Hepatitis refers to a group of viruses (A, B, C) that primarily lead to inflammation in the liver (hepar). Hepatitis B infection is very common (endemic) in some countries, and some women become long-term carriers of the virus. Hepatitis C is most often acquired from blood transfusions. A simple blood test will tell you if you have been exposed to these viruses. If you work in a job where there is an increased risk of contacting Hep B, or are travelling to a country with a high incidence of Hep B, you should be immunised prior to travel. If your blood test is positive for Hep B, there is a risk of transmitting the infection to the baby. The Paediatricians (baby doctors) can give antibodies and immunisation to the baby after birth, so as to reduce the risk of the baby being affected by the infection.

Normally, being pregnant will not affect the course of the hepatitis, unless a woman has hepatitis E, which can worsen severely in some cases. Pregnancy itself will not hasten the disease process or make it worse, although if the liver is already burdened and scarred with cirrhosis, the extra demands of pregnancy may predispose the expectant mother to a condition called acute fatty liver of pregnancy.

Hepatitis A

Hepatitis A is transmitted by the oral-fecal route (such as from contaminated water or diapers, for example). It occurs in roughly 1 in every thousand pregnant women worldwide. It can be diagnosed by checking the levels of IgM anti-HAV antibodies (which can persist for months after the infection). The main treatment is rest and a nutritious diet, and usually the woman will recover within one to two months. If a newborn is exposed, the infection is usually mild and they will have a lifelong immunity to the disease. If a pregnant woman is exposed (such as when traveling or by contact with known carriers) she will be given immune gamma globulin (IG) to help protect her from getting the disease.

Hepatitis B

Hepatitis B is one of the most highly transmitted forms of hepatitis from mother to child around the world, especially in developing countries. Because this virus is highly contagious, and the risk that the newborn infant will develop hepatitis B is 10 to 20% if the mother is positive for the hepatitis B surface antigen, and as high as 90 percent if she is also positive for the HbeAg.

Usually, the disease is passed on during delivery with exposure to the blood and fluids during the birth process. Therefore although the mother will usually become jaundiced during the acute stage, some women have no symptoms of hepatitis, mandatory screening of all women for hepatitis B is recommended during the first prenatal visit.

If a pregnant woman tests positive during her prenatal visits for hepatitis B, she will receive hepatitis B immune globulin, and be told to completely abstain from alcohol. When her infant is born, the newborn will receive hepatitis B immune globulin at birth, and should be vaccinated with a hepatitis B vaccine at one week, one month, and six months after birth.

Most women become pregnant during the years between 20 and 40, which is also the age group in which the incidence of hepatitis C infection is rising most quickly. Any woman with risk factors for hepatitis C (such as exposure to transfusions, contaminated needles, or injected drug use) should be screened for hepatitis C before and during pregnancy. The risk of a pregnant woman passing the hepatitis C virus to her unborn child has been related to the levels of quantitative RNA levels in her blood, and also whether she is also HIV positive. The risk of transmission to the infant is less (0 to 18%) if the mother is HIV negative and if she has no history of i.v. drug use or of blood transfusions. Transmission of the virus to the fetus is highest in women with hepatitis C RNA titer greater than 1 million copies/mL. Mothers without hepatitis C RNA levels detected did not transmit hepatitis C infection to their infants. A pregnant woman with hepatitis will need to be followed by a specialist who can check their liver function tests on a regular basis.

Getting help
If you wish to make an appointment to seek further advice and or treatment, please email Dr Harrington's secretary.