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Pregnancy Can Be Good for Women with HCV

Thursday, October 16, 2003
NEW YORK (Reuters Health) - Pregnancy and subsequent delivery may help women with chronic hepatitis C clear the virus from their blood, new research suggests.

Hepatitis C is a liver disease caused by infection with the hepatis C virus (HCV), which is spread through contact in some way with contaminated blood. In most patients, the virus is never completely cleared from the body and, after many years of infection, serious liver problems, such as scarring and cancer, can occur.

The new findings, which are reported in the Journal of Medical Virology, are based on a study of 22 pregnant and 120 non-pregnant women with chronic hepatitis C.In the pregnant group, two women permanently cleared HCV from their blood after delivery and one women temporarily cleared the virus, Dr. Masashi Mizokami, from Nagoya City University Graduate School of Medical Sciences in Japan, and colleagues report.In contrast, in the non-pregnant group, one woman cleared HCV permanently and another cleared it intermittently.

Considering the size of both groups, this means that 14 percent of pregnant women cleared the virus, compared with only 2 percent of non-pregnant women."The mechanism by which pregnancy and delivery influence HCV (blood levels) is not well understood," the authors note in their article in the Journal of Medical Virology. However, it may be relate to differences in how the immune system works during pregnancy compared with other times.  Taken together, the findings suggest that "pregnancy and (delivery) may improve the prognosis in women" with chronic HCV.
31 Responses
Avatar universal
Interesting ... but what about the risk of passing HCV to the child?
Avatar universal
Here's something I found on the HCV Advocate Website regarding the risk of transmission from mother to child:

HCV and Pregnancy

Many women with HCV are concerned about the risk of transmitting the virus to their babies during pregnancy or birth. Studies consistently show that the rate of perinatal or vertical transmission is low, about 5% or 1 in 20. Vertical transmission is most likely to happen when the mother has a high HCV viral load; several studies have shown that no transmission occurred when women had undetectable viral loads. Studies also show that women who are co-infected with both HCV and HIV have a higher risk (15-35%) of transmitting HCV to their infants. One British study has suggested that the risk of vertical HCV transmission may be reduced through Cesarean delivery; however, according to the Society of Obstetricians and Gynecologists of Canada, ?routine Cesarean section is not recommended as a specific measure to reduce the risk of vertical transmission of HCV.?

Although HCV has been detected in breast milk in some studies, there is no indication that breastfeeding transmits the virus. Most experts do not discourage HCV-positive women from breastfeeding. But women may wish to exercise caution if their nipples are cracked or bleeding. HCV is not transmitted from mothers to children through normal household contact.

According to Terrault, who treats many women with HCV, being pregnant does not adversely affect the progression of hepatitis C. Likewise, women with HCV do not have a higher rate of pregnancy or birth complications compared to uninfected women. However, women with severe, advanced liver disease may experience difficulties during pregnancy.

Universal prenatal screening of women for HCV is not currently recommended. Babies of HCV-positive women should be tested for HCV after 12-18 months. According to the Centers for Disease Control and Prevention, most infants infected with HCV at birth have no symptoms and do well during childhood. Studies suggest that infants are more likely than adults to completely clear the virus from their bodies. HCV treatment has not been well studied in infants and children.


Avatar universal
Hi:

I am glad you found the article; it is the one I was trying to lead you to.  From everything I read, transmitting the virus to a child seems to be very low risk.  Unfortunately, my 12-year-old daughter is infected; apparently at birth.  I had no idea until this year about my being infected.  I too was probably infected at birth from an exchange transfusion for RH disease.

After doing a lot of reading on the subject it seems that transmission risk increases if the mother is HIV positive. (I was not).  Also, if the mother has a high hcv viral load it seems that transmission rates are higher. (My viral load is very low @ 260,000, but have no idea what it was when I was pregnant) Another thing I read is that forcep delivery seems to be associated with a higher risk; my daugher was delivered by forceps.  From what I read, nursing does not seem to pose any greater risks, BUT I do remember bleeding from my nipples some while nursing. (sorry if this is graphic, but it is part of nursing)  Nursing can be very rough on delicate tissues not used to a hungry baby, and often the skin cracks/bleeds.  In retrospect, I have to wonder if this could have been how she was infected being that she was probably teething, and I would imagine that could be a route of transmission; bottom line is I will never know for sure.  At least you have the benefit of being aware of these issues.  Since overall the risks seem to be very low, I would not worry too much. Just try to be real honest with yourself about how you will feel if it was to be passed to your child, and if you can handle that emotionally.  Another consideration is that if the worst should happen, people infected as infants tend to do much better over time than those infected as adults, but of course, there are never any guarantees.  Also, the disease usually moves so slow, and by the time your child is old enough to begin school, there will probably be much more effective treatments with lower side effects than currently available.

Like everything it seems with this disease, you have to gather all the information and make an informed choice based on your individual circumstances.  Knowing I infected my daughter at birth, if I had to do it over again, I definately would still have her.  Only I would know to take as many precautions as reasonably possible.
Avatar universal
My friend has HCV and has two children. If there is a 5% chance of a child getting it, then is there a one in ten chance one of her children has it? To me, that sounds quite high.
Avatar universal
How did you find out that you had hepc?
Avatar universal
Like many people, I discovered I had Hep C (last month) through a routine exam required by a life insurance application.  I assumed it was a false positive at first, because I knew that my fertility clinic had given me an HCV test back in March 2003, prior to my embryo transfer procedure.  But when I called the clinic to re-confirm that, they said...."oh my goodness, somehow we must have missed it.  Upon closer inspection of your lab report, you did test positive for Hepatitis C back in March."  That was my first lesson in the importance of requesting copies of all lab reports. Arggh!

Susan
Avatar universal
Thanks for sharing your story with us.  I'm sorry to hear that your daughter is infected.  I know you don't need me to tell you that it's certainly not your fault.  But the issue would be different in my case, and perhaps "fault" would be relevant, because I would be knowingly choosing to bring a child into the world in spite of the possible risks.

In my case, my husband and I have pretty much given up hope that we'll conceive naturally at my age.  In fact, my last pregnancy/miscarriage (June 2003), was the result of using donated embryos from another couple who didn't want their "leftovers" to go used. I know, I know...it sounds weird.  It's like giving birth to your own adopted child.  But there's an estimated 400,000 cryopreserved embryos sitting in "suspended animation" at fertility clinics in the U.S.  Many will eventually be destroyed.  I bring all this up because I'd like to think that my husband and I are giving some of these embryos a chance at life, and perhaps that makes the small risk of HCV transmission worth it.

What are your plans for your daughter regarding treatment?  Are you waiting until better meds are available?  

Susan
Avatar universal
Hi:

I am not sure yet what I will do regarding treatment for my daughter.  I have pretty much decided to wait for biopsy results for both of us before making any decisions.  I go back and forth.  She has already seen a specialist in July; my first appointment with a specialist is Thursday.  Neither one of us has had a biopsy yet.  On her next visit in January I will request a biopsy.  On one hand I don't want her to have to deal with having hep c going into her teenage years, it seems kids handle sides better than adults, and peg-intron was recently fda approved for kids.  But if she has no damage, then I think I would rather wait till something better with less sides comes along.  My one concern is her liver enzymes are mildly elevated.  In one way it is a god send that they are elevated; her first pediatrician proclaimed her hep c free because she had a false-negative anti-hcv test even though her liver enzymes were elevated.  Her elevated liver enzymes are what made me get her another pediatrician and request a qualitative pcr and repeat anti-hcv, which were both positive.  If I listened to her first pediatrian we would still think she was okay.  This confused her greatly; when the second doctor gave us the results we were both stunned.  She said, "but the other doctor said I didn't have it."  I was stunned also; I thought I was being an overly cautious parent(I am aware many things could have caused the elevated enzymes) and really never expected her to be positive.  My instincts told me that under the circumstances it is better to be safe and double check.  That is why I cringe when I read recommendations to have children tested once, and if negative, they are fine.  I realize that the odds are they ARE fine, false negatives don't happen often, but they do happen.  It is much, much, better that we know so I can watch what medications she is given, etc.   It has been a crazy, roller coaster ride the past 6 months since this all started.  I understand why people decide to treat, and why some people decide to wait.  It is a difficult decision.  For me, the biopsy results will help greatly in making that decision.  Waiting is the absolute worst part for me.  Waiting for insurance to be approved, waiting for a specialist appointment, waiting for a biopsy appointment, waiting for results, etc.  My daughter is already here, I can't imagine her not being here even knowing what I now know.  I can't say how I would feel if I had to make the decision to have a child with the knowledge that I am infected. I honestly haven't thought it through.  You sound like a very thoughtful and caring person, so I am sure you will make the right decision.
Avatar universal
I was infected via transfusion during my 1st c-section, and had my daughter 6yrs latern not knowing I was infected..  Frankly, that's when my hep c took off.  Looking back, all symptoms were attributed to other causes or were to vauge to classify.

Now, you have something else to think about.  Your hep c could get much, much worse not better.  Also, you are going into this knowing you're seriously ill and will be diverting available nutrients from the child to your self.  So the child is already at a disadvantage even before its born.

How SELFISH is that?  What do you say to the kid, 'Sorry your IQ is borderline, b/MY HEALTH was the only reason you were conceived."

What if you get worse, 'Sorry, you failed to heal me, to bad about your problems, b/your just a failed experiment anyway!'

Some times there are stupid sh-- on this forum, b/conceiving to cure is the worst ever.

You have a better chance of cl by smokin' pot.  Statistically, the odds are higher and you're not playing GOD!
Avatar universal
Wow, you've got a lot to deal with.  My thoughts and prayers are with you and your daughter.  Good luck with your appointment on Thursday.  Please let us know how it goes.  

Susan
Avatar universal
Travelmom:

I am so, so sorry about Amanda.  We emailed eachother briefly a couple of months ago, and I look for your posts to see how Amanda is doing.  I understand your reasoning, and certainly take it to heart.  I will definately keep in mind your experience when making my decision.  It seems like either way you turn there are potential pitfalls.  Please know you and Amanda are always in my prayers, and I think of you often.
Avatar universal
The chances of giving hcv to your baby is actually closer to 3%.  Have a baby for the love of God.  Some day you'll look back at this hcv mess as a distant memory.  You'll be fine, your baby will be fine.  Have faith.  I have three-- all hcv free, and my gi said go ahead and have a fourth..... hands are already too full, but have your baby-- don't worry or you'll have a harder time conceiving.
Avatar universal
The chances of giving hcv to your baby is actually closer to 3%.  Have a baby for the love of God.  Some day you'll look back at this hcv mess as a distant memory.  You'll be fine, your baby will be fine.  Have faith.  I have three-- all hcv free, and my gi said go ahead and have a fourth..... hands are already too full, but have your baby-- don't worry or you'll have a harder time conceiving.
Avatar universal
Just a reminder of the other site when threads get full here.

http://groups.msn.com/HotHeps/messages.msnw

It's mainly people from this site who started it and it's gotten pretty quiet.

Don't forget

http://health.groups.yahoo.com/group/hepsongs/

for copies of Friday Fight Songs and songs by other Heppers as well.

Kim
Avatar universal
When I found out I had hep c my doctors told me it was fine to have a baby-the risk is so low. Because of my age, the lenght of this treatment and the wait time after treatment I wasn't sure what to do. We left it up to God and I got pregnant immediately. It was the best thing we've ever done.
Avatar universal
I think you need to read some of my recent posts before you jump to the ridiculous conclusion that I plan to use pregnancy as a "cure" for my HCV.  

I've been trying to get pregnant for the past 30 months (prior to learning just last month that I have HCV).  I've had five pregnancies that ended in miscarriage and one adoption that fell through when the birth mother changed her mind about giving up her newborn.  My motivation to get pregnant or to adopt is no different than what motivates most other human beings: I want to love and nuture a child.  

How horribly mean-spirited of you to call me selfish when you don't know a damn thing about me or my history.  My GI is recommending that I continue my plans for becoming pregnant and I was simply pondering that possibility with the help of some of the folks here.    I've made no final decisions.  I'm an intelligent, responsible person who would certainly consider all issues and risks before doing ANYTHING.  

Take your RIBA rage out on someone else.

Susan
Avatar universal
Just wanted to tell you that my 15 year old daughter also has hep c.  Transmitted from me to her at birth.  She had a very benign case until she turned 11.  From that point on her progression took off.  She is now stage 4, cirrhosis and not responding to any treatment.  My advise to you, treat her even if her biopsy shows a mild case.  Chances of responding are better when you have a milder case.  You never know what her future will bring.  I too said by the time Amanda turned 18 there will be better, less toxic treatments available and chose to wait...not knowing she would get so sick.  Grab whats available now and cure her if you can.. Statistics say children do much better with the virus...not in our case.  so you really are taking a chance with waiting...Just my experience.  Don't want to scare you, just want to let you know there are exceptions to the "norm". Let us know what you decide and I hope you both stay well.
Best Wishes
Jodi
Avatar universal
NO ONE advocated pregnancy for the SOLE reason of improving hepatitis c. Of course having a child to improve your hepatitis c would be selfish.  That would be having a child for all the wrong reasons.  What is most disturbing about this disease is the difficulty in determining who will progress, who will respond to treatment, who will die of it, or who will die of something else.  These decisions/outcomes are highly individual and variable.  All available information has to be taken into consideration, as well as individual analysis of the risks involved in any decisions made.  Every day people decide to have children when cancer, diabetes, and a whole host of diseases run in their family.  Should we tell a person with a family history of diabetes whose child develops the illness that they were playing God in having that child to begin with?  Not too long ago many women and/or children died during childbirth itself; was it selfish for them to become pregnant?  My daughter is highly creative, beautiful and intelligent (of course I am bias), despite my having hep c while pregnant; she was certainly not robbed of nutrients or love, and I had been infected for 24 years before I became pregnant with her.  To play God is to decide who deserves to live.  To play God is to decide that being alive with an illness makes your life less valuable.  There are many people with chronic illnesses and disabilities who contribute greatly to the world; if we could have known there was a chance they might be born with an illness, should we have chosen for them not to exist at all?  No one was playing God.  It is HUMAN to want to nurture and love a child, even if there is a chance that child may not be "perfect;" and who among us can claim to be perfect?
Avatar universal
travelmom, GwithHepC

This situation must be so hard for you gals and making the right choice is a very tough task. I pray for both of you and your daughters.

New Sojurn I think Susan, from what I have read recently is in a tough situation. She just found out about having Hep c and I don't know about you but when I heard I had it I waited almost 2 yrs to deal with it. I was in good physical shape and had everything going for me. Looking back I think I was in denial. Susan has been trying to have a child for awhile now, so like the song says "You Can't Change Horses In The Middle Of The Stream". Well I say it's hard to stop them at least! I am sure she will make the most thoughtful discion.


GOD BLESS all of us for trying to deal with our disease and our individual difficult life situations.

Bob
Avatar universal
Susan, here's a recent <a href="http://hepatology2.aasldjournals.org/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=fullfree&id=ajhep036s106">review</a>  regarding maternal transmission. A fair bit of it is devoted to the public health question of antibody testing (cheap) vs viral detection (expensive) which is not relevant since you already know you're carrying the virus.  Still, the summary of transmission risk culled from recent studies (Table 2) should be on point. It also looks like the   likelihood of resolution in the infant, if they become infected, is pretty high.
Avatar universal
HI JUST WANTED TO SAY THAT I JUST HAD MY 4 YR OLD DAUGHTER TESTED 2 WKS AGO JUST GOT THE LETTER IN THE MAIL FROM THE DOCTOR.GREAT NEWS NO HEP C YEAH!THANK YOU GOD.I DID'NT WANT HER TO GO THOUGHT ALL OF THIS FOR SOMETHING A DID YEARS AGO. I DON'T KNOW WANT I WOULD HAVE DONE.WELL I'M OFF TO THE DOCTOR'S OFFICE TODAY TO LEARN HOW TO POKE. DON'T KNOW IF I'M GOING TO GET MY 1ST SHOT THERE OR DO IT MYSELF AT HOME.I'LL LET YOU ALL KNOW HOW IT GOES.
      MY THOUGHTS AND PRAYERS ARE WITH BOTH GIRLS.
                GOD BLESS US ALL
                ----------------        
  

  P.S. DO YOU THINK I SHOULD HAVE HER TESTED AGAIN ??????
Avatar universal
Thank you all for your encouragement and support. Willing...I really appeciate the link you provided.  I'm gathering that kind of information in order to make an informed decision.

I also want to issue a public apology to New Sorjourn for my "Riba Rage" comment.  If I thought that someone was using a child for selfish purposes, I would be angry, too.  I'm sorry for reacting so strongly to your post.

Have a great day everyone.

Susan

Avatar universal
Are you one of those lucky people who cleared the virus on your own without treatment?  

Regarding our local clinic....after their slip up, we've lost all confidence in them and have already decided that we'll use another one (in a different state) if we move forward with pursuing a pregnancy.

Let us know if how your IVF procedure turns out.  I'll be keeping my fingers crossed for a positive result!

Susan
Avatar universal
Please don't worry about our worrying!!!! I have always been a worrier, it's my personality. When it comes to my children I always feel that it is better to be safe than sorry. Thanks for the heads up.      berlynn
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