Hepatitis B and Pregnancy
Why should I have a blood test for hepatitis B?
Like other forms of hepatitis, hepatitis B is a virus that can cause severe liver damage. Unfortunately, a third of the people who have hepatitis B fail to show any symptoms of the disease. (Doctors would say they are "asymptomatic.") In fact, they may not even know they have it. The danger during pregnancy is that the virus can be easily transmitted to a child during the delivery. For this reason, all pregnant women should be tested for hepatitis B.
If you find out you are infected, get treatment for it and make sure your doctor has supplies on hand to vaccinate your newborn in the delivery room. All newborns whose mothers carry hepatitis B should receive the hepatitis vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth so that they do not also get infected. This timing is crucial, because otherwise they will likely be infected with the liver disease as well. For infants, as the Hepatitis B Foundation notes, there is no second chance.
How can you get hepatitis B?
Hepatitis B is spread through sexual contact, sharing needles, or contact with body fluid. It can't be spread through food or water or by social contact or hugging someone.
Hepatitis B is a greater risk to certain groups of people, including health workers who come into regular contact with human blood, people who have multiple sex partners or a history of sexually transmitted diseases, men who have sex with other men, or people who use intravenous drugs.
The risk is also greater for people born in -- or whose parents immigrated from -- certain areas of the world where the virus is more common, and where transmission from mother to baby is the most common cause of exposure. Those areas include sub-Saharan Africa, Southeast Asia, the Amazon Basin in South America, the Pacific Islands, the Middle East, and Greenland. In North America, hepatitis B is also common in the state of Alaska and the northernmost sections of Canada.
What are the symptoms of hepatitis B?
In most cases, you'll have a fever and other symptoms of a viral syndrome that will clear up by itself. However, in about 10 percent of cases, your body may not be able to clear all the virus, and you'll then be a "carrier" of hepatitis B.
If you are a carrier, the virus may lurk in your blood for years and gradually wreak havoc on your liver. Symptoms of the disease include:
- yellow skin or yellowing of the whites of your eyes
- loss of appetite
- stomach pain or abdominal discomfort, especially near the liver
- brown or dark urine
- mild fever
- joint pain
About a third of adults never develop symptoms, however. In any case, you may not show any symptoms until your liver is already significantly harmed -- damage that after many years may even lead to cirrhosis or liver cancer.
How does the doctor determine if you have hepatitis B, and who should be vaccinated against it?
A blood test is the only surefire way to tell whether you are infected. Vaccination is particularly important if you work in a healthcare profession that exposes you to the virus, if your sexual partner has tested positive for the virus, if you live with a family member who has a chronic hepatitis B infection, if you have hemophilia, or if you travel to areas where hepatitis B is common.
If you do have hepatitis B, your doctor will take special precautions to protect your baby at the time of delivery. In addition, all your family members should be tested for hepatitis B, and people in your household should be immunized against it.
You should have your blood checked every few months to see how your liver is doing; you may also want to consult with a liver specialist. If there's inflammation, a number of treatments can reduce the risk that the disease will progress.
How will this virus affect my pregnancy?
Hepatitis B doesn't usually cause problems during pregnancy, but the virus can be passed to a newborn during delivery, whether it's vaginal or a C-section.
Newborns who are not vaccinated may develop symptoms of acute hepatitis B infection about one to four months following infection; most develop the condition between four and six weeks. Unlike that of adults, their condition is more likely to be chronic. Children with a chronic infection also have a 25 percent chance of eventually dying from cirrhosis or liver cancer.
However, your hepatitis B test will give doctors the information they need to protect your baby. If you test positive for the virus, make sure your doctor gives your newborn the hepatitis B immune globulin and the first of 3 vaccines against hepatitis B within 12 hours after the delivery.
Even if you test negative, the government recommends that all babies get the hepatitis B shot and follow-up boosters to protect them from the virus.
What do hepatitis B shots involve?
The good news is that hepatitis B shots are relatively easy to administer and can give your baby lifelong protection against the disease. The vaccine is also considered safe for unborn babies and for breastfeeding mothers.
The vaccination involves three shots. If you test positive, the first dose for your baby will come immediately following delivery, along with a medication called hepatitis B immune globulin (HBIG).
A second shot is administered a month later, and a third given at six months. Follow-up testing should be done between 9- 15 months.
Remember, if you know you are infected, request the vaccines in advance and, if you have a partner or a friend in the delivery room, enlist their help in reminding hospital staff to give your baby the shots. You may be too tired, overwhelmed, or overjoyed to remember to ask.
If these shots are given the first 12 hours of your baby's life, an infant has more than a 90 percent chance of protection from the hepatitis B virus for the rest of her life.
Centers for Disease Control and Prevention. Hepatitis B: Frequently Asked Questions. http://www.cdc.gov/ncidod/diseases/hepatitis/b/faqb.htm
Mayo Clinic. Hepatitis B. http://www.mayoclinic.com/invoke.cfm?id=DS00398
Lin K.W. et al. Hepatitis B. American Family Physician, 2004;69:75-82,86 http://www.aafp.org/afp/20040101/75.html
The Cleveland Clinic Health Information Center. Hepatitis B. http://www.clevelandclinic.org/health/health-info/docs/0100/0128.asp?index=4246
Hepatitis B Foundation. FAQ: Pregnancy and Hepatitits B. http://www.hepb.org/patients/pregnancy_and_hepatitis_b.htmHepatitis B Foundation. Pregnant Women and Hepatitis B. http://www.hepb.org/06-0269.hepb