Viral Hepatitis in Pregnancy

Hepatitis is a serious infection that affects the liver. Viral hepatitis is caused by viruses and is easily spread. The most common types of viral hepatitis in the United States are hepatitis A, hepatitis B, and hepatitis C.

Hepatitis A causes short-term illness. Hepatitis B and hepatitis C can lead to serious, long-term illness. During pregnancy they can also cause problems for you and your fetus.

Hepatitis A and hepatitis B can be prevented with vaccines that are safe to get during pregnancy. Screening for hepatitis B and C is recommended in each pregnancy.

Infection with hepatitis virus can be acute (short-term) or chronic (long-term). Acute infection causes only mild symptoms or no symptoms at all. When symptoms do occur, they may include

• tiredness

• loss of appetite

• nausea and vomiting

• jaundice (yellowing of the skin and eyes)

• stomach pain

• pain in the muscles and joints

• diarrhea (hepatitis A only)

Hepatitis A causes acute illness that usually ends within 2 months. Rarely, symptoms may last up to 6 months.

Hepatitis B can be acute or chronic. In some people hepatitis B infection can clear up completely in a few weeks without treatment. Those who get rid of the hepatitis B virus become immune to it. They cannot get the virus again.

A small number of adults and many children younger than 5 never get rid of the hepatitis B virus. They are known as carriers. Most carriers do not have any symptoms, but a small number develop serious long-term illness.

Chronic infection can lead to liver damage, liver cancer, and early death. There is no cure for hepatitis B, but symptoms can be managed.

Hepatitis C can be acute or chronic. For some people, the illness is short. But many people will have long-term illness.

Yes, most adults infected with the hepatitis C virus become carriers. Most carriers develop long-term liver disease. A smaller number will develop serious, life-threatening liver problems. Hepatitis C can be cured in most people with antiviral medication.

Hepatitis A often spreads through contaminated food or water. It also spreads through the feces of people who are infected. In the United States, hepatitis A is often spread in foodborne outbreaks or by people who have traveled to countries where hepatitis A is common.

Hepatitis B virus spreads through direct contact with the body fluids (such as blood, semen, or vaginal fluids) of an infected person. This can happen during unprotected sex or while sharing needles used to inject (“shoot”) drugs. A baby can be infected during birth if the mother has hepatitis B.

Hepatitis B virus can also be spread if you live with an infected person and share household items that may come into contact with body fluids, such as toothbrushes or razors. Hepatitis B is not spread by casual contact with people and objects. Hepatitis B is not spread by breastfeeding.

Hepatitis C virus spreads through direct contact with infected blood. This can happen while sharing needles or sharing household items that come into contact with blood. A baby can be infected during birth if the mother has hepatitis C infection. It can also be spread during unprotected sex, but it is harder to spread the virus this way. It is not spread by casual contact or breastfeeding.

Vaccines can prevent hepatitis A and hepatitis B virus infection. These vaccines can be given before or during pregnancy.

There is no vaccine to protect against the hepatitis C virus. Avoiding certain types of behavior is the only way to prevent infection:

• Use a latex condom during sex.

• Know your sexual partners. The more partners you or your partners have, the higher your risk of getting an infection.

• If you are injecting drugs, get help and try to stop. If you cannot stop, do not share needles.

The hepatitis A vaccine is recommended for anyone at increased risk for getting the hepatitis A virus, including people who

• have traveled outside the United States

• use illegal drugs

• are experiencing homelessness

The vaccine is also recommended for anyone at increased risk for severe disease from hepatitis A infection, including people with chronic liver disease and human immunodeficiency virus (HIV). Talk with your health care professional about your risk factors. The vaccine can also be given to anyone who asks for it.

The hepatitis B vaccine is recommended for everyone during pregnancy if you have not previously been vaccinated. There is also a shot called hepatitis B immune globulin (HBIG) that can be given along with the vaccine if you have had recent contact with the hepatitis B virus and are not already vaccinated. HBIG contains antibodies to the virus. It can give additional protection against infection in certain situations.

There have been some reports of hepatitis A passing from a mother to the fetus, but this seems to be rare.

Serious complications of hepatitis A are rare. There is no treatment for hepatitis A, which is why vaccination is important.

If you have hepatitis A in pregnancy, talk with your health care professional about managing any symptoms. Management of symptoms during pregnancy is similar to management of symptoms in people who are not pregnant.

Without medication, about 9 in 10 pregnant women with acute hepatitis B virus infection will pass the virus to their babies. About 1 in 10 women with chronic infection will do so. The baby can get the virus by being exposed to infected blood and fluids during labor and delivery.

Hepatitis B virus infection can be severe in babies. It can threaten their lives. Even babies who appear well may be at risk of serious health problems.

Infected newborns are at high risk of becoming carriers. When carriers become adults, they are at increased risk of dying of serious liver disease or liver cancer.

Yes, everyone should be tested for hepatitis B during pregnancy. There are different blood tests for hepatitis B virus infection. They can tell whether you have been infected recently or whether you are a carrier. They can also tell whether you have had the hepatitis B virus in the past and are now immune to it or whether you have had the hepatitis B vaccine.

If your test result shows that you are infected with the hepatitis B virus, you will need more tests to learn whether your liver is still healthy.

Medication called antivirals may be recommended in certain cases. Antiviral medication can help protect your liver and reduce the risk of passing hepatitis B infection to your baby when you give birth.

Yes, being infected with the hepatitis B virus means that your children, your sexual partners, and others living in your household are at risk of infection. They should be told about testing and vaccination.

No, having hepatitis B infection does not affect how you will give birth. You can still have a vaginal delivery if you have hepatitis B.

If you were not tested and you do not know whether you are infected, you should be tested for hepatitis B infection when you go to the hospital to have your baby.

Within a few hours of birth, your baby will receive the first dose of the hepatitis B vaccine. A shot of HBIG is given as well. Two more doses of the vaccine are given over the next 6 months. You still can breastfeed your baby if you have hepatitis B infection.

After the vaccine series is complete, the baby will be tested for hepatitis B infection. A test also is done to measure the level of antibodies that have been made as a result of the vaccine. A second vaccine series may be given if test results show that the baby is not infected with the hepatitis B virus but has not made enough antibodies to the virus.

If test results show that the baby is infected with the hepatitis B virus, the baby will need to have ongoing medical care. Regular visits with the baby’s doctor will be needed to assess the baby’s health and how well the liver is working.

Yes, your baby should still receive the hepatitis B vaccine. The first dose of the vaccine is recommended for all babies within 24 hours of birth. A second dose is usually given when babies are 1 to 2 months old, and the last dose is given between 6 and 18 months.

About 4 in 100 women who are infected with the hepatitis C virus will pass it to their babies. The risk is related to how much of the virus a woman has and whether she also is infected with HIV.

Yes, hepatitis C testing is recommended for everyone during each pregnancy. Currently, there are no hepatitis C treatments approved for use during pregnancy. And there are no preventive measures available that can reduce the risk of passing the virus on to the baby. But if you have the virus, you will need special care during pregnancy to make sure you stay healthy.

Outside of pregnancy, hepatitis C testing is recommended at least once for all adults. If you test positive for hepatitis C before pregnancy, you can start treatment before getting pregnant. There is an antiviral medication that can cure hepatitis C in some people.

If you are infected with the hepatitis C virus, your baby will be tested, usually when your baby is at least 18 months old. Babies who become infected with the hepatitis C virus will need ongoing medical care.

You will also need long-term health care. You can start treatment with an antiviral medication after pregnancy. If you breastfeed your baby, treatment should start after finishing breastfeeding.

Yes, you can still breastfeed your baby if you have hepatitis C infection.

Antibodies: Proteins in the blood that the body makes in reaction to foreign substances, such as bacteria and viruses.

Carriers: People who are infected with the organism of a disease without showing symptoms. These people can pass the disease to other people.

Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Hepatitis: Infection of the liver.

Hepatitis A: An infection caused by a virus that can be spread by contaminated food or water.

Hepatitis B: An infection caused by a virus that can be spread through blood, semen, or other body fluid infected with the virus.

Hepatitis B Immune Globulin (HBIG): A substance given to provide temporary protection against infection with hepatitis B virus.

Hepatitis C: An infection caused by a virus that can be spread through infected blood.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system. If left untreated, HIV can cause acquired immunodeficiency syndrome (AIDS).

Immune: Protected against infectious disease.

Jaundice: A buildup of bilirubin (a brownish yellow substance formed from the breakdown of red cells in the blood) that causes the skin to have a yellowish appearance.

Semen: The fluid made by male sex glands that contains sperm.

Vaccination: Giving a vaccine to help the body’s natural immune system develop protection from a disease.

Vaccine: A substance that helps the body fight disease. Vaccines are made from very small amounts of weak or dead agents that cause disease (bacteria, toxins, and viruses).

Viruses: Agents that cause certain types of infections.