hepatitis B

INFORMATION FOR WOMEN WHO HAVE HEPATITIS B VIRUS DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is hepatitis B virus?

Hepatitis B virus (HBV) causes infection and inflammation of the liver, leading to very serious, long-term illness.

How common is hepatitis B during pregnancy?

More than 2 billion people are infected with HBV, causing approximately 600,000 deaths per year, but the prevalence of this infection during pregnancy varies widely around the planet. In the United States, the maternal prevalence of HBV (the percentage of women testing positive for HBV infection) has been reported at 0.9 percent (9 out of 1,000 pregnant women), although the numbers vary between different populations of pregnant women within the US. In locations where the virus is endemic (present commonly among people living there), HBV infection has been reported in pregnant women at much higher rates, in some cases even approaching 10 percent (10 out of 100 pregnant women) or more. In HBV endemic regions, the most important route by which HBV spreads is mother-to-child transmission.

Women at high risk for developing HBV infection include those who have had any sexual partners within the last six months who have tested positive for HBV, those who interact closely with people who are high risk (including physicians, nurses, or other health workers), and intravenous drug users.

How is hepatitis B infection diagnosed?

A lab would draw a sample of your blood. Your blood would then be tested for the HBV surface antibody (HBsAg) and also for the HBV core antibody (HBcAb). Additionally, your physicians may perform an ultrasound examination of your liver and a liver biopsy, meaning that a small amount of tissue would be taken from your liver for examination.

Does hepatitis B cause problems during pregnancy?

HBV causes infection and inflammation of the liver, leading to abdominal pain, vomiting, and jaundice (yellowing of the skin). Severe illness can develop rapidly and then go away, or the virus can continue in a chronic state (meaning that it is present and producing symptoms that are milder but go on, or wax and wane, over many years), or both of these things can happen. People who have chronic hepatitis B are carriers, meaning that they can easily infect other people who are exposed to their body fluids. Also, they can suffer long-term consequences in their livers, such as cirrhosis, liver cancer, or failure of the liver, all of which can be fatal.

Pregnant women who develop HBV infections can experience the acute illness (intense, short-term illness). They also can enter the chronic carrier state, either directly after being infected, or following an acute HBV illness.

Does hepatitis B during pregnancy cause problems for the baby?

HBV infection in the mother causes a very real risk of giving the virus to the baby during delivery or before birth, and children who become infected at birth, or in the womb, have the highest risk of developing long-term HBV disease.

What to consider about taking medications when you are pregnant:

  • The risks to yourself and your baby if you do not treat the hepatitis B virus infection
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat hepatitis B during pregnancy?

Appropriate medications and other treatments depend on the timing of your HBV exposure and the course of your illness. If you learn that you may have been infected with HBV within the past 12 hours, there is an emergency injection that you can receive, called immunoglobulin. It is an antibody similar to antibodies that you would be making against the virus had you been vaccinated earlier. The immunoglobulin can protect you for a short period of time, but when you get it, doctors also can give you the first dose of the HBV vaccine, which normally is administered as three injections, with one month between the first two doses, and then a longer period of time (generally 5-11 months) between the second and third dose. Alternatively, you can opt for a combined vaccine against both HBV and hepatitis A virus (HAV). This combined HAV/HAB vaccine requires more doses, and more time, however. Either you can have three injections, spread over a six-month period, or you can have three injections within one month, followed by a booster twelve months later.

HBV vaccine is a recombinant vaccine, meaning that it is made through genetic engineering techniques, wherein genetic instructions for proteins that occur on the coat of the virus are used to create those proteins in bacteria, or other organisms, in a laboratory setting. Only those coat proteins are proteins, not any aspect of the virus that could enable infection and reproduction of new virus particles. After injection into you, the proteins in that recombinant HBV vaccine teach your immune system to recognize HBV, in the event that you are ever exposed to it. Since HBV vaccine is not a live vaccine but instead consists of proteins made with genetic engineering, it is thought to be safe for the baby.

If you develop a chronic HBV infection, your physician may recommend antiviral medication, such as entecavir, tenofovir, adefovir, lamivudine, or telbivudine. Studies of lamivudine, telbivudine, and tenofovir during pregnancy have not shown any harmful effects on the developing baby, but we don’t know about entecavir and adefovir. While it is always possible that the drugs will later be shown to produce some adverse effects on the baby, its very well established that infection with HBV in the mothers is very bad for the baby, so fighting the virus is a top priority. Your physician also may give you injections of interferon alfa-2b, which works with your immune system to fight the virus. Interferon alfa-2b is thought to be safe during pregnancy, as long as it is not combined with a drug called ribavirin.

Who should NOT stop taking medication for hepatitis B in pregnancy?

If your doctor prescribes medication to fight HBV during pregnancy, you should not stop this treatment as the virus can have consequences that are fatal for you and for your baby.

What should I know about choosing a medication for hepatitis B in pregnancy?

You may find Pregistrys expert reports about the individual medications to treat hepatitis B infections here and various vaccines (For HBV see Engerix-B and Recombivax HBhere. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for hepatitis B when I am breastfeeding?

It is recommended that you avoid breastfeeding when you are being treated with antiviral medications, such as lamivudine, telbivudine, and tenofovir. Since there are no live virus components in the HBV vaccine, it is not harmful to a nursing infant, so there is no conflict with getting the vaccine while you are breastfeeding.

What alternative therapies besides medications are there to treat hepatitis B during pregnancy?

The most effective treatment is prevention through vaccination. Pregnant women are tested to see if they carry HBV, or have been exposed to it. Pregnant women who havent been vaccinated already should receive HBV vaccine if they are at high ris
k for being infected with the virus.

For those who have become infected, treatment includes supportive measures such as rest, drinking plenty of water to maintain your body fluids, and eating well to maintain good nutrition. For cases of HBV with a severely damaged liver, curative treatment involves transplantation of the liver, meaning that your diseased liver is replaced surgically with a liver, or part of a liver, from another person. Organ transplantation is not performed on pregnant women; if you require emergency liver transplantation and a suitable match is found for you, there could be a need to terminate your pregnancy.

What can I do for myself and my baby when I have hepatitis B during pregnancy?

Use the medication that your doctor prescribes, or recommends, and follow all instructions. If you are not currently infected and might be at high risk for HBV infection, see your physician to begin receiving the vaccine.

Resources for hepatitis B during pregnancy:

For more information about hepatitis B during pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:

Mayo Clinic: Hepatitis B

US Centers for Disease Control and Prevention: Maternal Vaccines: Part of a Healthy Pregnancy

 

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General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


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