Chapter 211 Hepatitis in Pregnancy
INTRODUCTION
Prevalence: Hepatitis—0.1% to 1.5% of pregnancies (one third of Americans have antibodies to hepatitis A). The prevalence of hepatitis in pregnancy has declined in the past 15 years.
ETIOLOGY AND PATHOGENESIS
Causes: Five different forms of hepatitis may be involved. Hepatitis A is caused by a ribonucleic acid (RNA) virus that is transmitted by fecal–oral contamination and accounts for 30% to 50% of acute disease. Hepatitis B is caused by a small DNA virus that accounts for 40% to 45% of occurrences. It is estimated that acute hepatitis B occurs in 1 to 2 of 1000 pregnancies and that chronic infections are present in 5 to 15 of 1000 pregnancies. Hepatitis B is transmitted by parenteral and sexual contact. Hepatitis B is easily transmitted sexually: 25% of people who have sexual contact with an infected person become infected. Hepatitis C (non-A, non-B) accounts for 10% to 20% of cases and is caused by a single-stranded RNA virus spread by parenteral exposure. Hepatitis D is caused by an RNA virus that requires coinfection with the hepatitis B virus. Significant mortality and long-term consequences may occur from this less common infection. Hepatitis E, G and other forms of non-A, non-B hepatitis are uncommon but may occur during pregnancy as well.
Risk Factors: Groups at greatest risk for hepatitis B are intravenous drug users, hemophiliacs, homosexuals, and health care workers. Poor handwashing habits, multiple sexual partners, a history of sexually transmitted disease, tattoos, and multiple blood transfusions (hepatitis C) increase the risk of infection as well.
