Se also
Hepatitis C, delta , E and Herpes simplex hepatitis
Viral hepatitis does not differ from those who are non-pregnant patients except for Hepatitis E, which can be very severe.
Hepatitis A virus (HA)
Transmission: Fecal-oral. Incubations period 2-6 weeks. contagious 2 weeks before and 2 weeks after icterus 75 % of adults has symptoms.
Vertical transmission very rare with max risk for fetus near delivery if mother is contagious.
Diagnosis: Anti-HAV-IGM
Prophylaxis: 1 vaccine protect for one year. 2. vaccine given 6-12 month after the first protects in 20 years.
Hepatit A vaccine (HAVRIX 1400) can be given 7 days before exposure.
Hepatitis B virus (HBV)
Transmission: Parenteral, sex and vertical transmission
(2-40 % after needle lesion)
Incubations period 2-6 month. contagious 4-6 weeks before icterus and 3-4 month after if not chronic infection
Risk of HBV transmission is 10 times more frequent than hepatitis C and 100 times more frequent than HIV.
Acute hepatitis IgM - anti HBC:
Risk for chronic disease are > 90% in newborns and < 5% in adults. If anti HBS develop the woman is immune
HBsAg |
HBV-DNA |
HbeAg |
anti-HBe |
anti-HBs anti-HBc |
anti-HBc |
Contagiousness |
+ |
+ |
+ |
- |
- |
+ |
Very contagious |
+ |
- |
- |
+ |
- |
+ |
Not very contagious |
+ |
+ |
+/- |
+/- |
- |
+ |
Contagious |
+ |
+ |
- |
+ |
- |
+ |
Contagious |
- |
- |
- |
+ |
+ |
+ |
Previous infection, not contagious |
- |
. |
. |
. |
+ |
- |
Vaccinated |
Transmission following acute HBV infection during the first trimester of pregnancy is rare unless the mother develops a persistent infection. The risk is about 6% in the 2nd trimester and rises significantly to 67% if infection is acquired on the 3rd trimester of pregnancy. The risk of
mother to child transmission of HBV is strongly related to the infectivity of maternal blood.
THE CHILD is normally asymptomatic unless the mother is anti HBe pos with mutated virus in which case fulminent hepatitis can occur;
Maternal-neonatal transmission usually occurs at delivery but may also be transplacental 5%.
Infection rates are highest in infants exposed to HBsAg antigen positive women who are Hepatitis B antigen (HBeAG) positive. Nearly 95% of infants born to mothers who are HBeAg positive become infected compared with 2-15% of women who are HBsAG positive but HBeAg negative. For the small number of carrier mother with HBe antibody the risk of vertical transmission is much lower, 10-20% and does not lead to chronic hepatitis B infection in those children who are infected. Neonates infected at birth have > 90% chance of becoming chronic carriers of hepatitis B with the associated risks of subsequent cirrhosis and hepatocellular carcinoma. When a mother is found to be hepatitis B surface antigen positive, it is recommended to screen for anti HBe and antibody status.
The majority of infection is acquired at the time of birth. Whether the risk is higher in infant delivered vaginally than those delivered by CS section is not well established and not recommended although this has been reported in one study. Breastfeeding does not seem to be associated with an increased risk of mother to child transmission but conclusive evidence to support this is lacking. There is a 5% risk of intrauterine infection with certain genotypes. There is a theoretical risk by amniocentesis and external version, and scalp electrodes should be avoided.
Treatment of infants, (if mother is HBsAg positive) is vaccination with Hepatitis B vaccine (Engerix-B = 0,5 ml) and Hepatitis B immunoglobulin (Anautiv = 1 ml) immediately after birth, given at two different locations, at least before 24-72 hours, and can interrupt 85-99% of such mother-infant transmission.
Prophylaxis: It is recommended that newborns are given vaccination at 1, 2 and 12 months.
References:
(1) ACOG Committee Opinion No. 234, May 2000.
(2) MacLean, A., et al. Infection and Pregnancy, RCOG Press 2001.
(3) Nielson-Piercy, C. Handbook of Obstetric Medicine. 2001 Edition.
(4) UpToDate 2005, Online 13.3
(5) Sundhedsstyrelsen. Vejledning om forebyggelse mod viral hepatitis. June 2002
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