Breastfeeding and Viral Hepatitis

Can I Breastfeed My Baby If I Have Hepatitis?

Mother Breastfeeding Baby
Ricardo Dias/EyeEm/Getty Images

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.

Hepatitis A and Hepatitis E

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 consistant 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 HAV IG to the newborn if the mother is symptomatic two weeks before delivery and one week after delivery. Other doctors consider this practice unnecessary as mother-to-child transmission of HAV is relatively rare.

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 pregnant woman as 20% of them are likely to develop fulminant hepatitis (acute liver failure). However, as with hepatitis A, breastfeeding is still considered safe for HEV-infected mothers.

Hepatitis B and Hepatitis D

Hepatitis B virus (HBV) is passed from person to person through infected blood, mostly commonly 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 when present in high levels in either blood, semen or saliva.

Unlike hepatitis A and E, HBV can be spread from the 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.

However, HBV transmission does not occur through breast milk, making it perfectly safe for infant unless there is 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 IG within 12 hours of birth. Hepatitis B vaccine requires three doses: one at birth, the second in two months, and the third in six months.

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 injecting drug use, specifically the use of share needles and/or injecting drug paraphernalia.

About 1% to 2% of pregnant women are estimated to have HCV. Transmission primarily occurs in utero and carries risk of around 5%, 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 breast-fed 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 AAP all support breastfeeding by HCV-infected mothers.  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.


American Academy of Pediatrics (AAP). "Policy Statement: Breastfeeding and Use of Human Milk." Accessed on December 29, 2015.

Centers for Disease Control and Prevention (CDC). "Infectious Diseases and Specific Conditions Affecting Human Milk: Hepatitis B and C Infections."  Atlanta, Georgia; May 22, 2007.

U.S. Department of Health and Human Services (DHHS). "Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States." Rockville, Maryland. Update issued May 21, 2013.

Continue Reading