Hepatitis B During Pregnancy
Chronic hepatitis B virus (HBV) infection affects about 350 million individuals worldwide. Management of HBV infection during pregnancy is difficult because of peculiar and somewhat controversial aspects. Most healthy adults are able to fight off hepatitis B infection within a few months, without treatment.
However, up to one in 10 adults who get infected continue to carry the virus. This is called chronic, or long-running, hepatitis. Over time, it can cause serious damage to the liver. Unfortunately, there’s no cure for chronic hepatitis B, but good medical care and a healthy lifestyle can do a lot to slow it down. A pregnant woman having hepatitis B can pass the virus on to your baby. That’s why a routine blood test to detect hepatitis B is offered to all pregnant women. Unlike adults, most babies can’t fight it off on their own.
Carriers of Hepatitis B
Because hepatitis B takes such a long time to show, it can be hard to say how a person caught it. We know the virus is most commonly spread in these ways:
- Having unprotected sex with a person who has the virus.
- Blood-to-blood contact, such as from sharing needles if you inject drugs
- Through a “needlestick” injury if you work in healthcare.
- From mum to baby.
Infected blood can enter your body through an open cut or scratch, which means you could get infected from:
- Contaminated needles used for tattoos or body piercing.
- Sharing a toothbrush or razor with someone who has the virus.
- Having medical or dental treatment where equipment hasn’t been sterilised properly, or having a blood transfusion in a country where blood is not tested for the virus.
Signs of Hepatitis During Pregnancy
Common signs of hepatitis include
- Nausea and vomiting
- Loss of appetite
- Fever
- Abdominal pain
- Jaundice, or yellowing of the skin and the whites of the eyes.
The problem is, depending on the type of virus, symptoms might not show up for months or years after infection, or you may have no symptoms at all.
“Hepatitis B Panel” of Blood Tests
Only one sample of blood is needed for a hepatitis B blood test, but the “Hepatitis B Panel” includes three parts. All three test results are needed to fully understand whether a person is infected or not.
- HBsAg (Hepatitis B surface antigen)
- Anti-HBs or HBsAb (Hepatitis B surface antibody)
- Anti-HBc or HBcAb (Hepatitis B core antibody).
Treatment Guidelines
Treatment may start in the third trimester of your pregnancy, depending on how high your viral load is. Treatment should continue for four weeks to 12 weeks after you give birth. Your doctor may advise you to take this medication longer if it will benefit your health.
If your viral load is lower, it’s likely that your doctor won’t advise you to start treatment at this time, unless you have liver disease.
There are many different medications for hepatitis B, and some are known or thought to be unsafe during pregnancy. For this reason, if you already know you have hepatitis B, it’s a good idea to talk to your doctor before trying for a baby.
If you’re already having treatment when you become pregnant, make sure you tell your doctor in case she needs to change your medication.
If you have hepatitis B during pregnancy, the infection can flare up again after you’ve had your baby. If you have the virus, 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. After the vaccine series is complete, your baby will be tested for hepatitis B virus infection.
Having hepatitis B infection does not affect how you will give birth. You still can have a vaginal delivery if you are infected with the hepatitis B virus.
Note: Women who are diagnosed with hepatitis B during pregnancy should be referred for follow up care with a physician skilled at managing hepatitis B infection. Your physician should perform additional laboratory testing, including hepatitis B e-antigen, HBV DNA level, and liver function tests (ALT).
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