By Dr Divya C
The term, viral hepatitis, refers to primary infection of the liver by any one of the hepatitis viruses, such as Types A, B, C, D , E and G. Listed below are types of hepatitis and how they could affect a pregnant woman.
Hepatitis A (HAV)
HAV is a single-stranded RNA virus belonging to the family Picornaviridae. It is spread via the faecal–oral route and is associated with poor sanitary conditions. HAV infection is common during childhood in developing countries like India and usually results in mild hepatitisand has minimal risk in pregnancy.
Hepatitis B (HBV)
HBV is a DNA virus belonging to the family Hepadnaviridae. Majority of patients with acute infection would remain asymptomatic and only few develop jaundice with hepatitis.
Hepatitis B infection in adulthood leads to chronic hepatitis where theincubation period of the virus ranges from 30 to 180 days. The virus may be detected within 30 to 60 days after infection, can persist and develop into chronic Hepatitis B. It commonly spreads from mother to child at birth (perinatal transmission) or through exposure to infected blood. Patients should be continued on HBV antiviral therapy throughout the pregnancy and after delivery in the long term if found positive for Hepatitis B virus.
Hepatitis B also spreads by needle stick injury, tattooing, piercing and exposure to infected blood and body fluids, such as saliva and menstrual, vaginal and seminal fluids.
Routine screening for Hepatitis B is done in pregnant women.
Hepatitis B Symptoms
- Fatigue
- Sudden nausea and vomiting
- Abdominal pain or discomfort
- Clay-coloured bowel movements
- Loss of appetite
- Low-grade fever
- Dark urine
- Joint pain
Hepatitis B Diagnosis
It is not possible to differentiate Hepatitis B from hepatitis caused by other viral agents, and hence laboratory confirmation is essential. They can also distinguish acute and chronic infections. The sample of choice for the diagnosis of HBV infection is blood.
- Serological tests for viral antigens and antibodies
- Nucleic acid-based tests are available to directly detect HBV-DNA in serum or plasma
Hepatitis C (HCV)
HCV causes both acute and chronic infection, HCV leads to chronic viraemia and 25% of these patients can develop chronic hepatitis.
Hepatitis E (HEV)
HEV is an RNA virus belonging to the family herpeviridae. HEV is primarily spread by faecal–oral route. The incubation period of HEV infection is around 2–9 weeks. HEV also spreads by blood. Pregnant women with Hepatitis E, particularly those in the second or third trimesters, are at higher risk of acute liver failure, fetal loss and mortality.
Routine screening for hepatitis C and E in pregnant women is done in high prevalent areas.
Prevention Of Hepatitis
- Improving the sanitary conditions and providing of safe, clean drinking water help in curtailing the spread of HAV. Vaccination is the best way to prevent HAV
- Active screening of high-risk groups for HCV infection and educational training targeting high risk but also the general population and Health care workers
- The preventive strategy for HBV infection includes screening of blood and blood products and routine testing of tissue and organ donors
- There is a need to strengthen and prioritizing infant and childhood vaccination as it is a vaccine preventable disease
The author is ADL, HOD, Microbiology, Neuberg Anand Reference Laboratory
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