Viral hepatitis and pregnancy

This paper reviews data on the mutual relationship between pregnancy and vi ral hepatitis and the mother-to-infant transmission of the virus. In the we stern world, hepatitis A, B or C do not seem to influence the course of pre gnancy, or to be associated with foetal risks. In contrast, women who contr act a hepatitis E infection in their third trimester of pregnancy have a re latively high probability to develop a fulminant hepatitis. Mother-to-infan t transmission of hepatitis A seems to be very uncommon. On the contrary, H BsAg and HBeAg positive mothers have a 80-90% risk to transmit the disease to their offspring, more than 85% of these becoming chronic carriers of HBs Ag, The risk depends on the level of viral replication. In HBsAg positive a nd HBeAg negative mothers the rate of transmission is only 2-15%, these bab ies rarely become carriers. A possible explanation is the transplacental pa ssage of the HBeAg making the infant tolerant to the hepatitis B virus. As most of the infections occur during or directly after delivery, the neonate s are suitable for postexposure prophylaxis. It is recommended by the Cente rs for Disease Control and Prevention and the American Academy of Pediatric s that newborns of HBsAg positive mothers should receive hepatitis B immuno globulins within 12 hours after birth concurrently with the first paediatri c dose of the vaccine. Vaccination should be completed at 1 and 6 months. T his regimen confers a protective efficacy of greater than or equal to 90%, Vertical transmission of hepatitis C is considered to be relatively rare, a round 11% when HCV-RNA is positive, The highest rates of vertical transmiss ion of HCV are noted in women with high HCV-RNA level or concurrent HN infe ction, The risk is extremely tow when no HCV-RNA is detected. There is curr ently no treatment to prevent this vertical transmission; routine screening of all mothers is unwarranted, and pregnancies among HCV-positive mothers should not be discouraged, but their infants should be tested for anti-HCV at 1 year and followed for the development of hepatitis. Breast feeding doe s not seem to play an important role in the transmission of hepatitis B and C.