Hepatitis B in Pregnancy

The inflammation of liver due to any reason is called hepatitis. Hepatitis B is caused by a Hepatitis B virus and it can spread from person to person via body fluids such as blood, semen and vaginal fluid. The body is capable of fighting and eradicating the virus without the help of any medicine, if the immune system is strong enough. In 5-10% cases the virus is not completely cleared and stays in the body and can lead to some serious liver damage. The virus can stay dormant for a long period of time and this is known as chronic hepatitis B. And if you test positive for hepatitis B in pregnancy, don't worry, there're ways to protect your baby.

How to Tell If You Have Hepatitis B

There are no specific symptoms of hepatitis B and the best way to find out if you have it or not is to have a blood test. Hepatitis B screening is done during early pregnancy. If the test is positive, your midwife or doctor will take certain measures to protect the baby from getting infected.

The non-specific symptoms are:

  • Pain in abdomen, diarrhea or vomiting
  • Tiredness, and aches and pains
  • Loss of appetite

These can come and go and can be confused with other pregnancy symptoms. If the virus is active, there can be jaundice and yellow discoloration of eyes and skin, itching, dark urine and pale stools.

How Will Hepatitis B Affect Pregnancy?

Most of the times, hepatitis B in pregnancy would not cause any harm to you or your baby. However, it may increase your risk for some complications. To avoid any complications, regular tests and very good antenatal care are recommended. Possibe complications can be:

  • Premature birth
  • Heavy bleeding in last trimester of pregnancy
  • Low birth weight baby
  • Development of pregnancy induced diabetes

Since hepatitis B is spread via blood and body fluids, there is a chance that the baby might get infected. Most of the times, this viral transmission takes place during birth; a caesarean section and vaginal delivery carry equal risk of transmission.

If the mother has history of hepatitis B in pregnancy, the baby needs to be vaccinated immediately after birth. Antibodies against the virus are also given to some babies at increased risk. These babies need follow up tests and further doses of vaccine against hepatitis B virus at one month, two months and twelve months of age for full protection. Blood tests are done at one year to see if a booster dose at five years is required or not.

It is necessary to follow the vaccination and test schedule to protect baby against this virus. If they are not vaccinated, there is a 90% chance that they will develop chronic hepatitis eventually.

How Will It Be Managed?

The goal to manage hepatitis B in pregnancy is to protect the mother and the baby from any harmful effects of the infection and to prevent further spread of the virus. If your test for hepatitis B is positive, more blood tests will be done to assess the viral load, type and the condition of your liver.

  • Anything that can damage the liver like alcohol or medicines containing acetaminophen should be avoided at all costs.
  • Specialist care is required. Your partner and everyone else who has close contact with you need to be tested. And if they test negative for hepatitis B, they should be vaccinated. To stop further spread of the virus, use condoms.
  • There are certain medicines which can prevent the spread of virus to the baby and tenofovir is prescribed for that purpose. Regular assessment of liver function is also done.
  • The risks of transmission of the virus to the baby at birth are the same for vaginal delivery and C section. When the doctors or midwives conducting the delivery know that the mother has hepatitis B, they take all the preventive measures to minimize the risk of transmission.
  • The baby is vaccinated at birth and follow up is required. Complete vaccination and antibodies dose at birth prevents the transmission of virus in 95% babies. And it is okay for the mother to breast feed the baby.

How to Know If Your Baby Is Protected?

The effectiveness of vaccine is monitored by blood tests which are done around two months after the last vaccine dose. The results can confirm if the baby is fully protected or not. Sometimes a booster dose is required at five years.

The complete course of vaccine, at birth, one month, two months and one year offers a lifelong protection against hepatitis B and is recommended for all children.

Hepatitis B does not spread by:

  • Breast feeding: You can breastfeed your baby after the vaccination. The virus does not spread via human milk and breastfeeding is absolutely safe.
  • Cooking and eating: There is no evidence that hepatitis B spreads by sharing utensils. You are not likely to catch the virus if you eat something cooked by a hepatitis B positive person. If you are a carrier, you can cook for your family and friends without any fear of spreading the virus.  
  • Hugging and kissing: You can hold, hug and kiss your bundle of joy without any hesitation or fear. Hepatitis B virus is not transmitted by holding, hugging or kissing any one. There is no evidence that sneezing or coughing can spread it.
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