Hepatitis is an inflammation of the liver, an organ vital for many bodily functions. This inflammation is often caused by viral infections. Viral hepatitis includes distinct types like A, B, and C, which can lead to a range of liver damage, from mild illness to severe, long-term conditions.
Standard Hepatitis Screening
Testing for hepatitis is a routine part of prenatal care to identify specific viral types, primarily Hepatitis B (HBV) and Hepatitis C (HCV). Healthcare providers typically offer a blood test during the initial prenatal visit. This screening is recommended for every pregnancy, regardless of prior vaccination or previous negative test results.
The blood test aims to detect the presence of specific antigens or antibodies associated with the hepatitis viruses. For Hepatitis B, the test looks for the hepatitis B surface antigen (HBsAg). For Hepatitis C, an antibody test (anti-HCV) is usually performed first; if positive, a follow-up RNA test confirms current infection. This proactive approach allows for early identification and management of potential infections.
Importance of Screening
Screening for hepatitis during pregnancy is important for protecting both the pregnant individual and the developing baby. A primary reason is to prevent mother-to-child transmission (MTCT) of the virus, which can occur during birth. If an infant acquires Hepatitis B at birth, there is up to a 90% chance of developing a lifelong chronic infection. Such infections increase the risk of severe liver damage, including cirrhosis and liver cancer, later in life.
Identifying hepatitis in the pregnant individual allows for appropriate medical interventions to safeguard their health. Hepatitis can cause a chronic infection leading to progressive liver disease. Early detection helps healthcare providers monitor liver function and plan care, which can reduce health implications for the mother and the risk of the baby acquiring the infection.
Managing a Positive Diagnosis
If a pregnant individual tests positive for hepatitis, a specialized management plan is initiated to protect their health during pregnancy. For Hepatitis B, additional laboratory tests, such as a viral load (HBV DNA) test, determine the amount of virus in the blood. If the viral load is high, typically above 200,000 IU/mL, antiviral medications may be recommended during the third trimester, usually starting around 28 to 32 weeks. Tenofovir is a commonly preferred antiviral, aiming to reduce the viral load and the risk of transmission to the baby.
For Hepatitis C, antiviral treatments are generally not administered during pregnancy due to limited safety data for the developing baby. Instead, management focuses on supportive care and monitoring liver function through regular tests. Treatment with direct-acting antivirals (DAAs) is typically deferred until after delivery, often once breastfeeding is completed. Close medical consultation is essential to create a personalized care plan balancing maternal health needs with pregnancy safety.
Protecting the Newborn
Interventions are implemented immediately after birth to protect newborns from hepatitis transmission, especially when the birthing parent has Hepatitis B. The baby should receive both the Hepatitis B vaccine and Hepatitis B Immune Globulin (HBIG) within 12 hours of birth. This combination provides immediate, temporary antibodies from HBIG and initiates the baby’s own long-term immune response through vaccination. This measure is highly effective, reducing the risk of transmission by over 90%.
The Hepatitis B vaccine series involves multiple doses over several months, usually at birth, 1-2 months, and 6-18 months, to ensure lasting protection. For infants born to mothers with Hepatitis B, follow-up testing is recommended after the vaccine series is completed, typically between 9 and 12 months, to confirm immunity and check for the absence of the virus. Breastfeeding is generally safe for mothers with hepatitis, provided the newborn receives appropriate immunoprophylaxis at birth, unless there are cracked nipples or bleeding.