Hepatitis in Pregnancy - Causes, Symptoms, and Treatment

Introduction:

Hepatitis is the inflammation of the liver. It can be self-limiting or develop into fibrosis (scarring), cirrhosis, or liver cancer. The most common cause of hepatitis is the hepatitis virus, including A, B, C, D, E, other infections, and toxic substances. Alcohol, autoimmune diseases, and certain drugs can also cause hepatitis. Effects on pregnancy, treatment, and prevention vary significantly between the types of hepatitis.

What Are the Causes of Hepatitis?

1. Hepatitis A: It is caused by consuming food items that have been infected with the affected person's feces, serum, and saliva due to poor hygiene and sanitation and food contamination with sewage water. Recovery in many people can happen on their own without treatment and passing it on to their children during pregnancy is rare. The virus can however be transmitted through intercourse and rarely through a blood transfusion.

2. Hepatitis B: The hepatitis B virus causes hepatitis B. This virus is passed from individual to individual by blood, semen, or other body fluids. The common way of spreading hepatitis B is through sexual contact, sharing needles, accidental needle sticks, and from mother to child. Pregnant women with chronic hepatitis B have a 90 percent chance of passing the infection to their newborns. Hepatitis B virus does not infect the unborn unless there have been breaks in the maternal-fetal barrier.

3. Hepatitis C: The major transmission mode of hepatitis C virus is mostly through sexual contact, infected blood transmission, infected drug users sharing needles, and mother-to-baby transmission. During the first six months after exposure, the infection will be in acute form. If not treated, it would progress to chronic hepatitis C. Hepatitis C is a significant cause of cirrhosis and hepatocellular carcinoma.

4. Hepatitis D: It is transmitted through the same route as the hepatitis B virus. The hepatitis D virus needs the hepatitis B strain to survive. The coinfection (infection with multiple species) of the hepatitis D and B virus leads to severe acute infection. Superinfection (second infection superimposed on an earlier one) of hepatitis D virus on chronic hepatitis B virus leads to progression to chronic hepatitis D.

5. Hepatitis E Virus: It is mainly transmitted through the consumption of contaminated water or food. Therefore, it is most common in developing countries with poor sanitation.

What Are the Symptoms of Hepatitis in the Pregnant Population?

The patient will remain asymptomatic or have mild clinical disease in acute cases. In chronic hepatitis B and C, viral infection may progress to the following:

• Cirrhosis (chronic liver damage).

• Ascites (fluid accumulation in spaces within the abdomen).

• Hepatic encephalopathy (nervous system disorder due to severe liver disease).

• Coagulopathy (blood's ability to form clots is impaired).

• Esophageal variceal (abnormal, enlarged veins of the esophagus) bleeding.

The other common symptoms include:

• Jaundice (bilirubin build-up in the blood causing yellowish skin color).

• Abnormally low body weight.

• Abdominal pain.

• Discomfort and fatigue.

• Myalgia (muscle pain).

• Dark urine.

• Pain in the muscles.

• Nausea.

• Vomiting.

What Risks Does Hepatitis Cause During Pregnancy?

• Hepatitis A infection can cause an increased risk of preterm birth (birth before the 37th week of pregnancy), placental abruption (a complication where the placenta gets detached from the womb), premature rupture of amniotic fluid, vaginal bleeding, and placental separation. In addition, in rare cases, hepatitis A can cause liver damage to the fetus. It can be preventable by the hepatitis vaccine.

• The complications of the hepatitis B virus in pregnancy are rare. However, in patients with chronic hepatitis B virus, there is a risk of preterm birth, placental abruption, gestational hypertension (high blood pressure in pregnancy), weight gain, and fetal growth restriction.

• Around 10 percent of women with hepatitis C during pregnancy will transmit the virus to their infant. The rate of transmission of hepatitis C is dependent on the quantity of virus circulating in the blood. Fetal growth restriction, fetal distress, cephalohematoma (blood collecting between a newborn's scalp and skull), neonatal seizures (abnormal electrical activity in the brain cells), and intraventricular hemorrhage (bleeding into the ventricles of the brain) are the complications observed in the fetus.

• Hepatitis D transmission during pregnancy is infrequent. It is unknown if pregnancy increases liver disease progression in people with hepatitis D, but frequent monitoring of liver health during pregnancy is essential.

• Hepatitis E during pregnancy is a difficult situation because it is hazardous for the fetus. It can cause stillbirth, preterm birth, and acute liver failure in infants.

What Is the Treatment for Hepatitis in Pregnancy?

Hepatitis treatment depends on the cause and severity of the infection, affecting the pregnant woman's health.

1. Hepatitis A is not treated during pregnancy as it does not cause serious complications. However, it may cause early labor if it occurs after the first trimester, so the patient is advised to take the hepatitis A vaccine or immunoglobulin during pregnancy. Also, newborns should be given hepatitis A immunoglobulin within 48 hours of birth. The risk of transmitting the hepatitis A virus through breast milk is minimal, so breastfeeding is not a contraindication.

2. Hepatitis B treatment is considered safe during pregnancy. It can also be prevented by giving a hepatitis B vaccine during the first trimester. Antiviral drugs like Tenofovir, Telbivudine, or Lamivudine have not increased the risk of fetus exposure during pregnancy. A hepatitis B vaccine or immunoglobulin can be administered while pregnant within 12 to 24 hours of birth to babies of hepatitis B-infected mothers.

3. The treatment of hepatitis C during pregnancy is not recommended because it is unknown whether hepatitis C treatment with direct-acting antivirals is safe during pregnancy. Ideally, the hepatitis C virus should be treated and cured before a person gets pregnant. However, there is no contraindication for breastfeeding in mothers infected with the hepatitis C virus.

4. The treatment for hepatitis D is contraindicated during pregnancy because the available treatments, including PEGylated interferon and alpha interferon, are not safe during pregnancy. In addition, the transmission of hepatitis D has decreased due to the perinatal prevention and treatment of hepatitis B virus infection.

5. The treatment for hepatitis E is contraindicated during pregnancy. The hepatitis E virus recombinant protein vaccine has decreased the transmission of hepatitis E virus in developing countries.

Conclusion

Hepatitis is the common cause of jaundice in pregnancy and is associated with significant gestational and fetal complications. Proper screening for hepatitis B and C virus is recommended for all pregnant women. Multidisciplinary care, including obstetrics, hepatology, and pediatrics, is essential for optimizing outcomes for both mother and child.