Hepatitis A and C in Pregnancy
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Direct answer
Hepatitis A is an acute faecal-oral infection that never becomes chronic and does not usually cause vertical transmission. Hepatitis C is a bloodborne infection that passes from mother to infant in a few per cent of pregnancies, with higher rates when HIV coexists. Antenatal screening for hepatitis C is widely advised, and direct-acting antiviral drugs are deferred until after delivery.
What you must remember
- Hepatitis A transmission: faecal-oral spread through contaminated food and water; the infection is self-limiting and does not become chronic.
- Hepatitis A prophylaxis: immunoglobulin for close contacts, and the inactivated vaccine for those at risk, which pregnancy does not contraindicate.
- Acute hepatitis A in pregnancy: maternal illness is more serious in the third trimester, with a risk of preterm labour and, rarely, fulminant hepatitis.
- Hepatitis C transmission: mother-to-infant spread occurs in a few per cent of pregnancies, rising with HIV co-infection or high maternal viral load.
- Diagnosis: anti-HCV antibody screening, followed by HCV RNA testing to confirm active infection.
- Treatment timing: direct-acting antivirals are deferred until after delivery because safety data in pregnancy are limited.
- Caesarean and breastfeeding: caesarean does not lower transmission, and breastfeeding is generally not contraindicated in hepatitis C.
Comparing the two viruses in pregnancy
Hepatitis A and hepatitis C are both hepatotropic viruses, yet they differ in route, chronicity and the way pregnancy is managed. The table gathers the points examiners most often compare.
| Feature | Hepatitis A | Hepatitis C |
|---|---|---|
| Route | Faecal-oral | Blood and body fluids |
| Chronicity | Never chronic | Often chronic |
| Vertical transmission | Not clinically significant | A few per cent of pregnancies |
| Prevention | Vaccine and immunoglobulin | No vaccine; screening and harm reduction |
| Treatment in pregnancy | Supportive | Direct-acting antivirals deferred after delivery |
The key distinction is that hepatitis A is managed by preventing spread and supporting the mother, whereas hepatitis C requires screening, confirmation and a plan for delayed treatment. Both viral markers should be read with the clinical picture rather than in isolation. In practice, a pregnant woman with hepatitis C is also screened for HIV and hepatitis B, because co-infection changes both the transmission risk and the plan.
Where the exam tries to catch you
Vignettes test whether the student knows which viral hepatitis is chronic and which delivery decisions truly change transmission.
- Trap: Starting direct-acting antivirals for hepatitis C in the second trimester. Correct: Treatment is deferred until after delivery because pregnancy data are limited, and the decision is individualised.
- Trap: Planning caesarean to prevent hepatitis C transmission. Correct: Caesarean does not lower vertical transmission, so obstetric indications alone decide delivery.
- Trap: Withholding breastfeeding for hepatitis C. Correct: Breastfeeding is generally allowed, because the risk of transmission through milk is low.
Frequently asked questions
Does hepatitis A become chronic in pregnancy?
Hepatitis A does not become chronic in pregnancy or at any other time. The infection resolves within weeks, and immunity after recovery is usually lifelong. Exposed pregnant women should receive immunoglobulin, and the vaccine can be given if they are at risk.
What is the risk of hepatitis C transmission from mother to baby?
Mother-to-infant hepatitis C transmission occurs in a few per cent of pregnancies, with higher rates when HIV coexists or viral load is high. Caesarean delivery and breastfeeding do not materially change this risk. Infants need later testing to confirm whether infection has occurred.
Why are direct-acting antivirals not given during pregnancy for hepatitis C?
Direct-acting antivirals are deferred because safety data in pregnancy are limited. Treatment is planned after delivery, and the decision remains individual for each woman. Monitoring continues in the meantime.
Which test confirms active hepatitis C infection?
Detection of HCV RNA by PCR confirms active infection, since anti-HCV antibodies show past or present exposure. A positive antibody screen is therefore followed by RNA testing. This distinction guides both counselling and the timing of treatment.