Aa
Oh Baby!!
I'm considering haveing another baby ,I already have 3 healthy kids ,but my husband wants THE BOY ... I'm 33yrs old was planning on treating with new drugs . So my question Would you have baby first or treat first ..I'm just afraid of the possible birth defects from treatment drugs ,,
oop's I ment diagnosed May 2010 & geno1 .I suppose,, My desire is to try to give my husband the boy, and if it were to be another girl then we would love her all the same ...
oop's I ment diagnosed May 2010 & geno1 .I suppose,, My desire is to try to give my husband the boy, and if it were to be another girl then we would love her all the same ...
thank you all for posting your opinions .I obviously have a lot to consider & for argument sake I had all three by c-section , & had no idea I have hcv ,just got diagnosed in May 2011! I talked to gastro about this & he said I should treat first & I imagine my gyno will tell me have baby first ...any way I apreciate all of your responses ,I'm going to find out what stage I'm in & go from there ,thanks again
There are so many things that can influence one's viewpoint on your question, and definitely some good food for thought above by other posters. The exact impact of fetal exposure to hep c treatment drugs is not well-documented as yet, but I think not only is exposure to virus vs. drug an important consideration, but also the time-lines of pregnancy vs. treatment.
If you were to start treatment today at age 33, you would have to delay conception for at least a year or more, which would mean you would be 35 or older, and it's important to also consider that birth defects increase significantly as we age. Being over 35 at time of delivery poses other concerns for baby's health, independent of drug exposures. Also, the particular health concerns for babies born to women older than 35 are currently not curable, whereas in the near future, it appears hep c might be so. It's also important to keep in mind that treatment currently is not successful for all patients, and you could very well delay conceiving to treat, only to find that you did not achieve cure.
Presuming that your liver damage is not advanced, and depending on your genotype of hep c, you could be someone that would benefit from waiting for the new drugs expected to be available later this year, which have much higher success rates for certain genotypes. My instincts would most likely incline me to have baby first and treat later, but I can respect both viewpoints. Best of luck with your decision. ~eureka
PS: But out of curiosity... do YOU *want* to have another child, or is your thinking about another baby driven by your husband's desire to have a boy? And what happens if you have another girl?!?
If you were to start treatment today at age 33, you would have to delay conception for at least a year or more, which would mean you would be 35 or older, and it's important to also consider that birth defects increase significantly as we age. Being over 35 at time of delivery poses other concerns for baby's health, independent of drug exposures. Also, the particular health concerns for babies born to women older than 35 are currently not curable, whereas in the near future, it appears hep c might be so. It's also important to keep in mind that treatment currently is not successful for all patients, and you could very well delay conceiving to treat, only to find that you did not achieve cure.
Presuming that your liver damage is not advanced, and depending on your genotype of hep c, you could be someone that would benefit from waiting for the new drugs expected to be available later this year, which have much higher success rates for certain genotypes. My instincts would most likely incline me to have baby first and treat later, but I can respect both viewpoints. Best of luck with your decision. ~eureka
PS: But out of curiosity... do YOU *want* to have another child, or is your thinking about another baby driven by your husband's desire to have a boy? And what happens if you have another girl?!?
Man, I am not too stressed lately. I meant to say I would have my baby first. Sheesh. I am really really sorry.
Mike, that's a superb article and much more current. Thanks for posting it.
Additional comments from that article just below the ones you've included:
"· The presence of Hepatitis C infection does not appear to result in a higher risk pregnancy or a higher incidence of poor obstetric outcome."
Great!
"· Testing for the presence of Hepatitis C in infants born to infected mothers should not begin until at least one year following delivery. The natural history of Hepatitis C infected infants is poorly understood at this time."
Useful information.
"· Prophylactic caesarian section is not recommended in Hepatitis C infected mothers. The role of cesarean delivery in mothers co-infected with Hepatitis C and HIV remains controversial."
Seems to be consistent for mothers with HCV that Cesarean deliveries make no difference - perhaps this was thought to be true at one time or in some circles, however seems to be not the case according to many sources - and, that the presence of HIV creates other considerations.
"· Breastfeeding presents a negligible risk of Hepatitis C transmission. Given the well-documented benefits of breastfeeding, it is highly recommended. "
Also good information.
I did look for information to bear out whether low viral load reduces the risk of vertical transmission during pregnancy and I didn't find any however the fact that high viral load increases the risk would seem to translate that viral load does have a role to play. So I would have to say that my comment implying that viral load has no impact would be incorrect. I appreciate having something clarified if I've stated something that's inaccurate and it's good information, Mike - it adds more clarity to the subject and all good.
The interesting thing is that viral load fluctuates during pregnancy. They've tested this and found that the changes that occur because of pregnancy cause fluctuations in the viral load at certain points....so I'm not sure how accurate or helpful it is to go with low viral load as a positive predictor in reducing risk of transmission however it certainly seems that high viral load would be a consideration the other way.
The POSITIVE....is the portion at the bottom of your article!! That there is a test that indicates you and your baby might be protected from vertical transmission completely - this is good information for those who find out after pregnancy they are HCV positive:
"These researchers found that a specific gene, HLA-DRB1, could predict whether or not the infant acquires Hepatitis C infection from its mother. Based on this research:
1. When a mother and child have the same genetic variant of HLA-DRB1, there is no guarantee that vertical transmission will occur; it just increases the likelihood.
2. When a mother and child have different variations of HLA-DRB1, there appears to be guaranteed protection from vertical transmission."
And....GSGgirl and Specta/Dave....also excellent and pertinent points. Seems a good note to leave it on.
Additional comments from that article just below the ones you've included:
"· The presence of Hepatitis C infection does not appear to result in a higher risk pregnancy or a higher incidence of poor obstetric outcome."
Great!
"· Testing for the presence of Hepatitis C in infants born to infected mothers should not begin until at least one year following delivery. The natural history of Hepatitis C infected infants is poorly understood at this time."
Useful information.
"· Prophylactic caesarian section is not recommended in Hepatitis C infected mothers. The role of cesarean delivery in mothers co-infected with Hepatitis C and HIV remains controversial."
Seems to be consistent for mothers with HCV that Cesarean deliveries make no difference - perhaps this was thought to be true at one time or in some circles, however seems to be not the case according to many sources - and, that the presence of HIV creates other considerations.
"· Breastfeeding presents a negligible risk of Hepatitis C transmission. Given the well-documented benefits of breastfeeding, it is highly recommended. "
Also good information.
I did look for information to bear out whether low viral load reduces the risk of vertical transmission during pregnancy and I didn't find any however the fact that high viral load increases the risk would seem to translate that viral load does have a role to play. So I would have to say that my comment implying that viral load has no impact would be incorrect. I appreciate having something clarified if I've stated something that's inaccurate and it's good information, Mike - it adds more clarity to the subject and all good.
The interesting thing is that viral load fluctuates during pregnancy. They've tested this and found that the changes that occur because of pregnancy cause fluctuations in the viral load at certain points....so I'm not sure how accurate or helpful it is to go with low viral load as a positive predictor in reducing risk of transmission however it certainly seems that high viral load would be a consideration the other way.
The POSITIVE....is the portion at the bottom of your article!! That there is a test that indicates you and your baby might be protected from vertical transmission completely - this is good information for those who find out after pregnancy they are HCV positive:
"These researchers found that a specific gene, HLA-DRB1, could predict whether or not the infant acquires Hepatitis C infection from its mother. Based on this research:
1. When a mother and child have the same genetic variant of HLA-DRB1, there is no guarantee that vertical transmission will occur; it just increases the likelihood.
2. When a mother and child have different variations of HLA-DRB1, there appears to be guaranteed protection from vertical transmission."
And....GSGgirl and Specta/Dave....also excellent and pertinent points. Seems a good note to leave it on.
"other's have a right to expression their opinions"
meant to say-
others have a right to express their opinions
meant to say-
others have a right to express their opinions
Personally I don't believe this is mainly a medical decision, but a moral decision. If someone posts something on the forum other's have the right to expression their opinions. I would rather people be honest with me about their opinions when I post rather then feeling they are obligated to be "nice".
"...Although the statistics determining the rate of vertical transmission
is not uniform among these studies, experts believe the most accurate
estimate of vertical transmission from mothers with Hepatitis C is
five percent. Based upon a comprehensive review of trials
investigating Hepatitis C vertical transmission, the following appear
to represent the two largest risks for bearing a child with Hepatitis
C:
1. The mother is co-infected with Hepatitis C and HIV.
2. The mother has a high Hepatitis C viral load during birth.
In addition, physicians typically relay the following information to
pregnant women with Hepatitis C: .."
http://www.hepatitis-central.com/mt/archives/2010/08/newly_recognize.html
is not uniform among these studies, experts believe the most accurate
estimate of vertical transmission from mothers with Hepatitis C is
five percent. Based upon a comprehensive review of trials
investigating Hepatitis C vertical transmission, the following appear
to represent the two largest risks for bearing a child with Hepatitis
C:
1. The mother is co-infected with Hepatitis C and HIV.
2. The mother has a high Hepatitis C viral load during birth.
In addition, physicians typically relay the following information to
pregnant women with Hepatitis C: .."
http://www.hepatitis-central.com/mt/archives/2010/08/newly_recognize.html
Skylar
Seek advice both from your ob-gyn and hepatologist, they will base it on your medical history, lifestyle, vl, current condition, etc. "
I totally agree with this advise. None of us are doctors even though we like to think so at times so none of us should be listened to over your doctor unless it is a very obvious mistake on his part that you are 100% sure of. Like the poster above said it's only the internet and while we try to be as helpful as possible.....you can find studies that prove things this way or that way each and every time.
Seek advice both from your ob-gyn and hepatologist, they will base it on your medical history, lifestyle, vl, current condition, etc. "
I totally agree with this advise. None of us are doctors even though we like to think so at times so none of us should be listened to over your doctor unless it is a very obvious mistake on his part that you are 100% sure of. Like the poster above said it's only the internet and while we try to be as helpful as possible.....you can find studies that prove things this way or that way each and every time.
I honestly hope you go with your gut, do your research and question your doctors. Just make sure of exactly what you want to do.
And we all need to remember that this is only the internet and everybody interprets things differently
Good Luck
And we all need to remember that this is only the internet and everybody interprets things differently
Good Luck
You are indeed entitled to your opinion the same as everyone else. However, when you start using data to back up your opinion or state facts to back up your opinion, that needs to be accurate. I'm not trying to be argumentative here - you're stating things that are inaccurate. There will be other people making this decision and reading information so it needs to be as accurate as possible.
You mention low viral load as decreasing the risk, however I haven't seen anything that says viral load makes any difference on the risk level of vertical transmission.
http://www.hcvadvocate.org/hcsp/articles/HERRINE.html
"Genotype, viral load, vaginal vs. cesarean delivery, breast feeding or HIV co-infection were not associated with transmission. (6)"
As for vaginal vs Caesarian delivery:
"http://www.ajog.org/article/S0002-9378(08)00564-4/abstract:
"The vertical transmission rate for infants following vaginal delivery or emergency cesarean in labor was no different when compared with those delivered by planned cesarean (4.2% vs 3.0%, P = NS). Among women in whom hepatitis C RNA was detected antenatally, this finding remained (7.2% vs 5.3%, P = NS). No case of vertical transmission was noted among hepatitis C RNA-negative mothers.
Conclusion
This study reports a vertical transmission rate for hepatitis C of 4.1%. These results do not support a recommendation of planned cesarean to reduce vertical transmission of hepatitis C infection.
The reason HIV mothers are *potentially* advised to use C-Section is because HIV is transmitted differently than HCV. There are higher rates of HCV infection in HCV-HIV co-infected mothers. So clearly completely different situations and you can't take what applies to HIV and apply it to HCV.
You mention low viral load as decreasing the risk, however I haven't seen anything that says viral load makes any difference on the risk level of vertical transmission.
http://www.hcvadvocate.org/hcsp/articles/HERRINE.html
"Genotype, viral load, vaginal vs. cesarean delivery, breast feeding or HIV co-infection were not associated with transmission. (6)"
As for vaginal vs Caesarian delivery:
"http://www.ajog.org/article/S0002-9378(08)00564-4/abstract:
"The vertical transmission rate for infants following vaginal delivery or emergency cesarean in labor was no different when compared with those delivered by planned cesarean (4.2% vs 3.0%, P = NS). Among women in whom hepatitis C RNA was detected antenatally, this finding remained (7.2% vs 5.3%, P = NS). No case of vertical transmission was noted among hepatitis C RNA-negative mothers.
Conclusion
This study reports a vertical transmission rate for hepatitis C of 4.1%. These results do not support a recommendation of planned cesarean to reduce vertical transmission of hepatitis C infection.
The reason HIV mothers are *potentially* advised to use C-Section is because HIV is transmitted differently than HCV. There are higher rates of HCV infection in HCV-HIV co-infected mothers. So clearly completely different situations and you can't take what applies to HIV and apply it to HCV.
"and some of them contradict each other"
--------------------------------------------------------------------------
Again..there is not one study cited or that you have posted or that I could find that says that a c-section is safer as far as vertical transmission.
"Please don't forget, that HIV mothers are still advised to deliver with C-section, gotta be a good thing to have in mind if you have HCV. "
--------------------------------------------------------------------------------------------------------------------------------
We are not discussing HIV here. we are discussing HCV and it might be in someones mind t about a c-section however again..there is nothing that supports the fact thay it is a safer birth method
All the Best and kinda finished on this topic
WILL
Will, that's the point - I offered you two opinions to look at. And my UW docs still advised me for c-section. Just a reminder - all the "studies" cited by all of us above - are just studies, and some of them contradict each other. Please don't forget, that HIV mothers are still advised to deliver with C-section, gotta be a good thing to have in mind if you have HCV.
Trish - if I am not mistaken, they are still looking at at least 3 periods when transmission can happen - during pregnancy (in mother's womb), during delivery, and post delivery. As you could see, my doc was referring to delivery one, as this was his main concern, since with my low vl, the other periods were not of major concern.
Isobella - sorry to hear about your situation. My lactation consultant constantly reminded me about taking care of my breast and checking nipples for cracks, etc.
We all have our opinions. I guess what I am trying to say is - this quesiton/post sounds very personal to me and I am willing to share my own personal experience with Skyler.
Trish - if I am not mistaken, they are still looking at at least 3 periods when transmission can happen - during pregnancy (in mother's womb), during delivery, and post delivery. As you could see, my doc was referring to delivery one, as this was his main concern, since with my low vl, the other periods were not of major concern.
Isobella - sorry to hear about your situation. My lactation consultant constantly reminded me about taking care of my breast and checking nipples for cracks, etc.
We all have our opinions. I guess what I am trying to say is - this quesiton/post sounds very personal to me and I am willing to share my own personal experience with Skyler.
The information your ob-gyn had in 2007 - perhaps not accurate or up-to-date. I tend to wonder what her opinion would be if she had access to the current information that says vertical transmission is not due to the method of birth but the baby being in the womb and HCV being in the blood.
Please don't ignore the risk of transmission when nursing. Babies teethe, nipples can become chapped, ect. I don't know whether I passed it to my daughter through delivery, or at some point after during the 13 months I nursed, but I can tell you that it was the absolute worst day of my life when the results came back positive.
Not quite the legacy I had hoped to pass on. 6% is a small percentage, unless you're part of it.
Isobella
Not quite the legacy I had hoped to pass on. 6% is a small percentage, unless you're part of it.
Isobella
This is the link you provided above
Perinatal Transmission of Hepatitis C Virus
You answered:
Compared with vaginal delivery, elective Cesarean section has been documented as an effective method to decrease vertical HCV transmission. Thus, elective cesarean section is recommended for all pregnant women with HCV infection and a detectable HCV RNA level.
This answer is incorrect. Prospective cohort studies comparing Cesarean section with vaginal delivery as a contributing factor for mother-to-child HCV transmission have shown contradictory results. Because there is no clear-cut benefit of performing elective Cesarean section in this setting, in the United States, elective Cesarean section is not recommended for prevention of vertical HCV transmission.
Perinatal Transmission of Hepatitis C Virus
You answered:
Compared with vaginal delivery, elective Cesarean section has been documented as an effective method to decrease vertical HCV transmission. Thus, elective cesarean section is recommended for all pregnant women with HCV infection and a detectable HCV RNA level.
This answer is incorrect. Prospective cohort studies comparing Cesarean section with vaginal delivery as a contributing factor for mother-to-child HCV transmission have shown contradictory results. Because there is no clear-cut benefit of performing elective Cesarean section in this setting, in the United States, elective Cesarean section is not recommended for prevention of vertical HCV transmission.
Well again..you have really cited no proof that C-section is any safer than Vaginal birth.
The first link you cited is just a bunch of us folks talking (all laymen) about their own experiences and the second link you cited actually says the same thing as the study that I had previously put up .. that there is no difference in vertical transmission stats from either type of birth.
As I said ,, you relied on your medical team,the fine one that it is , and thankfully your children were in the 95% category that were not infected.
All the best
WILL
Seek advice both from your ob-gyn and hepatologist, they will base it on your medical history, lifestyle, vl, current condition, etc.
Check out the old discussin thread on this site where c-section vs vaginal delivery for HCV patients is discussed. Also, notice the mention of the standard practice... :
http://www.medhelp.org/posts/Hepatitis-C/is-c-section-a-safer-way/show/89727
Also, here is a link to UW's site where the same problem is mentioned:
http://depts.washington.edu/hepstudy/hepC/prevention/hcvpnt/1.html
I am from Seattle, most of the docs on my team were from UW, which is one of the best medical schools in the country. I have trust in their opinion :)
http://www.medhelp.org/posts/Hepatitis-C/is-c-section-a-safer-way/show/89727
Also, here is a link to UW's site where the same problem is mentioned:
http://depts.washington.edu/hepstudy/hepC/prevention/hcvpnt/1.html
I am from Seattle, most of the docs on my team were from UW, which is one of the best medical schools in the country. I have trust in their opinion :)
I can only imagine the next question in 10 months to be "when can I get my child tested" and "what do I do my child has HCV".
It is certainly great news that in your case your children were amongst the aprrox.95% of babies born to mothers that while pregnant are know to have HCV were not infected.
The OP was asking the folks here their personal opinion about what they thought in regards to having a child in relation to the timing of undergoing treatment..
Your opinion was one of many...that some may agree with and others not so much,however my only reason for asking you for clarification on you statement about minimal risk by C-section,is only because I had never heard that before and was curious enough to look it up and could find nothing to support that...actually there were a few articles that refuted that statement....
It sounds like you were advised by your medical team at the time and made your decisions based on that...thats all any of us can do.
However if currently (like the OP) anyone is basing their decisions in such an important matter it would seem prudent to base these on facts by studies and articles .
All the Best
WILL
maybe we should ask the ones who weren't so lucky, who did get hcv from birth. To each his own, and we all make our decisions based on our own logic or feelings or however we base our decisions.
its indeed a dangerous world and so many things can happen. I think the motivation behind having children is important, the motivation for doing anything is important, we all live with our decisions, and the fortunate children indeed have the advantage of having a good quality life.
this is a "hot' topic
its indeed a dangerous world and so many things can happen. I think the motivation behind having children is important, the motivation for doing anything is important, we all live with our decisions, and the fortunate children indeed have the advantage of having a good quality life.
this is a "hot' topic
I delivered in 2007, you are citing an article written in 2008 :)
The way my ob-gyn explained it to me - his main concern was transmission of HCV during delivery - C-section minimizes chances of newborn getting HCV from his mother during delivery. And it makes sense. Don't you think?
I was also told not to worry about my HCV during pregnancy, as my viral load was low - between 350,000 and 175,000 prior and during pregnancy. My hepatologist at the time seemed to believe that having a lower vl would also minimize the risk of transmission.
Finally, we used services of cord blood bank, which tested the cord blood samples from my twins and mine within hours of delivery. They found HCV in my sample but nothing in babies'. We later tested my twins for HCV antibodies when they were 10 months old - nothing was found. I tested them again when they were 16 months old - again, no virus, no antibodies were found.
When I was done with my tx and my kids turned 3 years old, we tested them again. No virus, no antibodies again. I feel good about my decision to have babies first and then treat. It wasn't easy to make, and I was concerned about that 5% chance. Yet, I was making my decisions based on stats and advices from quite a few medical professionals. The risk of my kids getting HCV from me was indeed minimal. To me, it didn't make sense to wait 3 more years to have a baby due to fear.
My final point in this discussion - not everyone achieves SVR, yet many of us do get some form of sx during and after tx. One should take this into consideration too - how soon will your body be ready to carry a baby after tx? You never know, right?
The way my ob-gyn explained it to me - his main concern was transmission of HCV during delivery - C-section minimizes chances of newborn getting HCV from his mother during delivery. And it makes sense. Don't you think?
I was also told not to worry about my HCV during pregnancy, as my viral load was low - between 350,000 and 175,000 prior and during pregnancy. My hepatologist at the time seemed to believe that having a lower vl would also minimize the risk of transmission.
Finally, we used services of cord blood bank, which tested the cord blood samples from my twins and mine within hours of delivery. They found HCV in my sample but nothing in babies'. We later tested my twins for HCV antibodies when they were 10 months old - nothing was found. I tested them again when they were 16 months old - again, no virus, no antibodies were found.
When I was done with my tx and my kids turned 3 years old, we tested them again. No virus, no antibodies again. I feel good about my decision to have babies first and then treat. It wasn't easy to make, and I was concerned about that 5% chance. Yet, I was making my decisions based on stats and advices from quite a few medical professionals. The risk of my kids getting HCV from me was indeed minimal. To me, it didn't make sense to wait 3 more years to have a baby due to fear.
My final point in this discussion - not everyone achieves SVR, yet many of us do get some form of sx during and after tx. One should take this into consideration too - how soon will your body be ready to carry a baby after tx? You never know, right?
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