Viral Hepatitis in Pregnancy: Problems for the Clinician Dealing with the Infant

Abstract

Stokes and colleagues first described transmission of hepatitis B virus (HBV) infection from a mother who was an HBV carrier to an infant born by cesarean section in 1954. Evidence of clinical hepatitis with jaundice, detected at 2 months of age, was later complicated by chronic active hepatitis. The infant died at 18 months of age with advanced cirrhosis of the liver. In the past decade tests have been developed that are specific for hepatitis B antigens and antibodies and they have enabled physicians to identify acute hepatitis B infection during pregnancy, as well as the presence of a chronic carrier state. Thus it has been possible to assess the effect of maternal HBV infection on the newborn infant. The attack rate of HBV infection in infants has been reported to range between 10% and 70%. Infection is usually detectable by 1 to 3 months of age. Although most infections are asymptomatic, fulminant hepatitis is seen on rare occasions. Of major significance is the tendency for the infected infants to become chronic HBV carriers with possible progression to chronic active hepatitis, cirrhosis, and rarely hepatoma. Hepatitis A virus (HAV) infection has not been a problem in the newborn. Hepatitis A is now an uncommon infection among adults in Western countries while in developing areas it is primarily a disease of childhood.