Viral Hepatitis in Pregnancy

Document Type : Case report


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.


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.


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
6. Dinsmoor MJ. Hepatitis in the obstetric patient. Infect. Dis Clin North Am 1997
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
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
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
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
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-
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
37. Krawczynski K, Aggarwal R, Kamili S. Hepatitis E. Infect Dis Clin North Am
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
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.