Hepatitis and Pregnancy: What Every Mother Should Know? Gynaecologist Explains

Know how hepatitis can affect pregnancy and what expectant mothers need to know. A gynaecologist explains the risks, symptoms, and essential precautions for a safe and healthy journey.

Acute viral hepatitis, which can be caused by general viral infections or pregnancy-specific diseases such as HELLP syndrome and acute fatty liver of pregnancy, is a major cause of jaundice during pregnancy. Pregnancy-related viral hepatitis, however, can also affect the health of the mother and foetus in several different ways. Hepatitis brought on by viruses A, B, C, D, and E poses particular difficulties in terms of breastfeeding, vaccination, pregnancy problems, and transmission.

Haemolysis, or the destruction of red blood cells, elevated liver enzymes, and low platelet counts are the hallmarks of HELLP syndrome, a dangerous pregnancy condition. Although it frequently coexists with preeclampsia, it can also happen on its own and, if left untreated, can be fatal.

Hepatitis Types and Their Impact

According to Dr Nidhi Nandan, Senior Consultant Obstetrics & Gynaecology, Sakra World Hospital Bengaluru, “Hepatitis A (HAV), primarily transmitted through the faecal-oral route in areas with poor sanitation, rarely causes intrauterine or perinatal transmission. Hepatitis A and E are typically spread through contaminated food and water. While they are usually self-limiting, hepatitis E in particular can be dangerous during pregnancy, especially in the third trimester.” It has been associated with acute liver failure, preterm birth, and even maternal mortality in severe cases. HAV typically takes 30 days to incubate. Saliva, serum, and faeces all have the highest concentrations of HAV.

She further added, “In contrast, hepatitis B and C are diseases that are spread through the blood. Perinatal transmission of the hepatitis B virus (HBV) is highly likely, particularly in mothers who test positive for HBeAg. The Hepatitis B virus (HBV) produces a protein called HBeAg, or Hepatitis B e-antigen, which is a sign of high infectivity and vigorous viral replication.” Its presence in the blood suggests that the virus is actively spreading and that the infected person is probably going to spread it to other people. HBV is the major concern in India. There is a 90% chance that a baby will get infected during delivery if proper steps are not taken.

Universal screening for HBV during pregnancy is crucial, and antiviral therapies are recommended for mothers with high viral loads to reduce transmission risk. Newborns should receive HBV immunoglobulin and vaccination immediately after birth, which enables safe breastfeeding. Similarly, Hepatitis C (HCV) is often transmitted through blood and vertically during delivery. Hepatitis D virus (HDV) requires coinfection with HBV and is rarely transmitted during pregnancy. Hepatitis E (HEV), on the other hand, can lead to severe complications, particularly in the third trimester, with a high maternal mortality rate during outbreaks.

Risks to the Baby

Hepatitis B and C transmission from mother to child is the main issue when it comes to hepatitis during pregnancy. Chronic hepatitis infections may not cause symptoms in newborns but may increase the risk of liver disease or liver cancer in later life.

All expectant mothers should be screened for hepatitis B and C, ideally during the initial prenatal visit. One blood test for detecting active infections is the hepatitis B surface antigen, or HBsAg. If the mother tests positive, further testing to assess her viral load and liver function may be necessary.

Prevention and Management

Hepatitis B is preventable through vaccination. So, pregnant women can receive vaccination during pregnancy.
If the mother is hepatitis B positive, then the newborn must receive both the hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) within 12 hours of birth.
To stop infections from spreading, mothers should abstain from alcohol, practise good hygiene, and refrain from sharing personal items like toothbrushes or razors.

In certain cases of hepatitis B, doctors may prescribe antiviral treatment throughout the third trimester to reduce the chance of transmission. However, due to a lack of safety data, antiviral treatment for hepatitis C is typically not advised during pregnancy. One of the main concerns is the safety of antiviral drugs for the mother and the growing foetus, and the advantages and disadvantages of treatment must be carefully considered.