Hep C and Breastfeeding: Is It Safe for Mothers To Breastfeed If They Have Hepatitis C Virus?

Written on October 20, 2023 by Lori Mulligan, MPH. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• HCV
• Is It Safe For A Mother Infected With HCV To Breastfeed Her Infant?
• Is It Safe For HCV-Positive Mothers To Breastfeed If Their Nipples Are Cracked And Bleeding?
• Co-infection With HCV and HIV
• Barriers To HCV-Positive Mothers Breastfeeding Infants
• Everlywell Offers A HCV Diagnostic Kit AND Online STI Consultation
• Related Content

The answer is yes, it is safe for mothers to breastfeed if they have hepatitis C virus (HCV) unless the nipples or areola are cracked or bleeding. Read on to find out more about HCV and the safety of breastfeeding, what to do if you’re co-infected with HCV and HIV, and barriers to breastfeeding among some HCV-positive people.

HCV

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV), which is transmitted by blood from an infected person. There is no vaccine for hepatitis C. The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially injecting drugs.

Is It Safe For A Mother Infected With HCV To Breastfeed Her Infant?

Yes. Mothers who have HCV can safely breastfeed. Though an infant can be infected with hepatitis C during pregnancy or delivery, breastfed infants do not have higher rates of hepatitis C than formula-fed infants. Breastfeeding may even help prevent the spread of hepatitis C from the mother to the baby by providing antibodies passed to the baby through the breast milk.[1]

Is It Safe For HCV-Positive Mothers To Breastfeed If Their Nipples Are Cracked And Bleeding?

Data are insufficient to say yes or no. However, HCV is spread by infected blood. Therefore, if the HCV-positive mother’s nipples and/or surrounding areola are cracked and bleeding, she should stop nursing temporarily. To maintain her milk supply while not breastfeeding, she can express or remove the milk from her breast and discard the breast milk until her nipples are healed. Once her nipples are no longer cracked or bleeding, the HCV-positive mother may fully resume breastfeeding.

Healthcare providers may need to refer mothers for lactation support to learn how to maintain milk production and how to supplement with donor human milk or formula while temporarily not breastfeeding.[2]

Co-infection With HCV and HIV

HCV-positive women coinfected with HIV should definitely not breastfeed, as this significantly increases the risk of HIV transmission.[3]

Barriers To HCV-Positive Mothers Breastfeeding Infants

Researchers conducted a retrospective cohort study of infants exposed to HCV presenting to a pediatric infectious disease clinic from 2012 to 2018 in Louisville, KY. De-identified demographic and clinical information from the mothers and infants was abstracted to a standardized form and recorded in a spreadsheet. The main outcome was documentation of breast milk or breastfeeding initiation at discharge from the birth hospital.

The researchers collected data on 505 infants perinatally exposed to HCV. Infants with unknown feeding regimens and/or unknown/positive maternal HIV status were excluded, leaving 404 infants for final analysis.

Barriers to breastfeeding identified included: discharge to non-biological parents, admission to the neonatal intensive care unit (NICU), and recreational drug use during pregnancy. Overall, the cohort of infants exposed to HCV had significantly lower rates of breastfeeding or breast milk initiation at hospital discharge. This study indicates that more support is needed to improve breastfeeding rates and breast milk use in infants born to HCV-positive mothers. Additional studies are warranted as HCV is currently a significant public health concern.[4]

Recent research was conducted to identify factors associated with breastfeeding initiation and to assess the relationship between breastfeeding and child outcomes among people with HCV during pregnancy.

The primary outcome was self-reported initiation of breastfeeding or provision of expressed breastmilk. Data on breastfeeding initiation were available for 587 participants. Eight people were excluded due to HIV co-infection, leaving 579 for final analysis. Of those, 63% initiated breastfeeding or provided breastmilk to their infant.

People with detectable hepatitis C virus in the blood during pregnancy were less likely to initiate breastfeeding than those who had undetectable viral load. Furthermore, those who were employed, privately insured, had at least a high school education, and did not use tobacco were more likely to initiate breastfeeding.

Children who were breastfed or received breastmilk had higher weight and were more likely to have a healthy weight at 18-24 months than children who were not.

The researchers concluded that although being HCV-positive with a detectable virus load is not a contraindication to breastfeeding, rates of breastfeeding initiation are lower among people with detectable virus than among those with an undetectable viral load and differed by socioeconomic status. Breastfeeding was associated with improved child growth. Patient and provider education on the safety and benefits of breastfeeding is needed.[5]

Everlywell Offers A HCV Diagnostic Kit AND Online STI Consultation

This at-home lab test will check for exposure to HCV. If your test results are positive, you’ll have the opportunity to connect with Everlywell's independent provider network at no additional cost to discuss your case.

Everlywell offers online STI consults in 2 hours or less. If you think you have been infected with HCV, fast and discreet care is just a click away. Create your health profile and complete an insurance coverage check (if applicable).

Related Content

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References

1. Serious illnesses and breastfeeding. American Academy of Pediatrics. https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Serious-Illnesses-and-Breastfeeding.aspx. 11/23/2021. Accessed on 10/8/2023.
2. Hepatitis B or C infections. CDC. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/hepatitis.html. 4/4/2023. Accessed on 10/8/2023.
3. HCV: Care of the infant born to HCV positive women. Government of Western Australia Child and Adolescent Health Service. https://cahs.health.wa.gov.au/~/media/HSPs/CAHS/Documents/Health-Professionals/Neonatology-guidelines/Hepatitis-C-Virus-HCV-Care-of-the-Infant-Born-to-HCV-Positive-Women.pdf 11/10/2021. Accessed on 10/8/2023.
4. Espinosa CM, Niestrath RG. Low breastfeeding rates and complex barriers to breastfeeding and breast milk utilization in hepatitis C perinatally exposed infants. Pediatrics (2021). 147 (3_Meeting Abstract): 323-324.
5. Grasch JL. Breastfeeding initiation among people with hepatitis C during pregnancy: Associated factors and offspring outcomes. American Journal of Obstetrics and Gynecology (2023). Vol 228, Issue 1, Supplement S489-S490. doi: 10.1016/j.ajog.2022.11.842.