Hepatitis B, a viral infection that affects the liver is especially a concern during pregnancy because it can be passed to the newborn at delivery. Hepatitis B can also be transmitted to the fetus if the pregnant lady is infected. Hepatitis B in pregnancy is linked to preterm delivery to some extent.



Facts on Hepatitis B


• Hepatitis B is not a teratogen as it doesn't cause congenital abnormalities but an infected baby may develop life-long liver complications such as cirrhosis of the liver or liver cancer.



• The newborn is more likely to acquire hepatitis B and become a chronic carrier if the mother acquires the infection at the later part of her pregnancy.



• Though recovery is fast, one in ten persons can become carriers for life. A carrier develops long term liver damage.



• Sadly, infected persons show no symptoms or at the most exhibit flu-like symptoms, vomiting, fatigue, loss of appetite and stomach pain which eventually go away without treatment. Specific symptom includes jaundice which doesn't always manifest.



• In most people acute hepatitis infection lasts a few months. The virus leaves the body but the antibodies remain.



• Women at highest risk including those who work in the healthcare line or those who have multiple partners should be vaccinated before or even during pregnancy.



• Some countries are considered high-risk, including Asia, Africa, Middle East and Far East. Frequent travelers to these places should be vaccinated



• In some countries all hospital born newborns are mandatorily inoculated before being discharged



• A preventive vaccine is widely available and is safe, even during pregnancy



• Transmission occurs in several ways:


1. From a carrier to her newborn during delivery


2. From an infected mother to her fetus during pregnancy


3. Unprotected sexual intercourse with a carrier (inclusive of contact with the contaminated saliva, semen)


4. Living with a carrier


5. Direct contact with the blood of an infected party e.g. drug users who share needles, equipment used during tattooing, ear piercing etc, blood transfusion.



What if the Mother is infected with Hepatitis B?


• A routine blood screening test is usually performed during a woman's first prenatal visit to check for hepatitis B infection or immunity. A check can also be done during the preconception visit.



• If you are not immune vaccination is necessary. The hepatitis vaccine is in 3 doses and the last is given 6 months after the first. Pregnancy should be postponed for at least 6 months. However if you do accidentally become pregnant in these 6 months your pregnancy is not at risk.



• If maternal blood test confirms the mother to be a carrier, the baby's pediatrician has to be informed so that proper treatment following birth can be carried out.



• At delivery the newborn will be thoroughly washed to remove all traces of maternal blood and other fluids promptly, and baby will be inoculated with the hepatitis B vaccine and hepatitis B immunoglobulin for protection within 12 hours of birth.



• Following the treatment at birth, the newborn will be given further shots between one and six months with the vaccine and immunoglobulin which is a serum made from the live virus.



• Several months after the last shot, baby will be tested to ensure enough antibodies are being made. Babies who test positive do not encounter liver problems later on.



• After delivery, the mother will be assessed and advised on managing or treating her own infection.



• Hepatitis B is not passed through breast milk and breastfeeding is considered safe. The mother will not be separated from her baby or discouraged from breastfeeding.