comment... - basicq

[ArchivalUser]

HBeAg positive pregnancy and fetus----comment on fetus risk of getting disease and prevention?

[ArchivalUser]

Viral hepatitis can occur in any trimester. All hepatotropic viruses can infect the pregnant patient.

Hepatitis A

Hepatitis A virus infection occurs in 1 per 1000 pregnancies. The clinical course is similar to that in patients who are not pregnant. Intrauterine and perinatal transmission has been reported but is rare. Prevention with passive immune globulin is safe for both mother and fetus.

Maternal infection rarely leads to fetal loss or developmental abnormalities. Pregnant women who travel to endemic areas can safely receive the hepatitis A vaccine. Breastfeeding is not contraindicated in patients infected with hepatitis A virus.

Hepatitis B

Hepatitis B virus can be transmitted vertically from the mother to the child, leading to chronic infection in the child. Of perinatal transmissions, 95% occur intrapartum. The risk of transmission is 10-40% in mothers who are HBe antigen (HBeAg)“negative and 90% in mothers who are HBeAg-positive. Acute disease occurs in 2 per 1000 pregnancies. Acute disease is not severe during pregnancy. Chronic disease occurs in 5-15 per 1000 pregnancies. All pregnant patients should be tested for hepatitis B surface antigen (HBsAg) antepartum. Active and passive immunization is 85-95% effective in preventing transmission to neonates.

Hepatitis C

Hepatitis C virus infection does not affect the course of pregnancy unless cirrhosis is present.

Murthy et al studied the impact of cirrhosis or previous liver transplant on maternal health during pregnancy and outcomes during labor and delivery among pregnant women with these conditions and found adverse health issues.12 Relative to general obstetric patients (n = 662,408), rates of cesarean section, preterm labor, peripartum infection, and hypertension were higher in pregnant, cirrhotic women (n -187) and those with a previous liver transplant (n = 86).12

Findings specific to cirrhotic, pregnant women were higher rates of death, venous thromboembolism, protein-calorie malnutrition, placental abruption, and peripartum blood transfusion. Furthermore, compared with women with compensated cirrhosis, pregnant women with clinically apparent decompensated cirrhosis also had higher rates of cesarean delivery, preterm labor, placenta previa, and peripartum blood transfusion.12

The risk of vertical transmission of HCV is low (1 million copies/mL).

However, in an Italian study, Bevilacqua et al investigated the role of genetic factors already known in adult HCV infection or liver disease progression and their association in mother-to-child transmission of HCV infection.14 Of 384 participants, there were 38 HCV-positive mother-child pairs; 104 infected, nontransmitting mothers with their 114 children; 21 vertically infected children, and 69 HCV-exposed, uninfected children.

The investigators found an association of maternal HLA-DRB104 with protection from vertical transmission (P = 0.023), whereas its presence in children was a risk factor for such transmission (P = 0.036).14 When they looked at the concordance degree in HLA-DRB1 locus, an HLA mother-child mismatch was found to be a protective factor (P = 0.017), which Bevilacqua et al suggested alloreactive immune responses may be involved in preventing HCV vertical transmission.14


Hepatitis D

Hepatitis D virus infection occurs in conjunction with hepatitis B virus infection. Vertical transmission is rare. Control of hepatitis B virus can help prevent spread.

Hepatitis E

Hepatitis E virus infection is rare in the United States and Europe. It mainly occurs in developing countries and is usually mild and self-limiting. However, hepatitis E can cause fulminant hepatic failure. This infection is more severe in the third trimester, with a mortality rate of 20%. The risk of spontaneous abortion and intrauterine death is 12%. Vertical transmission can occur. Breastfeeding is permissible.