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Breastfeeding and Viral Hepatitis

Can I Breastfeed My Baby and have Viral Hepatitis?

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Updated September 11, 2008

A common concern among mothers with viral hepatitis is if they should breastfeed their babies. Physicians and scientists agree that it's safe for a mother infected with viral hepatitis to breastfeed her baby. Considering that the American Academy of Pediatrics (AAP) is such a staunch advocate of breastfeeding, this will be good news to many who are worried. In fact, the AAP promotes breastfeeding as the best possible way for good health and development. Let's look at some specific viruses that cause hepatitis:

Hepatitis A and Hepatitis E

Hepatitis A virus (HAV) is spread mainly through the fecal-oral route, which means that in practice, it's spread through person-to-person contact and ingesting contaminated food or water. Because active virus is in the stool of someone infected, good hygiene such as proper handwashing is essential to prevent its spread. Contact with other body fluids are not high-risk ways to be exposed to hepatitis A. In fact, HAV hasn't been found in human breast milk.

If the mother has been exposed to HAV, she could safely take immune globulin (IG), which is purified antibodies that can protect her from developing the disease. For mothers already infected with HAV, some physicians recommend giving IG to the newborn if the mother's symptoms began between two weeks before delivery and one week after delivery. This is usually unnecessary because HAV perinatal transmission and severe disease in most infants is rare.

Hepatitis E is similar to hepatitis A in how it is spread. It is extremely rare in the United States (unless brought in by a traveler) but is common in Asia, Africa and Central America. For pregnant women, hepatitis E can be challenging because 20% of them will develop fulminant hepatitis. However, it's still considered safe for mothers with hepatitis E to breastfeed their infants.

Hepatitis B and Hepatitis D

Hepatitis B virus (HBV) is spread by contact with infected blood, usually by sharing contaminated needles or having sex with an infected person. The virus can be found in many body fluids, but is only at infectious levels in blood, semen and saliva. Another way HBV spreads is from the mother to the infant during birth. This is uncommon in Europe and North America, but happens more in Asia and in developing countries. However, studies show that infants aren't infected through breast milk, and mothers infected with hepatitis B virus are still able to breastfeed. Since HBV is spread by contact with infected blood, mothers who have hepatitis B should avoid letting their baby nurse from cracked and bleeding nipples.

Mothers infected with hepatitis B should vaccinate their infants with the hepatitis B vaccine along with hepatitis B IG within 12 hours of the baby's birth. Hepatitis B vaccine requires three doses, one at birth; the second in two months; and the third in six months.

Hepatitis D requires current infection with hepatitis B and spreads through contact with infected blood in similar ways to HBV. Transmission from the mother to the infant is uncommon. As with HBV infection, mothers with HDV can still breastfeed their newborns. Routine immunization of all babies at birth for HBV prevents infection from HDV.

Hepatitis C

Hepatitis C virus (HCV) is spread through contact with infected blood, much like hepatitis B. However unlike HBV, sexual exposure to HCV is very rare. About 1% to 2% of pregnant women are estimated to have hepatitis C and the risk of spreading hepatitis C to the baby averages about 5%. It's interesting that about the same number of bottlefed babies get hepatitis C as breastfed babies. For this reason, and the fact that there is no evidence that breastfeeding spreads HCV, women with hepatitis C can breastfeed their babies. The CDC, ACOG and AAP all support breastfeeding by HCV-infected mothers. However, cracked and bleeding nipples should be allowed to heal before breastfeeding.

It's important to know that if a pregnant woman is co-infected with HIV and HCV, there is an increased risk of spreading HCV to the newborn and that she should not breastfeed her baby.

Sources:

Centers for Disease Control and Prevention. May 22, 2007. Infectious Diseases and Specific Conditions Affecting Human Milk: Hepatitis B and C Infections.

Dienstag, JL. Acute Viral Hepatitis. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo (eds), Harrison’s Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008.

Pickering LK, Baker CJ, Overturf GD, Prber CG (eds), Red Book: 2003 Report of the Committee on Infectious Diseases, 26e. American Academy of Pediatrics, 2003.

Sjogren, MH. Hepatitis A. In: M Feldman, LS Friedman, LJ Brandt (eds), Gastrointestinal and Liver Disease, 8e. Philadelphia, Elsevier, 2006. 1639.

Perrillo R, Nair S. Hepatitis B and D. In: M Feldman, LS Friedman, LJ Brandt (eds), Gastrointestinal and Liver Disease, 8e. Philadelphia, Elsevier, 2006.

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