Hepatitis in Pregnancy

Introduction

• Description: Hepatitis is one of the most serious infections that occur during pregnancy.

• Prevalence: Hepatitis—0.1%–1.5% of pregnancies (one-third of Americans have antibodies to hepatitis A). Hepatitis B is the most common cause of jaundice during pregnancy. The prevalence of hepatitis in pregnancy has declined in the past 15 years.

• Predominant Age: Reproductive age.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Six or more different forms of hepatitis may be involved. Hepatitis A is caused by a ribonucleic acid (RNA) virus that is transmitted by fecal–oral contamination and accounts for 30%–50% of acute disease. Hepatitis B is caused by a small DNA virus that accounts for 40%–45% of occurrences. It is estimated that acute hepatitis B occurs in 1–2/1000 pregnancies and that chronic infections are present in 5–15/1000 pregnancies. Hepatitis B is transmitted by parenteral and sexual contact. Hepatitis B is easily sexually transmitted: 25% of people who have sexual contact with an infected person become infected. Hepatitis C (non-A, non-B) accounts for 10%–20% of cases and is caused by a single-stranded RNA virus, with at least six different genotypes, spread by parenteral exposure. Hepatitis D is caused by an RNA virus that requires coinfection with the hepatitis B virus. Significant mortality and long-term consequences may occur from this less common infection. Hepatitis E, G, and other forms of non-A, non-B hepatitis are uncommon but may occur during pregnancy as well. They generally mimic hepatitis A in acquisition, symptoms, and behavior.

• Risk Factors: Groups at greatest risk for hepatitis B are intravenous drug users, hemophiliacs, men who have sex with men, and healthcare workers. Poor hand washing habits, multiple sexual partners, a history of sexually transmitted infection, tattoos, and multiple blood transfusions (hepatitis C) increase the risk for an infection as well. Up to 40% of patients with hepatitis A are thought to have become infected by asymptomatic children under the age of 6 in their household.

Signs and Symptoms

• Unchanged by pregnancy

• Fever (60%), malaise (70%), fatigue, anorexia (50%), nausea (80%)

• Variable right upper quadrant pain (50%)

• Upper abdominal tenderness with hepatomegaly

• Dark urine (85%) and acholic stools

• Jaundice, a possibility in up to 60%

• Coagulopathy or encephalopathy (fulminant infections only)

Diagnostic Approach