OBGYN Explains More About Hepatitis, Pregnancy and Newborns

Our liver is one of the most important organs we have as it fights infections, filters the blood and processes nutrients. Many people know that heavy usage of alcohol can cause liver failure, but you should know that it may cause hepatitis, too. Some of the other things that may cause damage to the liver and later develop hepatitis include toxins, medications and some medical conditions. However, the most common cause of hepatitis is a virus. If you have been diagnosed with hepatitis and trying for a baby, you should consult your doctor first so you may follow the necessary precautions. However, in the spirit of World Hepatitis Day, Motherhood is here today with Dr Azrai Abu, an OBGYN from UKM Medical Centre to help enlighten parents on hepatitis and its effect on pregnancy and newborns! Q1: Can someone without hepatitis develop hepatitis when they are pregnant? Image credit: xFrame Dr Azrai: Every pregnant woman is at risk of pregnancy-induced hepatitis. However, the incidence is low (up to 3% only). Despite that, pregnancy-induced hepatitis can unfortunately be fatal to the mother and foetus if it is complicated to the severe form. Q2: What are the types of hepatitis that are common among pregnant mothers? Dr Azrai: The most common type of hepatitis is related to preeclampsia or hypertension in pregnancy. Other pregnancy-related liver diseases can be due to intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy and hyperemesis gravidarum. Besides that, pre-existing liver disease can also lead to hepatitis during pregnancy such as: Acute and chronic viral hepatitis Cirrhosis with or without portal hypertension Biliary diseases (gallstones and primary sclerosing cholangitis) Vascular alterations (Budd–Chiari syndrome) Wilson's disease Autoimmune liver diseases Metabolic disorders Drug-induced hepatotoxicity Q3: How does hepatitis affect a pregnant woman and her baby? Image credit: Pexels Dr Azrai: Pregnant women with hepatitis will develop liver derangement. This can lead to a risk of developing blood disorders such as coagulopathy and haemorrhage, fluid overload following low albumin in the body can lead to heart failure and a high risk to develop seizure or eclampsia. You should get a proper diagnosis and treatment early as the maternal mortality related to hepatitis can be as high as 40%. Subsequently, a foetus with a mother developing hepatitis predispose to risk of intrauterine growth restriction, iatrogenic preterm birth, abruption placenta and foetal demise. In the case of chronic high viral load-induced hepatitis such as hepatitis B, it associates with a high transmission rate to the baby up to 80-90%. Q4: Is there a special type of diet pregnant mothers with hepatitis should follow? Image credit: Pexels Dr Azrai: Mothers with hepatitis are prone to have a lack of protein in their blood circulation due to severe liver derangement. Perhaps by including more proteins in your daily life, you could lessen the severity of the liver derangement. Here are some of the sources of protein you can include in your daily diet: Lean meats – beef or lamb Poultry – chicken, turkey, or duck Fish and seafood – fish, prawns, crab, lobster, mussels, oysters, scallops, clams Eggs Dairy products – milk, yoghurt (Greek yoghurt’s the best choice!), or cottage cheese Nuts and seeds – almonds, walnuts, macadamias, hazelnuts, cashews, pumpkin seeds, sesame seeds, sunflower seeds Legumes and beans – all beans, lentils, chickpeas, split peas, tofu. Q5: Can a pregnant woman pass hepatitis to her baby? Dr Azrai: Only viral-related hepatitis specifically Hepatitis B can pass the virus to the baby leading to future risk of hepatitis, hepatomegaly, and liver failure. Otherwise, babies who are delivered from other causes of hepatitis-related disease rarely complicate with hepatitis. Q6: Should the father have hepatitis, can it be passed down to the newborn? Image credit: xFrame Dr Azrai: The father of the baby who develops hepatitis is not at risk to transfer the disease to the newborn. This won’t happen unless the mother develops hepatitis B infection from the partner and succumbs to hepatitis. Q7: Can a baby be born with hepatitis even though the parents don’t have hepatitis? Image credit: xFrame Dr Azrai: It is rare for the baby to develop hepatitis if both parents are well unless it is related to the congenital malformation of the hepatobiliary system or undiagnosed viral related liver disease. Q8: How is hepatitis treated during pregnancy? Image credit: xFrame Dr. Azrai: The treatment is based on the causes of hepatitis and warrants a combined care of an OBGYN with a gastroenterologist and neonatologist. Once a mother complicates with hepatitis during pregnancy, symptomatic temporary treatment such as antihypertensive, albumin therapy or blood product can be useful but cannot delay the further deterioration of the liver disease. Hence, the majority of the cases will require termination of pregnancy or abrupt delivery process despite the gestational age of the foetus before the occurrence of liver failure. In the case of hepatitis B virus-related hepatitis, antivirals are important to reduce the risk of transmission with additional immunoglobulin within 12 hours of birth. Q9: Can a mother diagnosed with hepatitis breastfeed? Image credit: Pexels Dr Azrai: Yes. There have been no cases of hepatitis being passed down to the baby through breastfeeding. So, mothers, don’t worry about this and consult with your OBGYN about what vaccines your newborn baby should receive if you live with hepatitis. Q10: Is there anything else you feel parents should know about hepatitis? Dr Azrai: Hepatitis during pregnancy is a very rare disorder however if you have any pre-existing disease predisposed to hepatitis; hepatitis virus infection, autoimmune disease, hypertension or obesity, it could happen. Optimisation of the condition is necessary before embarking on pregnancy in order to achieve a safe and uncomplicated pregnancy. We can all agree that prevention is better than cure. So, if you are trying to get pregnant, consult an OBGYN so you’re aware of both your health and your partners’. This is so you know what to expect out of the pregnancy and you can be well-prepared for it. Medical consultations will set your expectations on the journey ahead of you, and what better way for preparation is there with certified professionals by your side along the way. Source: Centers for Disease Control and Prevention. (2021). What is Viral Hepatitis? | CDC. CDC | Centers for Disease Control and Prevention. https://www.cdc.gov/hepatitis/abc/index.htm Dr Azrai Abu, Consultant in Obstetric, Gynaecology and Reproductive, UKM Medical Centre Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice from Motherhood. For any health-related concerns, it is advisable to consult with a qualified healthcare professional or medical practitioner. For more insightful stories and fun recipes, stay tuned to Motherhood Story!

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