Viral Hepatitis and Pregnancy
An acute hepatitis can have an onset during any trimester; it does not represent a risk for malformation in the baby, nor for the mother (with very rare exceptions). In fact, only hepatitis E virus poses a significantly increased risk to pregnant women. The most common scenario is a pregnancy in a women chronically infected with a hepatotropic virus. As far as the HBV is concerned, the majority of published studies reported no association with adverse pregnancy outcomes in HBsAg positive carriers. During pregnancy in chronic HCV infection a significant reduction in mean ALT levels has been reported, with a rebound during the post-partum period. In very few cases exacerbation of chronic hepatitis C has been reported in pregnancy. A co-factor which might play a role in the reduction of liver damage is the release of the endogenous IFN from the placenta. Observations regarding serum HCV-RNA concentration have been variable. In some women HCV-RNA levels rise toward the end of pregnancy. In general, pregnancy does not have a negative effect on either HBV or HCV infection. Conversely, chronic hepatitis does not appear to have an adverse effect on the course of pregnancy, or the birth weight of the newborn infant. The role of spontaneous abortion is approximately the same as in the general population. The overall rate of mother-to-child transmission for HCV is 1.7% if the mother is known to be anti-HCV positive only. If the mother is known to be viraemic, that is HCV-RNA-positive, the rate is 4.3%. Co-infection with HIV increases the rate of mother-to-child transmission up to 19.4%. Numerous risk factors for vertical transmission have been studied. In general, high viral load defined as at least 2.5 x 106 viral RNA copies/ml, HIV coinfection and invasive procedures are the most important factors. Both Interferon and Ribavirin are contraindicated during pregnancy. Viral clearance prior to pregnancy would increase the likelihood that a woman remains non-viraemic in pregnancy with a consequent reduced risk of vertical transmission.
Keywords: Pregnancy, miscarriage, thrombophilia, Leiden, prothrombin, MTHFR, Viral Hepatitis, chronic hepatitis C, Interferon, Ribavirin
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