I have a pt. who is about 15 weeks pregnant. She has Hepatitis C. She’s one of my favorite patients, although I suppose I’d like her more if she knew less about medicine. It’s always a bit unsettling to try to help a patient who basically knows more than you about her medical conditions. Actually, I’m kidding. Patients who educate themselves (she lives on the internet…she’ll probably read this within the first 10 minutes of posting) are the best to work with because they often partner with their doc in taking care of themselves.
So the two of us are working on taking care of her Hep C problem at the same time as her pregnancy. The question is whether or not Hep C while pregnant is a problem.
The answer – from what I’ve gathered after reading and talking with GI specialists – is that Hep C is a problem in general, but pregnancy doesn’t have much bearing on it. The only big issue is trying to prevent the new baby from getting it. And like most things with Hep C, we humans don’t have too much control over that outcome.
Hep C is a virus (see funky-cool pic), so we can’t kill it. There is hep A, B, C, D, E and probably F,G, and who knows how many others, each quite different from the others. Hepatitis infects the liver, as the name suggests. It causes an acute infection, which isn’t usually a big deal and is over in a few weeks. But it also causes a chronic infection that isn’t a big deal either…for about 20 years. Then it’s a real drag. Imagine being told that – as of today – you just swallowed a time-bomb that might or might not explode sometime in the distant future. Bummer for you, dude. Have a nice day.
That’s Hep C.
El Problemo is that the acute infection usually leads to a chronic one, which over time causes cirrhosis (basically, a rotting liver). Hep C is the most common reason for liver transplantation in the the U.S. And in case you’re wondering, the liver is important. If you want me to talk about how your liver does positive things for your life, I’m happy to do that. Suffice it to say that the liver is not like a fibula, or funny bone, or navel or second testicle. It’s called the liver ’cause you can’t live without it. And when a person goes into liver failure, the experience is disfiguring, painful and often very bloody.
“Hmmmm.” You think, “So, what’s the bad news, Dr. A?”
The bad news is that the baby can get it too. There isn’t good information on how the infection happens (called vertical transmission), or what causes it to happen to some kids and not others. Currently, smart researcher types believe the biggest risk for vertical transmission is when the mom is also infected with HIV. Another problem is if the mom’s viral load is high (it usually isn’t if the mom is chronic). If neither of these things are present, the limited studies done on this topic suggest a relatively low transmission rate…something like 4-8%. On one hand, this is nice, because you can flip that number around and say that there is a greater than 90% chance that the baby won’t get Hep C from mom. On the other hand, it’s still close to 1 in 10 babies who get it. It’s a half-empty/half-full perspective kind of thing.
The virus has been found in colostrum (part of the breast milk), but there’s no evidence that babies become infected by breastfeeding, e.g. if you swallow a gnat, it doesn’t mean you’re now infected with gnats. “What about C-section?” You might ask. “Can’t you just zap the kid right out of there and keep it from all that birthing mucky-muck?” There has only been one small study comparing C-section to vaginal delivery and, statistically-speaking, there was no difference. It makes sense to keep the baby away from mom’s infected blood as much as possible. But if you’ve been in on both vaginal deliveries and C-sections, you know that until the day when we can just reach up there and put the kid in a zip-lock bag and pull ’em out, birth is just going to be a bloody affair no matter what route you choose.
So, after all that, what I can say is that we aren’t going to do anything for my patient. We’ll test her new baby for Hep C during the first year of life. But that’s about it. It makes for an intellectual but otherwise normal pregnancy.
After talking up the bad, here’s some cool stuff: The few studies on this subject show that infection doesn’t affect pregnancy. One small study suggested, actually, that pregnancy was beneficial to the long-term odds of mom progressing to liver failure. Also, it appears that even kids who do manage to pick up the virus from their moms tend to do pretty well. Some clear the virus entirely. Those who don’t usually aren’t affected at all during childhood.
There’s lots more that can be said here about Hep C, about pregnancy…about how smart my patient is (she’ll probably write in correcting me on something in this post). But those are the basics. Hep C is the social security of medicine…we worry about it blowing up in the future, but we have this sneaking suspicion that if we take care of things now, things will turn out ok.