Can I Breastfeed with HCV?

One of the most active posts on this blog over the past year dealt with Hepatitis C in pregnancy.  Given the interest and number of questions about it, I’ve added another post specifically addressing breastfeeding while infected with HCV.

By the way:  I do use medical resources for this post.  But you’ll just have to believe it.  I’m not spending time citing sources.  It’s a blog.  Quote me at your own risk – I could be just making this up.

The short answer to the question is “we don’t know, but it’s probably safe” to breastfeed when infected with HCV.

There is quite a reasonable amount of research about it.  Of the numerous studies looking at HCV transmission to infants, none have documented infection from breastfeeding.  However, HCV has been found in colostrum, so the baby does come in contact with the virus.  It’s just that eating HCV is a REALLY tough way to pick up the disease – especially if you have no teeth.

So, breastfeeding is probably safe.  One cavieat: this does not apply if the patient also has HIV. HIV moms pass along HCV at nearly quadruple the rate of non-HIV moms (18% transmission rate vs. 4%).

Nobody knows why HIV increases these rates, but I’m sure you can reason that since that virus weakens the immune system, the patient’s ability to suppress the HCV is limited.  A recent systematic review identified 77 studies on the topic of HCV transmission to infants published from 1992 – 2000.  Of all the variables studied, the one that correlated most strongly HCV transmission was HIV co-infection.

And what are some of those ‘variables’?  The studied variables are the other things that people surmise might contribute to HCV transmission from mom to baby.  These include mode of delivery (vaginal vs C-section), type of Hep C (yep, there’s lots of strains), rupture of birthing membranes more than 6 hours before delivery, internal fetal monitoring (if you don’t know what this is, ask in the comments section and I’ll explain it).

So, here is a basic summary what what we think we know about that tricky HCV:

  • HIV infection is the biggest risk factor for passing hepatitis C to your baby.  It more than quadruples the risk of HCV transmission.
  • A high HCV viral load is also a problem.  Moms with viral loads higher than a certain threshold (1 x 10 to the 5th power) are more likely to transmit hepatitis to their infants, although we can’t say how much more likely.
  • The effect of type of HCV on transmission isn’t clear, but probably ins’t much of a factor.
  • Breast feeding appears to be safe except in women who are coinfected with HIV.
  • Studies of the effect of mode of delivery on transmission rates are all inconclusive.  We use this 4-syllable word to describe our highly profesional feelings of ineptitude.  We don’t know whether or not we should recommend C-sections to HCV moms.  There just isn’t good data to support either method.

Therefore, what I recommend to my patients is to breastfeed.  The benefits of mom’s milk outweigh the possible risks of giving the baby Hep C.  True, the disease is no cakewalk, but some argue that its a tough life to have to grow up without their mom and all she can probvide, like breastfeeding and the intimacy of such a practice.

So, take your pick.  True, the topic isn’t really important unless you get to know someone with this kind of problem.  But then, suddenly, the situation becomes much more real.

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