Hepatitis and pregnancy
Dr Nupur Gupta
Hepatitis means inflammation of the liver. It may occur without symptoms, although jaundice is the major manifestation of hepatitis. In jaundice, the serum bilirubin (liver enzyme) level increases beyond 2 mg % causing yellow discolouration of the skin, mucus membrane and conjunctiva of eyes along with decreased appetite, fatigue and weakness.
The causes of Hepatitis (Jaundice) during pregnancy are classified as-
A. Hepatitis or jaundice due to pregnancy
B. Hepatitis or jaundice not related to pregnancy
A. Hepatitis or Jaundice due to pregnancy: The reasons are
1. Intrahepatic cholestasis:Second most common cause of jaundice in pregnancy
Caused due to excess circulation of oestrogen leading to stasis of bile into bile canaliculi It usually occurs in the last trimester of pregnancy and may appear in subsequent pregnancies also. Generalised pruritus or whole body itching is the most common symptom. It may be associated with weakness, nausea and sometimes vomiting. Blood investigation shows little or no rise in bilirubin level but the other enzymes SGOT and serum alkaline phosphatase levels are elevated
2. Severe pre- eclampsia
3. Acute fatty liver
4. Endogenic shock
B. Hepatitis not related to pregnancy: The reasons are
1. Viral hepatitis – Most common cause of hepatitis during pregnancy.
Types of viral hepatitis- Hepatitis A, B, C, D, and E
Hepatitis A and E are mainly caused by drinking infected water or food products contamination
Hepatitis B, C and D are mainly caused through intravenous route or contact with body fluids, blood transfusion or sexual contact. In hepatitis B and D, there is a possibility of vertical transmission from mother to baby. We have seen rising trends of HCV in more and more pregnant women, because of the sharp rise in prescription drug abuse.
2. Haemolytic jaundice – Caused due to transfusion of mismatched blood
3. Jaundice due to gall bladder stones – Caused due to obstruction of bile duct due to gall stones
4. Drug induced – Certain drugs like acetaminophencause jaundice
Effect of hepatitis on mother and baby
For mother, there is increased risk of postdelivery heavy bleeding (PPH postpartum haemorrhage), haemorrhagic manifestations and hepatic coma
For baby, risk of abortion and premature delivery risk is higher
How can we prevent hepatitis?
· Taking care of personal hygiene
· Using disposable syringes and needles
· Eating properly cooked food
· Vaccines as per advise of the doctor
Simple precautions can make a great difference.Our expert team of Gynecologist & Gastroenterologist can manage viral hepatitis in pregnancy after assessing the risk of transmission to the baby, mother’s risk of decompensation, and understanding the side effects of antiviral drugs.
The writer is Gynecologist & Director, Well Woman Clinic, Gurguram