Confronting the viral threat of hepatitis in maternal care

By: Dr. Neha Sethi

In the journey of motherhood, safeguarding the health of both mother and child is of utmost importance. Yet, amidst the myriad joys and challenges, a silent threat looms: viral hepatitis. Picture this – a virus stealthily lurking, potentially wreaking havoc on the delicate balance of pregnancy. From hepatitis A to E, these insidious invaders pose risks beyond the immediate, with repercussions stretching far into the future.

Hepatitis, a severe liver infection, is primarily caused by various viruses including hepatitis A, B, C, and E. During pregnancy, these viruses can induce acute symptoms such as nausea, vomiting, fatigue, and abdominal discomfort, alongside more specific signs like dark urine and yellowing of the skin. While many cases resolve spontaneously, some necessitate medical intervention including fluid therapy and medications. Notably, chronic hepatitis B and C infections persist beyond six months, posing greater risks, particularly to infants born to infected mothers.

The hepatitis B virus, highly contagious through bodily fluids, including blood and saliva, can be transmitted from mother to child during childbirth. While some individuals clear the virus naturally, others become lifelong carriers, at risk of severe complications such as liver damage and cancer. Pregnant women with hepatitis B must be vigilant as transmission rates to newborns vary based on viral load, with significant risks if left unmanaged.

Despite the mode of delivery, hepatitis B does not dictate the need for a Caesarean birth. However, precautions are vital to mitigate transmission risks, especially as infants face high probabilities of chronic infection, potentially leading to life-threatening complications without proper management.

Routine screening for hepatitis B during prenatal care is imperative to implement preventive measures effectively. Vaccination within 24 hours of birth, alongside subsequent doses, forms the cornerstone of protection, bolstered by hepatitis B immunoglobulin administration to newborns for immediate defence. Additionally, antiviral therapy for mothers with high viral loads ensures viral suppression, safeguarding both maternal and foetal health throughout pregnancy.

By adhering to comprehensive preventive strategies and close medical supervision, pregnant women can significantly reduce the risk of vertical transmission of hepatitis B, ensuring the well-being of both mother and child.

Breastfeeding your baby after receiving HBIG and the hepatitis B vaccine at birth is generally safe, with minimal risk of transmitting hepatitis B through breast milk, particularly if your nipples remain intact. Continued antiviral treatment poses little risk to the baby, as they are exposed to minute amounts of the drug, with no evidence suggesting harm thus far.

Hepatitis A (HAV) during pregnancy is typically contracted through contaminated food or drink, with most individuals recovering without specific treatment. While transmission to the child is uncommon, HAV can trigger premature labour and other complications, necessitating timely vaccination within two weeks of exposure to safeguard both mother and baby.

Similar to hepatitis B, hepatitis C (HCV) can spread through bodily fluids and poses a risk of vertical transmission to infants, influenced by the maternal viral load and potential co-infection with HIV. Despite no approved treatments or preventive measures during pregnancy, infants born to HCV-infected mothers undergo testing around 18 months of age, with those infected requiring ongoing medical attention. Notably, breastfeeding is generally considered safe even with a hepatitis C infection, although long-term healthcare for both mother and child is essential.

In conclusion, let us not forget the power we hold in our hands – the power of knowledge and awareness. It is important that we spread the word to every new mother and expecting parent, shedding light on the risks and preventive measures against viral hepatitis. Through education and advocacy, we can empower individuals to take proactive steps towards protecting themselves and their precious bundles of joy.

Together, let us pave the way for a future where no mother or child need fear the silent menace of the stealthily lurking viral hepatitis.

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The author is a Consultant Obstetrician and Gynaecologist at the Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, and may be reached at s_neha26@um.edu.my