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Viral Hepatitis, A Through E, In Pregnancy

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Chronic Viral Hepatitis

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Key Principles

Pregnancy causes physiological changes in liver function and biochemical testing, which should be recognized before embarking on an extensive workup of liver disease in pregnancy.

Viral hepatitis A through D does not affect the pregnant woman any differently. However, hepatitis E develops into fulminant hepatic failure in 25–70% of pregnant women.

The treatment for acute infection during pregnancy is similar to the treatment of adults who are not pregnant and consists mainly of supportive care.

It is recommended that all pregnant women undergo testing for HBsAg during an early prenatal visit even if they have been previously tested or vaccinated.

Perinatal transmission represents one of the most common routes of transmission of chronic hepatitis B worldwide and probably accounts for more than half of the world’s chronic carriers.

A number of strategies have been employed to prevent mother-to-infant transmission. The most effective strategy is the combination of hepatitis B immune globulin (HBIG) and hepatitis B virus (HBV) vaccination within 12 h of birth followed by the completion of the vaccine series at 1 and 6 months of age.

Nucleos(t)ide analogue therapy with an FDA-approved anti-HBV agent is appropriate for managing CHB infection in mothers whose serum tests positive for HBsAg and who have high serum HBV DNA concentrations.

Vertical transmission of hepatitis D virus (HDV) has been reported but it is uncommon. The therapeutic strategies to prevent perinatal transmission of HBV are also effective in preventing the transmission of HDV

Vertical transmission of hepatitis C virus (HCV) is less common than in HBV infection but has been well documented. The treatment for acute and hepatitis C infection in pregnant women is supportive.

Breastfeeding is not contraindicated in women with hepatitis A virus (HAV) infection or chronic viral hepatitis B, C, or D. It is unclear at this time whether HEV transmission occurs while breastfeeding and therefore no formal recommendations can be made.

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  1. Georgetown University Medical Center, Washington, DC, USA

    Eashen Liu MD & Jacqueline Laurin MD

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  1. Department of Hepatology, Georgetown University Hospital, Reservoir Road GUH 3800, Washington, 20007, U.S.A.

    Kirti Shetty

  2. University of Connecticut Health Center, Farmington Ave. 236, Farmington, 06030-1845, U.S.A.

    George Y. Wu

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Liu, E., Laurin, J. (2009). Viral Hepatitis, A Through E, In Pregnancy. In: Shetty, K., Wu, G. (eds) Chronic Viral Hepatitis. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-59745-565-7_14

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