Hepatitis B and Hepatitis C in Pregnancy
Frequently Asked Questions: Pregnancy
Hepatitis B and hepatitis C are serious infections that affect the liver. Both diseases are contagious (easily spread) and caused by viruses. Both can lead to serious, long-term illness.
Not only does a pregnant woman face the risks of hepatitis herself, she also can pass the viruses to her baby. Many pregnant women may not even know that they are infected because infection sometimes causes no signs or symptoms.
Hepatitis B virus is spread by direct contact with the body fluids (such as blood, semen, or vaginal fluids) of an infected person. This can happen during unprotected sex or while sharing needles used to inject (“shoot”) drugs. A baby can be infected during birth if the mother has hepatitis B. Hepatitis B virus also can be spread if you live with an infected person and share household items that may come into contact with body fluids, such as toothbrushes or razors. Hepatitis B is not spread by casual contact with people and objects. Hepatitis B is not spread by breastfeeding.
Infection with hepatitis B virus can be acute or chronic. Acute infection is a short-term illness that happens in the first
6 months after a person is infected. Symptoms may include the following:
- Loss of appetite
- Nausea and vomiting
- Jaundice (yellowing of the skin and eyes)
- Stomach pain
- Pain in the muscles and joints
The infection can clear up completely in a few weeks without treatment. Those who do get rid of the hepatitis B virus become immune to it. They cannot get the virus again.
A small number of adults and many children younger than 5 years who are infected never get rid of the hepatitis B virus. This is called chronic infection. These people keep the virus for the rest of their lives. They are known as carriers. Most carriers do not have any symptoms. In a small number of carriers, chronic infection can lead to serious complications, such as cirrhosis of the liver, liver cancer, and early death.
There is no cure for hepatitis B virus infection, but symptoms can be managed. There also is a vaccine that prevents hepatitis B virus infection. People who have had recent contact with the hepatitis B virus and are not vaccinated can be given a shot called hepatitis B immune globulin (HBIG) along with the vaccine. HBIG contains antibodies to the virus. It can give additional protection against infection in certain situations.
If I am pregnant and infected with the hepatitis B virus, how likely is it that I will pass the virus to my baby?
About 90% of pregnant women with acute hepatitis B virus infection will pass the virus to their babies. Between 10% and 20% of women with chronic infection will do so.
Hepatitis B virus infection can be severe in babies. It can threaten their lives. Infected newborns have a high risk (up to 90%) of becoming carriers. They, too, can pass the virus to others. When they become adults, they have a 25% risk of dying of cirrhosis of the liver or liver cancer.
All pregnant women are tested for hepatitis B. There are different blood tests for hepatitis B virus infection. They can tell whether you have been infected recently or whether you are a carrier. They also can tell whether you have had the hepatitis B virus in the past and are now immune to it or whether you have had the hepatitis B vaccine.
If your test result shows that you are infected with the hepatitis B virus, you may have additional tests to check the function of your liver and your general health. Your other children, your sexual partners, and others living in your household are at risk of infection. They should be told about testing and vaccination.
Having hepatitis B infection does not affect how you will give birth. You still can have a vaginal delivery if you are infected with the hepatitis B virus.
Yes. You still can breastfeed your baby if you are infected with the hepatitis B virus.
If I am infected with the hepatitis B virus, what can be done to prevent my baby from becoming infected?
Within a few hours of birth, your baby will receive the first dose of the hepatitis B vaccine. A shot of HBIG is given as well. Two more doses of the vaccine are given over the next 6 months. After the vaccine series is complete, your baby will be tested for hepatitis B virus infection.
If test results show that the baby is infected with the hepatitis B virus, he or she will need to have ongoing medical care. Regular visits with the baby’s doctor will be needed to assess the baby’s health and how well the liver is working.
All babies are vaccinated against the hepatitis B virus. If you are not infected with the hepatitis B virus, your baby should get the first dose of vaccine before you leave the hospital. If it cannot be given by then, it should be given within 2 months of birth. The remaining doses are given within the next 6–18 months.
There is no vaccine to protect against the hepatitis C virus. Avoiding certain types of behavior is the only way to prevent infection.
The hepatitis C virus is spread by direct contact with infected blood. This can happen while sharing needles or sharing household items that come into contact with blood. A baby can be infected during birth if the mother has hepatitis C infection. It also can be spread during unprotected sex, but it is harder to spread the virus this way. It is not spread by casual contact or breastfeeding.
Hepatitis C virus infection causes signs and symptoms similar to those of hepatitis B virus infection. It also can cause no symptoms. Unlike hepatitis B virus infection, most adults infected with the hepatitis C virus—75% to 85%—become carriers. Most carriers develop long-term liver disease. A smaller number will develop cirrhosis of the liver and other serious, life-threatening liver problems.
If I am infected with the hepatitis C virus, how likely is it that I will pass the virus to my baby?
About 4% of women who are infected with the hepatitis C virus will pass it to their babies. The risk is related to how much of the virus a woman has and whether she also is infected with human immunodeficiency virus (HIV).
If you are infected with the hepatitis C virus, your baby usually will be tested when he or she is at least 18 months of age.
Yes. You still can breastfeed your baby if you are infected with the hepatitis C virus.
Antibodies: Proteins in the blood that the body makes in reaction to foreign substances, such as bacteria and viruses.
Carriers: People who are infected with the organism of a disease without showing symptoms. These people can pass the disease to other people.
Cirrhosis: A disease caused by loss of liver cells. The lost cells are replaced by scar tissue that impairs liver function.
Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.
Hepatitis B: An infection caused by a virus that can be spread through blood, semen, or other body fluid infected with the virus.
Hepatitis B Immune Globulin (HBIG): A substance given to provide temporary protection against infection with hepatitis B virus.
Hepatitis C: An infection caused by a virus that can be spread by sharing needles used to inject drugs.
Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system. If left untreated, HIV can cause acquired immunodeficiency syndrome (AIDS).
Immune: Protected against infectious disease.
Jaundice: A buildup of bilirubin (a brownish yellow substance formed from the breakdown of red cells in the blood) that causes the skin to have a yellowish appearance.
Semen: The fluid made by male sex glands that contains sperm.
Vaccination: Giving a vaccine to help the body’s natural immune system develop protection from a disease.
Vaccine: A substance that helps the body fight disease. Vaccines are made from very small amounts of weak or dead agents that cause disease (bacteria, toxins, and viruses).
Viruses: Agents that cause certain types of infections.
If you have further questions, contact your obstetrician–gynecologist.
FAQ093. Copyright September 2019 by the American College of Obstetricians and Gynecologists
This information is designed as an educational aid to patients and sets forth current information and opinions related to women’s health. It is not intended as a statement of the standard of care, nor does it comprise all proper treatments or methods of care. It is not a substitute for a treating clinician’s independent professional judgment. Read ACOG’s complete disclaimer.