Liver disease during pregnancy: acute viral hepatitis

Abstract

Acute viral hepatitis is the most common cause of jaundice in pregnancy. The course of most viral hepatitis infections (e.g., hepatitis A, B, C and D) is unaffected by pregnancy, however, a more severe course of viral hepatitis in pregnancy has been observed in patients with hepatitis E. Notwithstanding, opinions differ over the maternal and fetal outcome of pregnancy associated with viral hepatitis. While some authors reported that acute viral hepatitis carries a high risk for both mother and fetus others conclude that non-fulminant viral hepatitis did not influence the course of pregnancy or fetal well-being. Rate of transmission of the virus during pregnancy depends on the virus. For instance, intra-utero transmission of hepatitis A virus is very rare, but perinatal transmission could occur. Conversely sixty percent of pregnant women who acquire acute HBV infections at or near delivery will transmit the HBV virus to their offspring and mother to child transmission of hepatitis E virus infection was established between 33.3 and 50%. Breast-feeding is not contra-indicated in women infected with the hepa-titis A, E or C. However, for acute hepatitis B, with appropriate immunoprophylaxis, including hepatitis B immune globulin and hepatitis B vaccine, breast-feeding of infants of HBV infected mother's poses no additional risk for the transmission of the hepatitis B virus. Finally, whether live or inactivated vaccines are used, vaccination of pregnant women should be considered on the basis of risks versus benefits. Pregnant women who think they may have been exposed to hepatitis B may be given and hepatitis B immunoglobulin (ideally within 72 hours of exposure), as well as the hepatitis B vaccine.