The most common cause of jaundice in pregnant women in the United States is viral hepatitis. With the exception of hepatitis E infection, the clinical course and histologic findings of hepatitis A, B, C, and delta hepatitis do not differ between well-nourished pregnant women and nonpregnant individuals.
Acute Hepatitis A
Pregnant women with hepatitis A generally do not transmit the infection to their offspring. Presumably, the risk of transmission is limited by the brief viremic period and the lack of fecal contamination during delivery. Management does not differ from that of nonpregnant patients. In uncomplicated cases there is no rational basis for restricting protein intake or providing excessive quantities of carbohydrate. Effective prophylaxis against hepatitis A can be achieved with immune globulin and should be offered to pregnant women with household or sexual contacts who have acute hepatitis A.
Acute Hepatitis B
Infection with the hepatitis B virus (HBV) is a major cause of acute and chronic hepatitis, cirrhosis, and primary hepatocellular carcinoma throughout the world. Although pregnancy does not affect the course of hepatitis B and hepatitis B does not appear to affect the pregnancy adversely, concern centers around the vertical transmission of this virus from mother to child, which occurs at the time of birth.
Certain features appear to determine the likelihood and rate of perinatal transmission of HBV, including the period in pregnancy during which infection occurs, the mother’s infectivity as measured by her HBeAg status, and the mother’s racial and geographic background. Women who have acute hepatitis B during the first or second trimester rarely transmit the infection to their neonates and only do so if they become HBsAg carriers. On the other hand, women who contract the infection during the third trimester or near the time of delivery have a very high probability of transmitting the virus to their offspring. Mothers positive for both HBsAg and HBeAg infect more than 80% of untreated infants. Transmission by asymptomatic mothers is much higher in Asian countries (30% to 70%) than it is in the United States (5% to 20%) and most Western countries.
The most common outcome of infection in the newborn is persistent antigenemia, and up to 90% become HBV carriers. Some ultimately develop chronic active hepatitis, cirrhosis, and primary hepatocellular carcinoma. In addition, female carriers may subsequently perpetuate the cycle of perinatal transmission when they become pregnant. Because of the high prevalence of infection with hepatitis B virus, routine screening for HbsAg is recommended for all pregnant women. All infants of mothers who have active or chronic hepatitis should receive hepatitis B immune globulin during the first 12 hours after birth. They should then be immunized with hepatitis B vaccine during the first week of life, 1 month later, and again at approximately 6 months of age, a practice that is now standard for all infants.
Infection with hepatitis C (HCV) is a serious health problem. Despite the relatively benign nature of the acute infection, there is a high frequency of progression to chronic hepatitis (up to 50%), cirrhosis (20% to 25%), and hepatocellular carcinoma. Vertical transmission of HCV may occur but seems to be far less common than that for HBV. Coinfection with human immunodeficiency virus (HIV) in the mother may enhance transmission of HCV to the neonate.
Delta hepatitis (HDV) is caused by a defective RNA virus that is dependent on HBV for replication. Infection with HDV can occur as coinfection, which requires acquisition of HBV and HDV at the same time, or as superinfection with HDV in a chronic carrier of HBV. Perinatal transmission of HDV is very rare. Delta infection in the neonate can only occur if HDV is transmitted along with HBV; HBV carriers superinfected with HDV are usually anti-HBe-positive and therefore are much less likely to transmit HBV to their offspring.
Hepatitis E is a serious disease in pregnant women and is responsible for a high frequency of fatal, fulminant hepatitis in up to 20% of cases.
Revision date: July 6, 2011
Last revised: by Jorge P. Ribeiro, MD