Viral Hepatitis: Risks, Precautions, Prevention for Pregnant Women

Abbot Diagnostics Educational Services
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Breaking the cycle of hepatitis infection

(Hepatitis B)

Hepatitis is an ancient disease; however, it has only been in the last 20 years that research has intensified. This is largely due to the availability of simple blood tests that identify viruses capable of producing hepatitis. It is now evident that people exposed to blood or blood products in their work or through medical treatment, as well as people of certain ethnic backgrounds are more likely to become infected with hepatitis than others. Studies have not provided clear answers as to why people of certain ethnic backgrounds are highly susceptible to hepatitis and a variety of other liver ailments.

Recent hepatitis research involving thousands of people around the world has revealed important new information that may affect you. The age at which a person is exposed to hepatitis has a great deal to do with whether that person will harbor the disease for life (called a carrier) or recover from the infection. The younger the person at the time of exposure, the higher the probability the person will become a carrier.
Infants born to infectious mothers have a 90% chance of becoming carriers of hepatitis.

Today, pregnant women who are infected with hepatitis can do something about improving their baby’s chances of avoiding this dangerous disease.
The cycle of hepatitis infection can be broken. This booklet will explain the steps that should be followed by expectant mothers and their physicians.

A word before we begin…

The word “hepatitis” means “inflammation of the liver.” There are several causes of hepatitis, but of serious concern for a pregnant woman and her child is hepatitis caused by viruses, in particular one that is identified as Hepatitis B virus. Formerly, Hepatitis B was referred to as “serum” hepatitis, because it is often transmitted by blood and blood products. Today, we know that many body fluids, including breast milk and saliva, can transmit the Hepatitis B virus, as well. It can also be transmitted by sexual contact.

Today there is an effective treatment regimen that will prevent at least 85 percent of perinatally transmitted cases of chronic Hepatitis B in infants. Using a combination of Hepatitis B vaccine and Hepatitis B immunoglobulin (H-BIG) over a 6 month period will provide immediate and long-term protection for children born to carrier mothers and mothers with active type B hepatitis.

I’m pregnant, why should I worry about hepatitis?

If you have hepatitis, you can infect your child with the disease. Many babies who have been infected at birth suffer lifelong liver problems, including liver cancer.

How do I know if I have hepatitis?

The symptoms of hepatitis vary a great deal. During an active infection, many people lose their appetite, feel tired, and suspect that they have the flu; others have no symptoms at all. It is not uncommon to become severely ill for months. If you have been infected in the past, it is possible that you did not completely recover from the infection and remain a carrier. This means that although you do not appear to be ill presently, you could be infectious and spread the disease to others. Simple blood tests can determine for sure if you have hepatitis.

If I have a mild case of hepatitis, so mild in fact that I do not know I have the disease, can I still infect my newborn?

Yes. The virus can be transmitted to your newborn regardless of how well or ill you feel.

You said certain people are at greater risk of acquiring hepatitis, who are they?

The following groups have been identified as being at high risk for acquiring hepatitis:

•individuals of Asian, African, Caribbean, Pacific Island, American Indian, native Alaskan, or South American descent,
•Heath care professionals with an occupational exposure to blood or to other body fluids, including those who work in hemodialysis units
•Women with active or ongoing liver disease,
•Women who receive blood or blood products
•Current or former practitioners of prostitution
•Household contacts of persons with an active or ongoing case of Hepatitis B
•Residents or staff in institutions for the mentally retarded
•Certain military and police personnel.
How can I find out if I have hepatitis and not simply the flu or some other less serious disease?

Simple blood tests can confirm presence or absence or hepatitis virus infection. Your physician can make arrangements for you to have these tests.

What can I do to protect my child if I am found to be carrying the Hepatitis B virus?

At the time of delivery your physician can give your newborn injections of H -BIG and vaccine to protect against Hepatitis B infection. At one month and at six months, your baby should receive another dose of hepatitis vaccine. These measures will greatly reduce the chance that your baby will develop Hepatitis B infection. If infection does develop, these injections reduce the chance of the baby acquiring liver cancer or of becoming a lifelong carrier of the disease.

Should my baby be checked later by a doctor?

Yes, you should make arrangements for blood tests for your baby 6 months after birth and again at about 1 year after birth. Then, depending on the test results, additional vaccine may be given to your baby.

If I discover that I am a carrier of Hepatitis B virus, what should I do?

Your physician can arrange for additional blood tests. These tests can determine not only if you are an infectious carrier, but whether your condition is likely to improve over time.

Some carriers are minimally infectious and can lead normal lives. Others, however, must be extremely cautious about passing the disease to other people. The hepatitis vaccine, unfortunately, will be of no value to you if you have had or currently have hepatitis.

Can I nurse my baby if I am infectious with Hepatitis B virus?

Yes, if your baby is immunized with Hepatitis B immunoglobulin and hepatitis vaccine. Breast milk of infectious mothers does contain small amounts of Hepatitis B virus. The infants of these mothers continue to be exposed to the virus in other ways. Only the vaccination outlined in this booklet will help to protect your child from acquiring Hepatitis B virus infection.

Suggested readings

1.Centers for Disease Control: Recommendations of the Immunization

Practice Committee; Recommendations for the Protection Against Viral Hepatitis. MMWR. 34:313-335. 1985.

2. Chin J: Prevention of chronic Hepatitis B virus infection from mothers to infants in the United States. Pediatrics. 71:289-292. 1983.

3. Koff RS: Management of the Hepatitis B surface antigen carrier. Seminars in Liver Disease. 1:33-43, 1981.

4. Krugman S: The newly licensed Hepatitis B vaccine: Characteristics and indication for use. JAMA. 247: 2012-2015, 1982.

5. Krugman, S: Hepatitis B Immunoprophylaxis. Laboratory Medicine. 14: 727-732, 1983.