Viral Hepatitis in Pregnancy

Document Type : Case report

Authors

1 Associate Professor of Infectious Diseases and Tropical Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

2 Assistant Professor of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

3 Associate Professor of Internal Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

4 Internist Internal Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Abstract

The course of infection with most hepatitis viruses such as hepatitis A, B, and C is not affected by pregnancy; however, a more severe course of viral hepatitis in pregnancy has been observed in patients infected with hepatitis E virus. Rate of transmission of hepatitis viruses during pregnancy depends on the type of virus. For instance, intrauterine transmission of hepatitis A virus is very rare, but perinatal transmission could occur. Conversely 60% of pregnant women who acquire acute infection with hepatitis B virus at or near delivery will transmit the virus to their offspring. Mother to child transmission of hepatitis E virus has been reported about 33.3-50%. Breast-feeding is not contra-indicated in women infected with hepatitis A, E, or C. During acute infection with hepatitis B virus, breast-feeding poses no additional risk for transmission of the virus if appropriate immunoprophylaxis including hepatitis B immunoglobulin and hepatitis B vaccine is administered.

Keywords


1. Massoud A. Common liver disorders with pregnancy. ASJOG 2004;1;138-43.
2. Kumar A, Sharma KA, Gupta RK, Kar P, Murthy NS. Hepatitis C virus infection during
pregnancy in North India. Int J Gynecol Obstet 2005 Jan;88(1):55-6.
3. Aggarwal R. Hepatitis E and pregnancy. Indian J Gastroenterol 2007 Jan-Feb;26(1):3-5. 
 
4. Renge RL, Dani VS, Chitambar SD, Arankalle VA. Vertical transmission of hepatitis
A. Indian J Pediatr 2002 Jun;69(6):535-6.
5. Hunt CM, Sharara AI. Liver disease in pregnancy. Am Fam Physician 1999 Feb
15;59(4):829-36.
6. Dinsmoor MJ. Hepatitis in the obstetric patient. Infect. Dis Clin North Am 1997
Mar;11(1):77-91.
7. Duff P. Perinatal infectious disease. Introd Semin Perinatol 1998;22(4):241.
8. Erkan T, Kutlu T, Cullu F, Tumay GT. A case of vertical transmission of hepatitis A
virus infection. Acta Paediatr 1998; 87(9):1008-9.
9. Duff P. Hepatitis in pregnancy. Semin Perinatol 1998; 22(4): 277-83.
10. Elinav E, Ben-Dov IZ, Shapira Y, Daudi N, Adler R, Shouval D, et al. Acute hepatitis
A infection in pregnancy is associated with high rates of gestational complications and
preterm labor. Gastroenterology 2006 Apr;130(4):1129-34.
11. Mast EE, Margolis HS, Fiore AE, Brink EW, Goldstein ST, Wang SA, et al. A
comprehensive immunization strategy to eliminate transmission of hepatitis B virus
infection in the United States: recommendations of the Advisory Committee on
Immunization Practices (ACIP) part 1: immunization of infants, children, and
adolescents. MMWR Recomm Rep 2005 Dec;54(RR-16):1-31.
12. Ayatollahi J, Hadi-Nodooshan H.[ Slirve of Anti-HAV(Anti- hepatitis A virus) from
IGG class among Yazd guide school students.] [Article in Farsi]. J Shahid Sadoughi
Univ Med Sci Health Serv 2002 Winter;9(4 (Special Issue):81-6.
13. Ayatollahi J. Awareness of peoples of Yazd city about vaccination in adults. Iranian. J
Obstet Gyneocol Infertil 2004;7(1):20-4.
14. Gall SA. Maternal immunization. Obstet Gynecol Clin North Am 2003;30(4):623-36.
15. Ferreira CT, da Silveira TR. Viral hepatitis prevention by immunization. J Pediatr (Rio
J) 2006 Jul;82(3 Suppl):S55-66.
16. Ayatollahi J, Sharifi MR. [Prevalence of hepatitis B vaccination among medical
students of Shahid Sadoughi Univ. Infec Trop J 1382;20(8):51-4.
17. De Silvestri A, Avanzini MA, Terulla V, Zucca S, Polatti F, Belloni C. Decline of
maternal hepatitis A virus antibody levels in infants. Acta Paediatr 2002;91(8):882-4.
18. Breastfeeding and the use of human milk. American Academy of Pediatrics. Work
Group on Breastfeeding. Pediatrics 1997 Dec;100(6):1035-9.
19. Pungpapong S, Kim WR, Poterucha JJ. Natural history of hepatitis B virus infection: an
update for clinicians. Mayo Clin Proc 2007 Aug;82(8):967-75.
20. Ayatollahi J, Navab Azam A, Ezoddini Ardakani A.[Hepatitis B] [Article in Farsi]. J
Shahid Sadoughi Univ Med Sci Health Serv 2007;15(2):93-101.
21. Xu DZ, Yan YP, Choi BC, Xu JQ, Men K, Zhang JX, et al. Risk factors and mechanism
of transplacental transmission of hepatitis B virus: a case-control study. J Med Virol
2002;67(1):20-6.
22. Gambarin-Gelwan M. Hepatitis B in pregnancy. Clin Liver Dis 2007 Nov;11(4):945-63.
23. Nguyen G, Garcia RT, Nguyen N,Trinah H, Keeffe EB, Nguyen MH. Clinical course of
hepatitis B virus infection during pregnancy. Aliment Pharmacol Ther 2009; 29:755–64.
24. Ayatollahi J. [Immunization and infectious diseases] [Article in Farsi]. Payvand
1385;327:54-6.
25. Ayatollahi J, Sharifi MR, Sabzi F, Zare AR. Blood Level anti-HBS due to HB vaccine
in health case perssonle of Shahid Sadoughi Hospital-Yazd. Iranian J Obstet Gyneocol
Infertil 2004;7(1):48-51.
26. Pavel A, Tirsia E, Maior E, Cristea A. Detrimental effects of hepatitis B virus infection
on the development of the product of conception.Virologie 1983;34(1):35-40.
27. Conte D, Fraquelli M, Prati D, Colucci A, Minola E. Prevalence and clinical course of
chronic hepatitis C virus (HCV) infection and rate of HCV vertical transmission in a
cohort of 15,250 pregnant women. Hepatology 2000;31(3):751-5.
28. Resti M, Azzari C, Mannelli F, Moriondo M, Novembre E, de Martino M,et al. Mother
to child transmission of hepatitis C virus: prospective study of risk factors and timing of 
 
infection in children born to women seronegative for HIV-1. Tuscany Study Group on
Hepatitis C Virus Infection. BMJ 1998 Aug;317(7156):437-41.
29. Hadzic N. Hepatitis C in pregnancy. Arch Dis Child Fetal Neonatal Ed 2001
May;84(3):F201–4.
30. Soulie JC. [Hepatitis C and pregnancy: is it necessary to screen for the risk of vertical
transmission?] [Article in Farsi]. J Gynecol Obstet Biol Reprod 1993;22(6):631-4.
31. Hardikar W, Elliott EJ, Jones CA. The silent infection: should we be testing for
perinatal hepatitis C and, if so, how?. Med J Aust 2006;184(2):54-55.
32. Burns DN, Minkoff H. Hepatitis C: screening in pregnancy. Obstet Gynecol
1999;94(6):1044-8.
33. Lin HH, Kao JH, Hsu HY, Ni YH, Chang MH, Huang SC, et al. Absence of infection in
breast-fed infants born to hepatitis C virus-infected mothers. J Pediatr 1995;126(4):589-
91.
34. Kumar RM, Shahul S. Role of breast-feeding in transmission of hepatitis C virus to
infants of HCV-infected mothers. J Hepatol 1998;29(2):191-7.
35. Alavian SM. Hepatitis E virus infection. Neglected problemin in our region. Hepatitis
Montly 2007(3):119-21.
36. Okamoto H. Genetic variability and evolution of hepatitis E virus. Virus Res. 2007
Aug;127(2):216-28.
37. Krawczynski K, Aggarwal R, Kamili S. Hepatitis E. Infect Dis Clin North Am
2000;14(3):669-87.
38. Aggraval LA. Hepatitis E and pregnancy. Indian J Gastroentrol 2007;(26):1-5.
39. Wang L, Zhuang H. Hepatitis E: an overview and recent advances in vaccine research.
World J Gastroenterol 2004 Aug 1;10(15):2157-62.
40. Pal R, Aggarwal R, Naik SR, Das V, Das S, Naik S. Immunological alterations in
pregnant women with acute hepatitis E. J Gastroenterol Hepatol 2005;20(7):1094-101.
41. Shavakhi A, Esteghamat FS, Sharifian A, Mohammad Alizada AH, Khoda Dostan M,
Somi MH,et al. [Evaluation of hepatitis E in cirrhotic patients.Acase control study]
[Article in Farsi]. Govaresh J 2007;12(1):27-9.
42. Aminiafshar S, Alimagham M, Gachkar L,Yousefi F, Attarchi Z. Atihepatitis E virus
seropositivity in a group of blood donors.Iranian J Public Health. 2004;33(4):53-6.
43. Ghorbani GH, Alavian SM, Esfahani AA, Assari SH. Seroepidemiology of hepatitis E
virus in Iranian soldiers. Hepatits Monthly 2007;7(3):123-6.
44. Somi MH, Farhang S, Majid G, Shavakhi A, Pouri AA. Seroprevalence of hepatitis E in
patients with chronic liver disease from east Azerbaijan. Hepatits Monthly 2007;7(3):127-30.
45. Khuroo MS, Kamili S, Jameel S. Vertical transmission of hepatitis E virus. Lancet
1995;345(8956):1025-6.
46. Smith JL. A review of hepatitis E virus. J Food Prot 2001;64(4):572-86.
47. Singh S, Mohanty A, Joshi YK, Deka D, Mohanty S, Panda SK. Mother-to-child
transmission of hepatitis E virus infection. Indian J Pediatr 2003;70(1):37-9.