What to Know About Hepatitis and Pregnancy

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Hepatitis and pregnancy is a complicated topic because there are many different types of hepatitis. Hepatitis just means any disease that causes inflammation of the liver. It can be caused by a virus or a noninfectious cause.

Viral hepatitis can be caused by a number of different viruses, including hepatitis A, B, C, D, and E. Nonviral hepatitis can also occur during pregnancy. Treatment, prevention, and effects on the pregnancy vary significantly between the types of hepatitis.

This article will discuss how hepatitis affects fertility, gestation, and life after birth for both the parent and the child.

A pregnant person
Matthew Horwood / Getty Images

Hepatitis and Fertility

There is some limited evidence that viral hepatitis may negatively impact male fertility and sperm function. In contrast, viral hepatitis infections with hepatitis B and hepatitis C have not been shown to have a significant effect on maternal fertility.

However, hepatitis infection may indicate an increased risk of other sexually transmitted infections that can affect fertility. Individuals and couples who are experiencing fertility problems in the context of hepatitis infection should discuss that with their doctor.

Assisted reproduction techniques may need to be altered to reduce the risk of viral transmission between the partners. If only one partner is infected with a hepatitis virus (known as a serodiscordant couple), vaccination may also be an option to reduce the risk of sexual transmission.

Hepatitis and Gestation

Hepatitis can complicate pregnancy, but it is also possible for pregnancy to complicate hepatitis. In rare circumstances, pregnancy can cause a chronic hepatitis infection to flare up and increase liver damage. Hepatitis treatment during pregnancy may be recommended for this reason, as well as to reduce transmission to the infant.

Risks of Hepatitis and Pregnacy

Hepatitis A is a vaccine-preventable illness. New infections with hepatitis A are associated with an increased risk of preterm birth, placental abruption, and premature rupture of membranes. In rare cases, hepatitis A can cause liver damage to the fetus.

Hepatitis B and C are both associated with an increased risk of preterm delivery. Hepatitis C infection is also associated with an increased risk of spontaneous abortion and miscarriage.

As many as 10% of people with hepatitis C during pregnancy will transmit the virus to their infant. The rate of transmission of hepatitis B is very dependent on viral load (how much virus is circulating in the blood). People considering pregnancy should be vaccinated for hepatitis B.

Hepatitis E during pregnancy is extremely serious. In addition to pregnant people being at increased risk of hepatitis E, it is very dangerous for the fetus. There is an elevated risk of stillbirth and preterm birth and it can cause acute liver failure in infants. The risk of transmission from mother to fetus is estimated to range from 33% to 100%.

In contrast, hepatitis D transmission during pregnancy is quite rare. There is relatively little data on hepatitis D during pregnancy. It is not known if pregnancy increases the progression of liver disease in people with hepatitis D, but liver health should be monitored during pregnancy.

Autoimmune hepatitis is a rare liver disease caused by an overactive immune system. Pregnant people with autoimmune hepatitis are at risk of poor outcomes for both parent and fetus. Autoimmune hepatitis is associated with an increased risk of preterm birth, fetal growth restriction, and liver damage.

Prevalance of Hepatitis Diagnosis During Pregnancy

Around the world, an estimated 4.5 million people with hepatitis B give birth every year. The Centers for Disease Control and Prevention (CDC) estimates that, in 2015, over 20,000 pregnant people in the United States were infected with hepatitis B.

The number of people with hepatitis B has declined significantly since vaccination was first recommended.

Treatment of Hepatitis and Pregnancy

Treatment for hepatitis during pregnancy depends on the cause of hepatitis and the degree to which it is affecting the health of the pregnant person.

Hepatitis A is not generally treated during pregnancy. However, post-exposure prophylaxis is recommended for people who aren't immune. This is treatment with the hepatitis A vaccine or immunoglobulin after you have been exposed to hepatitis A.

Several treatments for hepatitis B have been shown to be safe during pregnancy, including lamivudine, telbivudine, and tenofovir. Tenofovir is considered to be the preferred treatment and is safe even in the first trimester. Treatment is not required but may be recommended for people with high viral load, particularly near the time of birth.

Hepatitis C should ideally be treated and cured before a person gets pregnant. Unfortunately, there is not yet good data on whether hepatitis C treatment with direct acting antivirals is safe during pregnancy. Therefore, treatment during pregnancy is not recommended.

Neither hepatitis D nor E are treated during pregnancy. This is because the treatments that are available, including ribavirin and pegylated interferon are not considered safe during pregnancy. If treatment is needed, it is usually supportive care for liver failure. Acute liver failure may require transplant.

Concerning Symptoms of Hepatitis and Pregnancy

Pregnant people with hepatitis should be aware of symptoms that could indicate either a new infection or worsening liver disease. These include:

  • Jaundice, or yellowing of the skin and eyes
  • Darkening of the color of the urine
  • Unusual bruising or bleeding beneath the skin, which can also be a sign of other conditions that affect blood clotting

Regular follow-up with an obstetrician can include monitoring of liver function. If a flare is detected, treatment may be needed.

Hepatitis and Postpartum

Hormone changes in the postpartum period have the potential to affect the course of viral hepatitis. Mild changes in liver function are somewhat common in the postpartum period. This may be related to changes in the immune system.

Postpartum clinical symptoms associated with hepatitis B are rare. Hepatitis C infection is associated with greater maternal health risk after delivery.

Impact on Recovery

In general, chronic hepatitis infection is not expected to significantly impact a person's recovery in the postpartum period. However, if there are complications associated with hepatitis—such as postpartum hemorrhage—this can prolong the recovery period.

Acute hepatitis flares may also be somewhat more common in the postpartum period. These can have a significant effect on maternal health.

Breastfeeding and Hepatitis

Breastfeeding is not considered to be a risk factor for the transmission of viral hepatitis. There is no need for people with viral hepatitis to restrict their breastfeeding. However, people with cracked or bleeding nipples should consider taking a break from breastfeeding until their nipples heal.

People who are being treated for hepatitis should discuss whether any particular drug regimen affects their ability to breastfeed. Treatment for hepatitis C is not recommended until after breastfeeding is complete.

Frequently Asked Questions

Do they test for hepatitis C when you're pregnant?

Routine screening for hepatitis C during each pregnancy is recommended by the CDC. Universal screening has been shown to be the most effective way of detecting hepatitis C. Therefore, every pregnant person should be tested. Being tested does not mean your provider thinks you are at high risk.

If you are not certain if your provider has tested you for hepatitis C, ask. Universal testing guidelines are relatively new, and not all doctors may be aware of them. This is particularly true if you are considering pregnancy but are not yet pregnant.

Given the availability of direct-acting antiretrovirals, treating hepatitis C prior to pregnancy may be best for both you and your future child.

Why do women who want to get pregnant have to take the hepatitis B vaccine for adults?

The hepatitis B vaccine is now commonly given to infants and is recommended for all people under age 19 who have not been vaccinated. If you are an adult who has not been vaccinated but wish to be vaccinated before getting pregnant, it is appropriate to request it.

A person who becomes newly infected with hepatitis B during pregnancy is very likely to transmit it to their infant. Vaccination is recommended for currently pregnant people who are at high risk for hepatitis but not currently infected and who have not yet been vaccinated.

Hepatitis B can be very serious in babies. It can cause both short-term and long-term problems. Vaccination is a safe and effective way to prevent hepatitis B in both the pregnant person and the infant. Regardless of maternal vaccine status, all infants should be vaccinated for hepatitis B within two months of being born.

How many pregnant moms have hepatitis B?

The CDC estimates that over 20,000 people who were pregnant in 2015 in the United States had hepatitis B. As almost 4 million babies were born in the United States in 2015, about 0.5% of births were to people who had hepatitis B.

Why is hepatitis bad for pregnant women?

The common forms of viral hepatitis can all pose significant problems for maternal and fetal health. New infections with viral hepatitis may be particularly risky during pregnancy.

Therefore, pregnant people should consider practicing safe sex and engaging in other risk reduction behaviors. For example, injection drug users should not share needles.

Hepatitis E is the riskiest type of viral hepatitis during pregnancy but not the most common. Both hepatitis C and hepatitis B are more common, and thus more likely to cause problems.

As both hepatitis A and hepatitis B can be prevented by vaccine, people considering pregnancy should consider vaccination for both if they have not yet been vaccinated.

Autoimmune hepatitis can also be risky for both the pregnant person and the fetus. With better treatment options, it has become safe to carry a pregnancy with autoimmune hepatitis. However, that requires careful monitoring by an obstetrician.

Summary

Hepatitis can impact pregnancy in several ways. Viral hepatitis may reduce male fertility, and it can be transmitted to a susceptible partner. Hepatitis A and B can be prevented by vaccination before pregnancy. Hepatitis C should be treated before pregnancy.

Viral hepatitis during pregnancy may lead to preterm birth and may be transmitted to the fetus. This can result in short-term and long-term problems for the infant after birth.

A Word From Verywell

The best way to address hepatitis in pregnancy is to prevent it. While not all hepatitis variants are preventable, safe, effective vaccines are available for hepatitis A and B. An effective cure is also now available for most types of hepatitis C. It can be deployed before a planned pregnancy to reduce risk to both parent and infant.

If you are already pregnant and infected with hepatitis, the best thing you can do is talk to your doctor. Although there are risks associated with hepatitis and pregnancy, many people have delivered healthy infants while dealing with liver disease.

In some cases, treatment options may be available. In others, appropriate monitoring can help your doctor keep on top of any risks to your health or the health of your fetus.

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