Overview
Viral hepatitis remains the leading cause of liver inflammation and liver cancer requiring transplantation. Viral hepatitis can affect members of all populations worldwide, including pregnant people. There are six identified viral hepatitides—A, B, C, D, E, and the more recently described, G. Each varies in its epidemiology, clinical course, and long-term sequelae. Important considerations in pregnancy include the degree of liver inflammation, risk of fulminant hepatitis, vertical transmission risk, treatment, and prevention. The majority of acute infections are subclinical.
Hepatitis A virus (HAV) and hepatitis E virus (HEV) are important causes of maternal infections in endemic regions, and HEV can be associated with considerable maternal morbidity and mortality. Hepatitis D virus (HDV) is an incomplete virus that when co-infected with hepatitis B virus (HBV) can cause disease that is more severe and can lead to fulminant hepatic necrosis. Hepatitis G, an RNA flavivirus renamed as human pegivirus, or “HPgV,” causes a parenterally transmitted infection of the reticuloendothelial system. It does not demonstrate hepatotropicity, and there is no evidence it causes clinical hepatitis; therefore, it will not be reviewed in this article.
Hepatitis B and hepatitis C are antenatally screened for and are more likely to lead to chronic infections.
Recommendations for appropriate screening and risk stratification, as well as antepartum, intrapartum, and postpartum considerations to reduce vertical transmission risk and minimize maternal and neonatal morbidity of viral hepatitis, will be reviewed in this article. For more information regarding viral hepatitis, please see the following resources from the Centers for Disease Control and Prevention (CDC):
Information for patients:
https://www.cdc.gov/hepatitis/resources/patientedmaterials.htm
Information for providers:
https://www.cdc.gov/hepatitis/index.htm