Hepatitis During Pregnancy
When a woman has hepatitis and becomes pregnant, one of her first
is "How will this affect my baby?" While this question does not have a
answer, the information below can help with understanding.
Her next question is often, "How will being pregnant affect my
Here, I will give a brief overview.
Normally, being pregnant will not affect the course of the hepatitis,
a woman has hepatitis E, which can worsen severely in some cases.
itself will not hasten the disease process or make it worse, although
the liver is already burdened and scarred with cirrhosis, the extra
of pregnancy may predispose the expectant mother to a condition called
fatty liver of pregnancy.
Acute fatty liver of pregnancy may be related to liver disease,
of an enzyme normally produced by the liver that allows the pregnant
to metabolize fatty acids, or the cause may not be known. This
can quickly become severe, and also affect the unborn child (who may
be born with a deficiency in this enzyme). The treatment is a quick
and treatment in intensive care. Normally, the pregnant woman will
quickly after the birth, and has a good prognosis if the liver damage
Another complication that can occur in both women with hepatitis and
without it are gallstones (cholelithiasis), which often create jaundice
pregnancy. It occurs in 6 % of all pregnancies, in part because of
in the bile salts during pregnancy. Also, the gall bladder empties more
during pregnancy, meaning the bile sits longer and the risk of
This condition is often treated with laparoscopy during the first six
of pregnancy, but during the last three months, the uterus is so
that this procedure can't be done.
Hepatitis A and Pregnancy
Hepatitis A is transmitted by the oral-fecal route (such as from
water or diapers, for example). It occurs in roughly 1 in every
pregnant women worldwide. It can be diagnosed by checking the levels of
anti-HAV antibodies (which can persist for months after the infection).
main treatment is rest and a nutritious diet, and usually the woman
recover within one to two months.
If a newborn is exposed, the infection is usually mild and they will
a lifelong immunity to the disease.
If a pregnant woman is exposed (such as when traveling or by contact
known carriers) she will be given immune gamma globulin (IG) to help
her from getting the disease.
Hepatitis B is one of the most highly transmitted forms of hepatitis
mother to child around the world, especially in developing countries.
the United States, 15,000 women a year who are positive for the
B surface antigen (meaning they have the disease) deliver.
Although the mother will usually become jaundiced during the acute
some women have no symptoms of hepatitis, which is one reason way CDC
include mandatory screening of all women for hepatitis B during the
prenatal visit. Why?
Because this virus is highly contagious, and the risk that the newborn
will develop hepatitis B is 10 to 20% if the mother is positive for the
B surface antigen, and as high as 90 percent if she is also positive
Usually, the disease is passed on during delivery with exposure to the
and fluids during the birth process.
If a pregnant woman tests positive during her prenatal visits for
B, she will receive hepatitis B immune globulin, and be told to
abstain from alcohol. When her infant is born, the newborn will receive
B immune globulin at birth, and should be vaccinated with a hepatitis B
at one week, one month, and six months after birth. This reduces the
that the infant will become infected with hepatitis B to a range of
to three percent, and is one reason why the Center for Disease Control
Prevention (CDC) has recommended that all newborn infants be vaccinated
Most women become pregnant during the years between 20 and 40, which is
the age group in which the incidence of hepatitis C infection is rising
quickly. Any woman with risk factors for hepatitis C (such as exposure
transfusions, contaminated needles, or injected drug use) should be
for hepatitis C before and during pregnancy.
Transmission of the virus from mother to infant is
but it is possible. A number of series have been published and it
that the risk of transmission is probably in the range to 2 to 5%. The
takes place either prior to birth or at the time of birth. The rate of
appears to be higher in women who also have HIV/AIDS and you may want
check your patient for the HIV virus and for hepatitis B just to be
The route of delivery does not appear to have an effect on the risk of
transmission and there is no clear precaution that is recommended in
terms of the pregnancy itself except to make sure the patient gets
appropriate peri-natal care. We
have looked hard for the virus in breast milk and we have never been
able to find it so we feel that breast-feeding is safe.
There is no preventive
at this time that can influence the rate of transmission of the virus
mother to infant.
A pregnant woman with hepatitis will need to be followed by a
who can check their liver function tests on a regular basis.
In a normal pregnancy, alkaline phosphatase levels can increase three
four times because the placenta creates alkaline phosphatase. ALT
can go up if viral hepatitis or damage to the liver occurs (from drugs,
stones, severe vomiting, or acute fatty liver of pregnancy).
Interferon therapy should be discontinued during pregnancy since the
on the fetus is unknown. At this time, there have not been sufficient
or information to determine the risk to the baby.
Women should not become pregnant while on Rebetron (interferon and
combination therapy). In fact, it is recommended by the manufacturer
a woman of childbearing age use effective contraception during
and for 6 months after treatment ends, because of the high risk for
defects in the fetus.
Mothers taking Rebetron medication should not breast feed because of
potential for an adverse reaction from the drug in their infant.
In general, pregnancy will not change the course of most forms of
With hepatitis A and B, although there is a risk of transmission to the
immunoglobulin therapy and vaccination can decrease it. The risk of
of hepatitis C to the infant seems related to the mother's level of
RNA and other factors. A pregnant woman may experience certain symptoms
as gallstones and elevated enzymes that may or may not be related to
disease, and she should check with her physician and her liver
before starting or discontinuing any medications.
M.D. Hunt, Christine, "Liver Disease in Pregnancy", American Family
Feb 15, 1999
"Hepatitis and Other Liver Diseases During Pregnancy', Atlanta
Medicine, Volume 4, Number 1 - January 16, 1996
"Hepatitis B Virus (HBV)"from the Baby Center Online prenatal Health
Tucker, D.E., MRCOG,"Hepatitis B and Pregnancy", Sept. 1998, Women's
"Important Safety Information", Rebetron.com
Agarwal, A.K., Rewari, B. B., Goel, Neeria,"Drug Prescribing in