Viral Hepatitis in pregnancy is a major public health concern in India. Most women with hepatitis will have a normal pregnancy.
Acute viral hepatitis is recognised as the commonest cause of Jaundice in pregnancy. It is a major public health concern in India, which is hyperendemic for hepatitis A virus (HAV) and hepatitis E virus (HEV). In pregnancy, larger morbidity and mortality of hepatitis, particularly through epidemics, have been noticed as a consequence to deprived prenatal care and maternal nutrition. Prevention and control of mother-to-child transmission is an important issue for pregnant population. Correspondingly, it is occasionally probable for the baby to become infected with the virus around the time of birth or during their early childhood years, particularly with hepatitis B and C.
Most women with Hepatitis will have a normal pregnancy, but the physical process of pregnancy may cause some problems on a woman’s liver. About 6% of women with hepatitis can develop gallstones (or ‘cholelithiasis’) during their pregnancy. Transmission of the virus during pregnancy does not usually happen, but the risk for this can be increased if the mother first becomes infected just before she conceives or during her pregnancy (this mainly relates to virus causing chronic hepatitis).
Risks of Viral Hepatitis in pregnant females :
| Type of Viral Hepatitis | Potential Risks to Mother | Timing of Pregnancy with Highest Risk |
| Hepatitis A | Gestational complication; preterm labor | 2nd half of pregnancy, especially 3rd trimester |
| Hepatitis B | Flares of chronic hepatitis B | Can occur during pregnancy or postpartum period |
| Hepatitis C | None | |
| Hepatitis E | Acute liver failure; eclampsia | 2nd and 3rd trimester |
| HSV hepatitis | Acute liver failure | 3rd trimester |
Clinical management of viral hepatitis in pregnancy:
| TYPE | RECOMMENDATION |
| Hepatitis A | Postexposure prevention with immunoglobulin should be given within 2 weeks of exposure to HAV.
This has been shown to decrease both the risk of acquiring the disease and the severity of the disease. Immunoglobulin has been shown to be safe for use in pregnancy. A single intramuscular dose of 0.02 mg/mL given within 2 weeks of exposure provides protection for 3 months in 80-90% of individuals |
| Hepatitis B | Treatment with antivirals is recommended for patients with HBV DNA levels persistently greater than 10,000 copies/ml.
Use of hepatitis B immunoglobulin and vaccination alone. Use of telbivudine, lamivudine, and tenofovir appears to be safe in pregnancy with no increased adverse maternal or foetal outcome |
| Hepatitis C | Currently the best indicator of effective treatment is a sustained viral suppression, defined by the absence of detectable HCV RNA in the serum as shown by a qualitative HCV RNA assay with lower limit of detection of 50 IU/mL or less by 24 weeks after the end of treatment. |
| Hepatitis D | Long-term alpha-interferon (IFNa) and pegylated alpha-interferon (PEG-IFNa) have been shown to induce remission of the disease with decreased viral replication |
| Hepatitis E | The prognosis for HEV infection is similar to that reported for HAV infection. Most HEV infections are self-limited, and hospitalization is usually not required. The therapy is directed towards providing supportive care. |
Noticeable points on Viral Hepatitis:
1. Hepatitis during pregnancy is more likely to have a fulminant course and fatal outcome. Fulminant hepatitis in pregnancy is primarily a last trimester phenomenon.
2.Hepatitis adversely effects the foetus and the chance of foetal survival appears to be lessened by both increasing severity of the maternal disease and prematurity.
3.While undernutrition of pregnant mothers with hepatitis appears to be the major factor leading to increased susceptibility to a fulminant course, metabolic and hormonal changes of the last trimester may play a contributing role in this phenomenon.
4.Vaccination can effectively prevent horizontal and vertical transmission of hepatitis B or C, which directly decreases the global burden of this disease, but their administration should be decided on the basis of whether the benefits outweigh the risks. Viral hepatitis vaccination during pregnancy benefits not only the mothers but also developing foetuses owing to passive protection from the mother. Therefore, vaccination of susceptible or high-risk pregnant women should be considered.
Also Read: VIRAL HEPATITIS IN DENTISTRY
Dr Sabin Syed
Program Coordinator – ECHO & PRAKASH
Institute of Liver and Biliary Sciences-New Delhi
Mob: 9911071707 (Valuable Contribution – Team PRAKASH)
