Breastfeeding and Viral Hepatitis

If you have viral hepatitis, you may be familiar with the fact that there are different ways in which the viruses can spread. So what does this mean if you have a baby? Will you be able to breastfeed? What precautions need to be taken with the different forms of hepatitis?

A common concern among mothers with viral hepatitis is the risk of transmission to their babies as a result of breastfeeding. While the bulk of scientific evidence indicates that the practice is perfectly safe, precautions should be taken in certain instances.

Among the supporters is the American Academy of Pediatrics (AAP), which actively endorses breastfeeding for mothers with hepatitis and considers it the best possible means for the development and good health of their newborns.

The conclusions are largely based on epidemiological research into mother-to-child transmission rates of hepatitis A, B, C, D and E in the U.S. and other developed countries.

Mother suffering from mastitis
Peter Dazeley / Getty Images

Hepatitis A

Hepatitis A virus (HAV) is spread mainly through the fecal-oral route, which includes ingesting contaminated food or water, engaging in oral-anal sex, and other incidences where fecal matter can be passed from person to person. As such, good hygiene, including thorough and consistent handwashing, is considered essential to preventing the spread of HAV.

Contact with other body fluids is not regarded as likely routes of transmission. No evidence of HAV has ever been isolated in human breast milk, which makes breastfeeding perfectly safe for nursing babies.

If the mother has been exposed to HAV, she can be given immune globulin (IG), a type of purified antibody that can protect her from developing the disease. For mothers already infected, some physicians recommend giving hepatitis A immune globulin to the newborn if the mother is symptomatic.

Hepatitis E

Hepatitis E virus (HEV) is similar to hepatitis A in the way in which it is spread. While it is extremely uncommon in the United States, it is frequently seen in parts of Asia, Africa, and Central America.

Hepatitis E can be challenging in a pregnant woman as 30% of women who contract the infection during pregnancy are likely to develop fatal fulminant hepatitis (acute liver failure). However, as with hepatitis A, breastfeeding is still considered safe for HEV-infected mothers.

Hepatitis B

Hepatitis B virus (HBV) is passed from person to person through infected blood, most commonly by sharing contaminated needles or having sex with an infected person. The U.S. Preventive Services Task Force recommends screening for hepatitis B for all pregnant people at their first prenatal visit.

The virus can be found in many body fluids but is only infectious when present in high levels in either blood, semen, or saliva.

Unlike hepatitis A and E, HBV can be spread from mother to child during birth. This route of transmission is uncommon in Europe and North America but is known to occur more frequently in developing countries with poor healthcare resources.

HBV transmission, however, does not occur through breast milk, making it perfectly safe for infants unless there is a risk of contact HBV-infected blood. Therefore, mothers with cracked or bleeding nipples should consider avoiding breastfeeding and substitute with an infant formula until such time as their nipples are healed.

Mothers should consider vaccinating their infants with the hepatitis B vaccine while ensuring that infant is given hepatitis B immune globulin within 12 hours of birth. Hepatitis B vaccine requires three doses: one shortly after birth, the second in one to two months, and the third in six to eighteen months.

Hepatitis D

Hepatitis D virus (HDV) is transmitted only in the presence of HVB and is spread by the same routes (blood, semen, saliva). Transmission from the mother to child is uncommon. As with HBV, mothers with HDV can still breastfeed their newborns. However, HBV immunization is strongly advised at birth to reduce the risk of HDV infection.

Hepatitis C

Hepatitis C virus (HCV) is predominately spread through contact with infected blood, much like hepatitis B. However, unlike HBV, sexual exposure to HCV is considered uncommon except in certain high-risk groups.

The main route of HCV transmission is injection drug use, specifically the use of share needles and/or injection drug paraphernalia.

Around 3.6% of pregnant women are estimated to have HCV. Transmission primarily occurs in utero (while a mother is pregnant and before delivery) and carries the risk of around less than 1%, depending on the mother's viral load and other risk factors.

There is, however, no evidence that HCV transmission occurs as a result of breastfeeding, with bottle-fed and breastfed babies having the same the risk of infection. For this reason, the Centers for Disease Control and Prevention, the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics all support breastfeeding by HCV-infected mothers. As with hepatitis B, however, precautions should be taken if the mother has cracked or bleeding nipples, allowing them time to heal before nursing her infant.

The one contraindication for breastfeeding is with mothers co-infected with HIV and HCV. Currently, in the U.S., breastfeeding is not recommended for HIV-infected mothers as there is a potential for transmission, mostly in untreated women and women with high HIV viral loads.

When Should Mothers Absolutely Not Breastfeed?

As you read through the information above, you may be concerned about breastfeeding and your baby's risk. If so, it may be helpful to understand when breastfeeding is not recommended according to the CDC, as there are actually very few conditions where this is true. Breastfeeding is not recommended for:

  • An infant diagnosed with the rare disorder galactosemia (newborn screening tests check for this disorder)
  • Mothers who are infected with the HIV virus, the human T-cell lymphotropic virus type I or type II, or are taking antiretroviral medications
  • Mothers who have untreated, active tuberculosis
  • Mothers who are dependent on an illicit drug
  • Mothers taking certain cancer chemotherapy drugs (such as antimetabolites) or radiation therapy

Bottom Line

Overall, the consensus of several national organizations is that the advantages of breastfeeding outweigh the risks when a mother has viral hepatitis.

An exception may occur if a mother with hepatitis B or hepatitis C has cracked or bleeding nipple. If this occurs, however, breastfeeding only needs to stop until the mother's nipples have healed, and can then be resumed.

12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Charles Daniel
 Charles Daniel, MPH, CHES is an infectious disease epidemiologist, specializing in hepatitis.