Hepatitis C and pregnancy: how true are the fears. Hepatitis detected after childbirth: treatment, feeding and other important issues

Hepatitis C is currently one of the most actual problems in hepatology due to latent course, resulting in difficulties in early diagnosis. Another danger of this disease lies in the rapid transition to cirrhosis or hepatocellular cancer. The incidence rate is increasing every year.

In obstetrics and pediatrics, due to the infection of the mother and her unborn child, viral hepatitis C during pregnancy and childbirth is of particular importance.

The hepatitis C virus is an RNA-containing virus that has an envelope. Currently, 6 main genotypes of the virus are known. The main distinguishing feature of this virus is the tendency to mutate, because of this, several dozen subspecies can be formed in each genotype. The mutational ability of the hepatitis C virus causes the development of its persistence (long-term presence and reproduction) in the body and difficulties in diagnosis and treatment.

The hepatitis C virus (HCV) is transmitted through the blood (parenteral route of transmission). According to statistics, most often HCV occurs in people suffering from drug addiction when using injection drugs. Previously, hepatitis C was called post-transfusion hepatitis, since it was often transmitted through the transfusion of blood and its components. Currently, the possibilities of diagnosis are much higher and this route of infection transmission is no longer prevailing.

It is also possible to become infected by medical care insufficiently sterilized or reused instruments. IN last years an increase in the number of infections during acupuncture, salon procedures(manicure, pedicure), tattooing, piercing, etc.

In the diagnosis, the same methods and analyzes are used: biochemical blood markers, ELISA, RIBA, PCR.

Screening for HBV (HBsAg determination) is done for all pregnant women at registration. If necessary, the analysis is repeated during pregnancy.

Complications

Of the complications of pregnancy in the manifest (pronounced) form of the acute phase of hepatitis, intrauterine fetal death, miscarriage - miscarriages and premature delivery occur.

What else you should know about hepatitis B in combination with pregnancy and motherhood:

In childbirth and postpartum period there is a possibility of massive uterine bleeding.
In the chronic phase of hepatitis, pregnancy complications are rare.
Antiviral therapy for hepatitis B is not given to pregnant women or children.
Features of obstetrics and the principles of breastfeeding are similar to those of hepatitis C.
In more than 80–90% of cases, children infected in the first year of life will develop chronic hepatitis.

Children born to women with positive reaction for HBV should receive hepatitis B immune globulin within 12 hours of birth. The hepatitis B vaccine for these children is given together with immunoglobulin or separately within a week. A month and six months later, the second and third doses are administered, respectively. Vaccination in 85-90% of cases prevents the development of infection and severe consequences caused by HBV.

Conclusion

To prevent the fatal consequences that can occur when HBV or HCV infection occurs during pregnancy, it is necessary to do tests that detect these and other viruses for both the expectant mother and her husband. At positive results tests for hepatitis B or C in a husband or wife, it is necessary to undergo full treatment before pregnancy.

During pregnancy planning married couple- husband and wife - you need to see a doctor for the so-called preconception preparation. At the same time, the state of health of the future father and, especially, the mother is examined, recommendations are given, and if necessary, treatment is carried out.

Hepatitis C in newborns develops as a result of infection by the transplacental route, that is, during intrauterine development from a sick mother. But according to WHO statistics, hepatitis C in newborns is transmitted through the placenta in about 3% of all cases. Most of the women with this disease give birth to healthy children. Hepatitis in newborns in the presence of the disease in the mother can occur immediately after birth. This happens during breastfeeding if there are cracks on the mother's nipples that bleed.

Infection of a child with a virus can occur directly during natural childbirth or by caesarean section.

Hepatitis in newborns often leads to a number of other pathologies. They occur during fetal development due to the fact that the mother's body is infected. This causes nutritional deficiencies and useful substances, which are necessary for normal development fetus.

intrauterine infection

The intrauterine route of infection of a child with the hepatitis C virus from an infected mother, which in medicine is also called vertical, is especially topical issue in the health sector.

During pregnancy in a woman with hepatitis C, two points are important:

the impact of the virus on the mother's body;
risk of fetal infection.

Most scientific studies indicate that the hepatitis C virus does not adversely affect either the course of pregnancy itself or the birth of a child. There is evidence that during pregnancy in sick women, the amount of virus in the blood is significantly reduced. There are suggestions that this occurs due to a change in immunological reactivity during the period of bearing a child and an increase in the plasma concentration of estrogens - female sex hormones.

Thus, pregnancy has no effect on the course of the disease. However chronic form disease can lead to birth premature baby or the occurrence of fetal growth retardation syndrome.

The degree of risk for the child

Percent birth defects development in children and various obstetric complications in women infected with hepatitis C, is not at all higher than in absolutely healthy women. If an uninfected child is born to a sick woman, then the disease can still affect him.

If the mother is infected with hepatitis C, the newborn develops jaundice, which resolves quickly. Further, the child will tend to various diseases liver. Their development can be prevented with the help of careful medical monitoring.

If a child born to a woman with hepatitis C is healthy, then measures must be taken to protect him from infection. chances of giving birth healthy baby very large - more than 95%. Wherein healthy newborn a child can be infected from a sick mother. The most common routes of infection are:

infection during childbirth with accidental damage skin child;
when breastfeeding, if there are cracks on the nipples of a sick mother, and the child has oral cavity- any abrasions or sores.

Women with hepatitis C should give birth in special infectious diseases departments, where they will be provided with proper care, and the staff will take all measures to keep the baby healthy. In this case, a woman in labor with hepatitis C will not pose a danger to other women giving birth. The best way to give birth is by caesarean section. This reduces the risk of infection in a newborn baby by five times, unlike vaginal delivery.

Antibodies of the virus in the child's blood

Hepatitis C in newborns cannot be diagnosed immediately, this takes some time. For this purpose, 4 times testing for antibodies and RNA of hepatitis C is carried out, at the age of the child 1, 3, 6 and 12 months.

Deciphering the results of the analysis in the newborn should be carried out carefully. There are situations when the presence of hepatitis C RNA is confirmed, but the reaction to antibodies is completely absent. This suggests that the child may develop seronegative chronic hepatitis C infection.

Acquired hepatitis in newborns can no longer be cured. Therefore, when the virus-infected blood enters any damage on the child's skin, the development of chronic hepatitis begins. None medications will no longer help and will not reduce the further spread of the disease if infection has occurred.

At the birth of a child from a sick mother, maternal antibodies may be detected in his blood. They pass through the placenta intrauterine development and may disappear within one year. However, with reduced immunity or the presence of concomitant infections, the hepatitis virus can begin to develop and infect the child's body.

If a newborn is suspected of having hepatitis C, then he is under constant supervision by doctors who use a special medical therapy. If the disease is confirmed by the tests performed, then the risk of developing a form of the disease that is life-threatening for the child is high.

Symptoms

In the presence of hepatitis C in a newborn child, markers of the virus and damage to liver cells are present in the blood. In this case, jaundice may not be. The child has:

lack of appetite;
constant subfebrile temperature;
violation of the chair;
liver enlargement;
dark color of urine;
discoloration of feces;
rashes on the skin.

Children with hepatitis C are very weak, succumb quickly to other diseases, and may be severely retarded. Hepatitis C is a complex disease, the prognosis of which depends on the stage of the disease, general condition child and other factors.

It is good when a nursing mother is absolutely healthy and nothing prevents her from feeding her baby with her milk. But what if she has hepatitis? Is it possible in this difficult case not to refuse breastfeeding?

Varieties of hepatitis

IN modern world hepatitis is a fairly common disease. In essence, this is a serious inflammation of the vital important body human liver. But the disease is very insidious. A person can live his life and not even assume that viruses are already living in his body, and attribute his malaise to common colds.

Often the patient learns about his infection absolutely by accident - at any dispensary examinations. But, as a rule, some symptoms of the disease are absolutely obvious even to others: the patient's skin and the whites of his eyes become yellow.

Official medicine knows seven varieties of viruses that cause hepatitis: A, B, C, D, E, F and G. They enter the body in different ways and their symptoms are also different. The first three types of viruses are the most common.

Hepatitis A and breastfeeding

This type of disease is also called Botkin's disease. It is the most common and fairly favorable form. viral hepatitis because its consequences are not as severe as in other forms. If the mother is ill with hepatitis A, it is not forbidden to breastfeed, but the baby in without fail a special drug is introduced that will protect him from infection - this is the usual standard anti-hepatitis immunoglobulin. In some cases, doctors do not recommend breastfeeding the baby and even insist on isolating the mother from the baby for the period of illness. Everything is decided absolutely individually.

Hepatitis B and breastfeeding

This is a more serious type of viral hepatitis, which can occur in completely different ways. Some people are just carriers of the virus, and, fortunately, do not get sick themselves, but in others more serious cases the disease is very difficult, serious liver damage is possible. Group B virus is extremely dangerous, as it can subsequently cause the development of cirrhosis and even liver cancer. And its peculiarity lies in the fact that it is not the infection itself that kills liver cells, but has an effect on immune system such an influence that it itself destroys this vital organ.

In the case of a nursing mother with hepatitis B, feeding is allowed almost without restrictions, but immediately after birth, the baby is given a special hyperimmune immunoglobulin to this type of hepatitis, and then vaccinated in four stages:

immediately after birth during the first twelve hours of life;
in one month;
six months;
in year.

After completing the entire series of vaccinations, the baby needs to be analyzed, which will make it possible to check the effectiveness of the vaccination, as well as whether hepatitis B infection has occurred during the birth through the mother's blood. Fortunately, no cases of infection with this virus through mother's milk have been registered, but a woman must be sure to carefully care for her nipples to prevent the occurrence of deep cracks and even the slightest bleeding.

Hepatitis C and breastfeeding

This is perhaps the most severe form of the disease. There is no vaccination against hepatitis C, moreover, even after effective treatment and subsequent recovery, they can be infected again. In this case, liver cells can be damaged not only due to the activity of the viruses themselves, but also as a result of the immune response of their own body, which “sends” special immune lymphocyte cells to globally destroy infected liver cells.

But breastfeeding is not prohibited even in case of illness with this type of virus, in addition, in medicine there is also not a single recorded case of transmission of the hepatitis C virus from mother's milk. This type of virus is transmitted exclusively with infected blood, so theoretically there is a risk of infection if the mother has deep bleeding cracks in the nipples (See ""). It is in this case breast-feeding recommended to stop and take all measures aimed at the maximum fast healing cracks. Resumption of feeding is possible immediately after this.

Summing up

If you find out that you have any type of viral hepatitis and want to feed your baby breast milk Be sure to check with your pediatrician. It is he who will help to take all the necessary medical measures in a timely manner, which will help your desire to come true. In addition, careful nipple hygiene in this case is vital and necessary, only in this way you can prevent infection of your baby.

Can hepatitis C be passed from father to child? This question worries many, especially those who are expecting a baby or planning a pregnancy. Some believe that this disease only spreads among drug addicts or among people who belong to the so-called risk group.

The main ways of transmission of the virus

There are several ways to acquire the virus, but the most common of them are the following transmission routes:

Drug use.
The use of insufficiently sterile instruments in manicure and tattoo parlors.
Working with infected blood.
Using dirty tools.
non-compliance sanitary norms V medical institutions.

Enough big risk get sick with HCV is in places of deprivation of liberty. In some cases (probability about 4%), this is possible during a blood transfusion procedure. The risk of infection is especially high in developing and underdeveloped countries, in medical institutions with low level medical care and the use of non-sterile instruments, as well as in violation of all norms and rules of sanitation.

Can hepatitis C be passed from father to child? Cases of sexual transmission of the virus are not frequent, but they still exist (about 4%). In homosexual relationships, the likelihood of infection is even lower, but it increases in proportion to the increase in the number of sexual partners and casual relationships. In order to minimize the likelihood of infection through sexual intercourse, it is enough elementary way protection (use of a condom).

HCV is transmitted exclusively parenterally, that is, when the skin is damaged and a sufficient amount of the virus enters the bloodstream. It is transmitted sexually much less frequently than hepatitis B. For example, in married couples where one partner is infected, the probability of infection in 10 years is only 5%.

Hepatitis C and pregnancy

Is hepatitis C transmitted from mother to child? The probability that future baby will be infected from the mother is extremely small, but this is possible in about 5% of cases, while infection can occur only in some cases:

directly during childbirth;
passage of the fetus through the birth canal.

Can Hepatitis C be passed from father to child? Transmission of HCV from an infected father to an unborn baby is not possible. Moreover, in modern medical centers specialists are able to vaccinate a child from an infected mother, which will prevent the further development of the disease.

Both men and women can now be vaccinated against hepatitis B (HCV vaccine for this moment not in demand): this will protect the unborn baby from infection.

Summing up, it should be noted that HCV is not terrible for the unborn baby, however, when planning a pregnancy, you should go through necessary examination and pass all the tests to determine the likelihood of infection of the child. In addition, if one of the parents has HCV, the baby can be vaccinated, which will prevent further development of the disease.

For many women, familiarity with the term " hepatitis C'occurs during pregnancy or its planning. This is due to the screening of pregnant women for various infections, among which are hepatitis C, hepatitis B and HIV. According to statistics, in Russia hepatitis C markers are detected in every thirtieth pregnant woman. We will try to answer the main questions that future mothers have in this situation, selected taking into account the activity of visitors to our site.

Does pregnancy affect the course of chronic hepatitis C (CHC)?

Pregnancy in patients with CHC does not adverse influence on the course and prognosis of liver disease. ALT levels usually decrease or even return to normal during the second and third trimesters of pregnancy. At the same time, the level of viremia tends to increase in the third trimester. ALT and viral load return to pre-pregnancy levels on average 3-6 months postpartum.

Can you give birth with HCV? Does hepatitis C affect pregnancy?

Studies conducted to date suggest that HCV infection does not reduce reproductive function and is not considered as a contraindication to conception and pregnancy. HCV infection does not affect the condition of the mother and fetus.

Can hepatitis C be passed from mother to child?

Dozens of studies have been conducted to assess the risk of mother-to-child transmission, according to the results of which the frequency of infection in a child ranges from 3% to 10%, averaging 5%, and is regarded as low. Transmission of the virus from mother to child can occur intranatally, that is, during childbirth, as well as in the prenatal and postnatal period (when caring for a child, breastfeeding). Infection during childbirth is of primary importance. In the prenatal and postnatal period, the frequency of infection of children from HCV mothers is extremely low. An important factor risk for mother-to-child transmission is viral load (hepatitis C RNA concentration in blood serum). It is considered more likely if the mother's viral load is above 10 6 -10 7 copies/ml. Among all infections, 95% occur in mothers with these viral load values. Anti-HCV-positive and HCV RNA-negative (the virus is not detected in the blood) mothers are not at risk of infecting the child.

Should hepatitis C be treated during pregnancy?

Taking into account the peculiarities of the course of CHC in pregnant women, as well as the adverse effects of interferon-α and ribavirin on the fetus, AVT is not recommended during pregnancy. In some cases it may be necessary drug treatment(for example, the appointment of drugs ursodeoxycholic acid), aimed at reducing the signs of cholestasis.

Is it necessary to do a caesarean section? Is it possible to give birth in a regular maternity hospital?

The results of studies of the influence of the method of delivery (through the natural birth canal or C-section) on the frequency of infection of the child are contradictory, however, in most studies no significant differences were obtained in the frequency of infection of the child, depending on the mode of delivery. Caesarean section is sometimes recommended for women with high viremia (over 10 6 copies/ml). Established that in mothers with HCV-HIV co-infection, planned caesarean section reduces the risk of HCV infection (as well as HIV), and therefore in such pregnant women the choice of delivery method (planned caesarean section only) is based solely on HIV status. All women with HCV infection give birth at normal maternity hospitals on a universal basis.

Can I breastfeed with hepatitis C?

The risk of transmission of hepatitis C is extremely low during breastfeeding, so it is not recommended to stop breastfeeding. However, when feeding, you need to pay attention to the condition of the nipples. Microtrauma to the mother's nipples and exposure of the baby to her blood increase the risk of infection, especially when the mother has a high viral load. In this case, you need to temporarily stop breastfeeding. In women with HCV-HIV co-infection who are breastfeeding, the incidence of HCV infection in newborns is significantly higher than in artificial feeding. For such women, the recommendations developed for HIV-infected women prohibit breastfeeding of newborns.

The child was found to have antibodies to the virus. He is sick? When and what tests should be done?

In all newborns from HCV-infected mothers, maternal anti-HCV, which crosses the placenta, is detected in the blood serum. Maternal antibodies disappear during the first year of life, although in rare cases they can be detected up to 1.5 years. The diagnosis of HCV infection in newborns can be based on the detection of HCV RNA (the first study is carried out in the period from 3 to 6 months of age), but it must be confirmed by repeated detection of HCV RNA (due to the possibility of a transient nature of viremia), and also anti-HCV detection at 18 months of age.

The child has HCV. What is the prognosis of the disease? Do I need to be vaccinated against other hepatitis?

It is believed that in children infected in the intranatal and perinatal period, hepatitis C proceeds mildly and does not lead to the development of cirrhosis and hepatocellular carcinoma (HCC). However, the child should be examined annually to control the course of the disease. Because superinfection with hepatitis A or B viruses may worsen the prognosis of HCV infection, hepatitis A and B vaccination should be considered in HCV-infected children.

Hepatitis B vaccine and pregnancy

Is it possible to vaccinate against hepatitis B during pregnancy, breastfeeding?
The influence of HBsAg antigens on fetal development is not yet fully understood, therefore, during pregnancy, hepatitis B vaccination should be carried out only when high risk infections. Accidental administration of a vaccine is not an indication for abortion. No negative effects have been identified during vaccination during lactation, so breastfeeding is not a contraindication to the introduction of the vaccine.

General recommendations for pregnant women infected with HCV and their children:

It is advisable to study the level of HCV viremia in the III trimester of pregnancy in all pregnant women with anti-HCV in the blood serum;
- it is recommended to avoid amniocentesis, electrodes on the skin of the fetus, the use of obstetric forceps, as well as prolonged waterless period childbirth, especially in women with high level viremia;
- there is no reason to recommend a planned caesarean section in order to reduce the risk of infection of the child;
- it is not recommended to prohibit breastfeeding of a newborn;
- all children diagnosed with perinatal HCV infection are subject to observation, including children with intermittent viremia.
For women with HCV-HIV coinfection, the recommendations developed for HIV-infected women apply:
- Mandatory planned caesarean section and prohibition of breastfeeding.

Chronic hepatitis C and pregnancy