Hepatitis C: Safe to breastfeed?

I am a Maternity Support Nurse and have a client who is a Hepatitis C carrier. She is pregnant, and thought she would be unable to breastfeed, until she met me! I recall reading that Hepatitis C carriers could breastfeed their babies safely. Is this true?

Hepatitis C virus (HCV) is contracted through the fecal-oral route, sexual contact, blood products and the use of contaminated needles by drug users. At this time, it is not known if breastfeeding is a route of transmission for HCV. It takes an average of 13 years to develop symptoms, so many infected people don't even realize that they have the virus. In approximately half of all cases they become chronically affected, with about 20 percent developing chronic liver disease.

The U.S. Food And Drug Administration has found "no evidence ... to support any special treatments or precautions for pregnant women (who are carriers of HCV) and their offspring." (1994) Though the U.S. Centers for Disease Control give no recommendations in regard to this issue, an official stated that breastfeeding is not contraindicated under normal circumstances, meaning mother's nipples are not bleeding, and no sores are present in the baby's mouth. (Breastfeeding Answer Book, 1997) It also seems prudent to avoid breastfeeding if the mother is in the acute stage of the illness.

At this point in time, the research in this area is not conclusive. Most of the studies do involve only small numbers. Larger study populations are needed. Research shows that although one or two breastfed infants in all the studies were infected with hepatitis C, this is consistent with the rates for (vertical) transmission from artificially-fed mom to baby. According to Lawrence Gartner, MD, Professor of Pediatrics and Obstetrics/Gynecology at the The University of Chicago, "while considering the 'theoretical' risk of transmission of hepatitis C in breastmilk, one must also consider the equally important theoretical possibility that the breastfed infant of a mother with hepatitis C virus may actually be protected from the development of hepatitis C liver disease...Studies of hepatitis B in China many years ago suggested that breastfed infants of hepatitis B carrier mothers were less likely to develop chronic hepatitis than artificially fed infants. It was believed that a passive-active immunization occurred in these breastfed infants...."

A breastfeeding mother will want to carefully weigh the distinct benefits of breastfeeding her baby, against the possible risk of transmission of HCV.

References:
Kurauchi O et al. Arch Gynec & Obstet 253:121, 1993
Lin et al. J. Pediatr 126:589, 1995
Ogasawara, S. et al. Lancet 341:561, 1993
Ruff A 1994
Uehara S et al. Tohoki J. Exp. Med. 171:195, 1993
Wejstal R et al. J Med Virol 30:178, 1990
Zanetti et al. Lancet 345:289, 1995