Addressing the Concerns of a Pregnant Patient with Hepatitis B
Hepatitis B is a silent infection which is often taken lightly and under-diagnosed and can be transmitted through infected blood and body fluids, as well as from mothers to babies during pregnancy and delivery. Dr Nurhazinat bt Mohd Yunus, Consultant Obstetrician and Gynaecologist, shares some important points about hepatitis B in pregnancy.
1. What are the most common concerns for pregnant patients regarding hepatitis B?
Patients are usually concerned about three things – their baby, their partner and lastly themselves.
Firstly, they are concerned whether their baby will be ok, and whether the virus will cause abnormalities to their baby. We need to reassure these patients that although their baby can be infected with the virus, it will not cause any abnormalities. There are viruses that are known to cause foetal abnormalities such as chicken pox, but not HBV.
Secondly, it involves their partner. Sometimes, patients do not know that they have hepatitis, so when they are found to be positive, a lot of questions arise. Have they always been a carrier? Did they get it from their side of the family, through blood transfusion, or from their husband? The list goes on. If their husband is tested negative, part of the management involves counselling the couple to use condom, get vaccinated, inform them about the possible risk of getting infected, and so on. We will try to find the cause and have them alert their family members as well. It is well worth to get their whole family screened and vaccinated.
The third concern revolves around the patients themselves and their future. Can they get pregnant again? Will they get sick in the future? Do they need to limit the number of children to bear? There are no straight answers to this as we need to check the patients’ viral load and liver function to see how aggressive the infection is.
2. Can patients with hepatitis B breastfeed their babies?
Most disease control committees have declared that there are no issues for mothers with hepatitis B to breastfeed. Of course, the risk is still there and there is no 100% guarantee that breast milk-transmitted infection will not occur. Most doctors recommend breastfeeding but there are also doctors who disagree. They feel that there is no point in exposing a baby to the smallest risk of contracting an infection and recommend feeding by formula milk instead, especially in well-developed countries where they have good infant formulas with low contamination rate. In the end, we can only counsel patients and provide the information, but patients will have to make the decision themselves.
3. What about antivirals? Are they safe to use during pregnancy and breastfeeding?
There are a few types of antivirals that are deemed relatively safe to use during pregnancy and breastfeeding. Usually pregnant women with hepatitis will be jointly managed by medical and obstetrics and gynaecology specialists. Most of the time, attending physicians will decide if their patients need to be on antivirals as they will continue to manage these patients even after delivery. These patients need more care, so their viral load and liver function must be closely monitored.
4. How can babies be protected if their mother has hepatitis? Is there any special care for babies who are infected?
Malaysia has a national vaccination programme where hepatitis B vaccination is given at birth. As such, the younger generation is better protected against the disease.
If a mother is tested positive for HBV infection, her baby will be given the vaccine and Hepatitis B immune globulin (HBIG), which is effective in preventing the development of the virus. If the vaccine is given together with the HBIG within 12 hours, it will reduce the rate of contracting the virus by 90%.
These babies will then undergo paediatrics follow-up and more tests will be done to confirm their hepatitis B status. Sometimes the infection will clear off, and sometimes the initial blood drawn for testing is actually the mother’s blood. There are a lot of possibilities but it is certain that these babies will need special care and probably lifelong follow-up.
5. How can doctors reassure patients regarding their disease?
If patients are pregnant and have hepatitis B, remind them that they can live a normal life with a normal life expectancy. They can still have as many children as they want, and we as doctors will not limit their childbirth choices just because they have hepatitis B. In between pregnancies, they need to undergo check-ups to assess if they are healthy, if their liver is ok, or if they need any medications. Even if all is well, remind them that they still need to continue their follow-ups for long-term monitoring.
Dr. Nor Anisa Hanan, 11 Jul 2018
Consultant Obstetrician and Gynaecologist
Tropicana Medical Centre