Viral Hepatitis in Pregnancy (HAV, HCV, HEV)

Viral Hepatitis is one of the leading causes of death related to Liver Disease. In this article, we discuss Viral Hepatitis During pregnancy with Hepatitis A, C, and E virus. Further, we will discuss Hepatitis C and D during Pregnancy in another post.

HEPATITIS A VIRUS

Hepatitis A Virus (HAV) | FDA
Hepatitis A Virus

It is a non-enveloped RNA virus having a size of 27nm. It falls in the Heptavirus genus, picorna group of enteroviruses. It is highly infectious. and generally shows an Incubation period of 4 weeks. Its Replication is limited to the liver and is transmitted through the faeco-oral route. It is associated with poor hygiene and poor sanitation.

HEPATITIS A DURING PREGNANCY

Signs and symptoms are usually unspecific and the majority are asymptomatic. 

Illness during the 3rd trimester may be associated with increased frequency of preterm labor.

Vertical transportation of the HAV virus has not been reported.

There is no evidence of congenital HAV infection thus, no intervention is recommended. 

SPECIFIC DIAGNOSIS:

Serological test- presence of anti-HAV IgM.

Alternative test- faecal antigen test

CLINICAL MANAGEMENT

Antibiotics,antiviral or corticosteroids are of no value. 

Administration of Ig’s may give immediate protection if given soon after the exposure of the virus.

Breastfeeding is encouraged with appropriate attention to hand washing. The hepatitis vaccine is safe to receive during pregnancy.

HEPATITIS C VIRUS

Hepatitis C virus: Morphogenesis, infection and therapy
Hepatitis C virus
  • HCV is a single-stranded RNA virus.
  • Genus Hepa-civirus
  • Family flaviviridae
  • Characterized by a high mutation rate.
  • The incubation period is 7-8 weeks but ranges from 3-21 weeks.
  • Up to 85% of infected individuals become chronic carriers.

RISK FACTORS

  1. Intravenous drug misuse
  2. Unscreened blood products
  3. Vertical transmission
  4. Needle-stick injury
  5. Iatrogenic parenteral transmission (eg-contaminated vaccination needles)
  6. Sharing toothbrushes/ razors.

HEPATITIS C VIRUS DURING PREGNANCY

Affects approximately 1.0-5% of all pregnancies 

Is more frequent in women with HIV infection.

Predominantly acquired through transfusion of blood and blood products 

It is also transmitted by sexual intercourse and by a vertical transmission during pg.

Majority of HCV infections are asymptomatic.

Rate of transmission is approximately 3-6% but the risk is very higher.

Is rarely transmitted by the breast feeding

INVESTIGATIONS

  1. Serology- Anti-HCV Ab.
  2. Virology- HCV RNA virus

MANAGEMENT:

There is no effective treatment available to treat HCV infections in the mothers and the newborns.

Until 2011 the treatment of choice was peg. Inf.-alfa   ( contraindicated in pregnancy as it causes decreased birth weight and increased fetal loss)

HEPATITIS E Virus

Genome organization of the hepatitis E virus. The 5′ end of the ...
Hepatitis E Virus

Single stranded RNA virus with 4 genotypes.

Hepaviridae family, hepevirius genus.

Transmitted through fecal-oral route.

Pregnancy is a risk factor for HEV.

Incubation period ranges from 15-60 days.

HEPATITIS E
DURING PREGNANCY

High incidence of death from fulminant hepatitis in pg. women

Common in 3rd trimester

Very high risk of vertical transmission 

Also associated with miscarriage, stillbirth, or neonatal death

Very high risk of preterm delivery with poor neonatal survival rates.

MANAGEMENT

Management of Hepatitis E in pg. and its complications are the same as non pg. individuals. 

Termination of pg. seems to be the logical choice for the Rx. of severe Hepatitis E infection.

Breastfeeding is considered safe in asymptomatic women.

For further information

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