World Hepatitis Day 2021: All You Need To Know About Hepatitis During Pregnancy

Hepatitis leads to inflammation in the liver which affects its functioning. The disease is the result of excessive alcohol use, toxins, some medications and certain medical conditions. However, it is often caused by a virus, the most common being hepatitis A virus, hepatitis B virus, and hepatitis C virus.

Hepatitis B virus (HBV) can cause cirrhosis (hardening or scarring), liver cancer and even death. The disease spreads through direct contact with the body fluids - blood, semen of an infected person. Casual contact with people and objects as well as breastfeeding is not responsible for the spread of the virus.

Global statistics as per WHO

An estimated 240 million people are chronically infected with Hepatitis B virus worldwide

India has over 40 million HBV carriers besides a prevalence of 3 - 4.2 % of Hepatitis B surface antigen (HBsAg).

Transmission in newborns

Mother to child infection usually happens at birth (perinatal transmission), or through horizontal transmission (exposure to infected blood), especially from an infected child to an uninfected child during the first 5 years of life.

In adulthood, HBV infection leads to chronic hepatitis in less than 5% of cases, whereas infection in infancy and early childhood leads to chronic hepatitis in about 95% of cases.

HBV in newborns

About nine out of ten pregnant women infected with acute HBV infection are likely to pass the virus to their babies. With chronic infection, the chances of transmission come down to between 1 and 2 in 10 women. Additionally, the baby can get the virus during labor and delivery by being exposed to infected blood and fluids. In babies, HBV infection can be severe and threaten their lives. Even babies who appear to be well may be at risk of serious health problems.

Furthermore, new-borns infected with HBV are at a higher risk of becoming carriers and are at increased risk of dying of serious liver disease or liver cancer as adults. Babies infected with HBV will need ongoing medical care to assess their health and liver function.

Prevention

Vaccination is the mainstay of hepatitis B prevention. As per recommendation by the World Health Organisation (WHO), all infants should receive the hepatitis B vaccine as soon as possible after birth, preferably within 24 hours - followed by two or three doses of hepatitis B vaccine at least four weeks apart to complete the series.

One of the most efficient modes of preventing HBV transmission is from mother to infant during birth. If both HBsAg and HBeAg test positive in the mother, approximately 80%-90 percent of the infants will become affected. To provide complete protection, infants born to moms with hepatitis B must get precise doses of hepatitis B vaccine and hepatitis B immune globulin (HBIG). Both of these should be given on the day of the birth, but in different thighs. Medication should be provided soon after birth in the delivery room or within the first 12-24 hours of life to protect newborns

WHO estimates that the proportion of children under five years of age chronically infected with HBV dropped to just under 1% in 2019 as compared to around 5% in the pre-vaccine era during 1980s to the early 2000s.

The last two decades have been a great public health success story with regards to scale-up of hepatitis B vaccine and contributed to the decrease in HBV infections among children.

(Dr. Archana Dhawan Bajaj, Gynaecologist, Obstetrician and IVF expert - Nurture IVF Clinic.)

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