a child with a positive HCV diagnosis can be managed, treated and cured — it is not a life sentence.
Q'8'Does HCV cause infertility or increase the risk of miscarriage?
HCV is not known to have either of these effects on women who don’t have cirrhosis; so women with HCV who don’t have cirrhosis should not worry about HCV affecting their ability to conceive, or causing miscarriage in early pregnancy. Women with advanced cirrhosis may have disrupted hormone levels and therefore possible menstrual irregularities, which could affect their ability to conceive. If you are a woman with HCV and are having difficulty conceiving, it would be appropriate to have a complete hormonal workup done as well as an evaluation by a Hepatologist.
16.Related Articles:
Related Articles
For more evidence-based pregnancy and women's health information, explore these related guides:
1.High-Risk Pregnancy: Causes, Symptoms, Risk Factors, and Management:
2. Eclampsia in Pregnancy: Causes, Warning Signs, Treatment, and Prevention
3. Preeclampsia: Causes, Symptoms, Diagnosis, Treatment, and Complications
4. Placenta Previa: Symptoms, Causes, Diagnosis, and Treatment Options
5. Gestational Diabetes: Diet, Lifestyle Changes, and Blood Sugar Management During Pregnancy
6. Pregnancy-Induced Hypertension (PIH): Complete Guide for Expectant Mothers
7. Renal Calculi (Kidney Stones): Causes, Symptoms, Treatment, and Prevention
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Kiser, JJ; Brooks, KM; et al. Pharmacokinetics, Safety, and Efficacy of Sofosbuvir/Velpatasvir in Pregnant Individuals with HCV. Clin Infect Dis. (2025). 80(4):744-751.
3. Cottrell, EB; Chou, R; et al.
Vertical Transmission of Hepatitis C: Systematic Reviews and Meta-analysis. Clin Infect Dis. (2013). 57(2):2098-2107.
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Management and Treatment of Hepatitis C.
Updated 2024. https://hcvguidelines.org
5.Centers for Disease Control and Prevention.
Viral Hepatitis Surveillance
Report 2023 — United States. (2025).
6.:Woodworth, KR; et al.
Birth Outcomes among Hepatitis C Positive Individuals During Pregnancy. Matern Child Health J. (2024). 28(6):979-983.
7. Locatelli, M; et al.
Impact of Hepatitis C Viral Parameters on Complications During Pregnancy and Risk for Mother to Child Transmission. J
Hepatol. (2022).
8. Obstetrics & Gynecology (2024).
Pregnancy Outcomes Among People with Hepatitis C Infection. PMID: 39173174.
9.Page, CM; Hughes, BL; Rhee EHJ; Kuller JA.
Management of Hepatitis C Virus Infection During Pregnancy: Review of Current Evidence and Recommendations. Obstet Gynecol Surv. (2017). 72:347-355.
10.Dugan, E; et al.
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18. Medical Disclaimer.
This article is written by a qualified Obstetrician and Gynaecologist for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personalized guidance regarding your specific situation. Clinical guidelines cited are current as of June 2025 and may be updated as new evidence emerges.
19.Author:
Dr.Humaira Latif
RMP,MBBS, Gynaecologist Obstetrician.
14 plus years of Experience
Medical and Health Content Creator.
20.Free Link for pdf checklist "Hep c in pregnancy symptoms checkList"
https://forms.gle/VDxJbwumaiL54TxS8
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