Hepatitis in pregnant women, viral hepatitis during pregnancy. Hepatitis C and pregnancy

Many women learn about hepatitis during late pregnancy. This is due to the fact that such studies for the presence of markers of an infectious nature are provided for in the medical records of a pregnant woman. The statistics on hepatitis in pregnant women are disappointing. Medicine records this disease in every thirtieth pregnant woman. And this fact raises many questions in them. Will the disease harm the child's health? Is it possible to treat the disease during pregnancy?

What is hepatitis, symptoms

The etiology of hepatitis is viral in nature. The causative agents of the disease can be viruses A, B, C, D, E. Some forms of the disease (hepatitis A and B) were studied quite recently, in the 70s of the last century. From this time on, screening is carried out for the presence of a certain form of hepatitis. Later, by examining donor blood, a new strain of viral hepatitis, form C, was identified. The danger of this type is that it can be transmitted through blood. And this is a direct way of infecting a child during pregnancy.

The prevalence of hepatitis C virus varies from country to country. For example, in the USA, a critical level of C virus antibodies is found in 1-3% of pregnant women, and in Egypt this number reaches 14%. Before the isolation of virus C antibodies, transmission of the disease was carried out through donated blood. But with the introduction of blood control, the amount of virus decreased. A person can also become infected through sexual contact and by using unsterile medical instruments.

Hepatitis C is common among drug addicts due to the repeated use of syringes. The acute form of hepatitis tends to become chronic. In this case, the patient may not even feel any somatic changes.

Most patients have no symptoms at all for a long period of time. But irreversible processes take place in the body. For such insidiousness, hepatitis C is also called the “gentle killer.”

20% of patients still notice a deterioration in their health. Feeling weak, decreased performance, drowsiness, nausea, decreased appetite. Some even lose weight. There may be discomfort in the right hypochondrium. Sometimes the disease manifests itself only as joint pain or various skin manifestations.

Testing for hepatitis C blood does not present any difficulties.

And there is no need to delay treatment. Otherwise, 6-8 years after infection, hepatitis can lead to cirrhosis of the liver. Hepatitis is difficult for children and the elderly.

Hepatitis during pregnancy

Analysis for hepatitis in pregnant women with chronic hepatitis shows a positive trend towards a decrease in antibodies in the second and third trimesters of pregnancy. The number of viruses increases after childbirth.

Despite the fact that hepatitis does not affect the course of pregnancy and labor, the risk of transmitting viral hepatitis from mother to child during pregnancy still exists.

The results of a study of infected pregnant women showed that at birth, from 2% to 9% of newborns were identified with a form of hepatitis. Compared to other hereditary diseases, this is a fairly low threshold.

Research shows that the most favorable moment for a child to become infected is considered to be labor and postpartum care for the child. Most cases of hepatitis infection occur during childbirth. Therefore, the use of medications by a pregnant woman and the specifics of medical support during childbirth are the main points that should be paid attention to.

Criteria for a pregnant woman's medical history

• Studying the medical history of a pregnant woman is associated with the presence of certain factors that, taken together, are favorable for hepatitis infection in a pregnant woman or a woman planning a pregnancy. In medical practice, this “risk group” includes the following categories:
• women with HIV positive factor;
• in cases where the sexual partner used drugs;
• with blood transfusion or substitutes;
• during hemodialysis;
• if you have a tattoo or piercing.

These criteria indicate that when collecting a history of a pregnant woman, doctors include such a woman in the “risk group” and conduct a more thorough examination.

Treatment of pregnant women with hepatitis

First of all, the use of therapeutic agents during pregnancy will require an assessment of the state of all physiological systems of the woman. To do this, screen for the presence of other chronic diseases. A pregnant woman should be informed about the level of infection and the possibility of transmitting the virus to her child.

The use of antiviral drugs during pregnancy has not been sufficiently studied to date. Typically, therapy to reduce the viral load on the liver uses interferon and ribavirin. But during pregnancy, ribavirin significantly affects the development of the fetus. As for another drug, interferon, it is quite easily tolerated by women during pregnancy and does not contribute to the development of fetal pathology.

In complex therapy, drugs containing ursodeoxycholic acid are used. This reduces liver cholestasis. There are many concerns about the use of vaccinations during pregnancy. It is used in rare cases when there is a high level of infection. But the effect on the child has not been fully studied. If the vaccine was administered accidentally, there is no need to terminate the pregnancy. Practice shows that accidental use of vaccination does not affect the development of the fetus. Such contraindications have not been identified during breastfeeding.

Labor during hepatitis

In medicine, there is not enough information about whether the risk of infection of the child during cesarean section will be reduced. The only correct decision is the medical indications for such an operation during labor.

Research on this issue in different medical research centers is quite contradictory. For example, Italian doctors say that a cesarean section reduces the risk of transmission of the hepatitis virus from mother to child in a ratio of 6% to 32% compared to natural childbirth. American doctors, on the contrary, indicate an increased risk of transmission of the virus during surgery in the ratio of 13% to 5%. The pregnant woman should be informed about this information.

In cases of voluntary choice of labor, a pregnant woman must take into account all the risks of transmitting infectious hepatitis. At the same time, a woman should know her level of viral intoxication. If the viral load is in the range of 100-107 copies per ml, then this amount increases the risk of infection during cesarean section.

The question of the possibility of breastfeeding during hepatitis is discussed by the attending physician and the mother. Research by German scientists has shown that the presence of hepatitis RNA in breast milk has not been detected. In similar studies by Japanese scientists (30 nursing mothers), such indicators were confirmed.

In only three cases were hepatitis substances found in small quantities. This is understandable. After all, the level of hepatitis RNA in blood serum significantly exceeds the presence of such substances in breast milk. However, there is no evidence that a child was infected during breastfeeding. Exceptions include HIV viruses and lymphocytic leukemia-lymphoma-1 (HTLV-1), which can be transmitted through breast milk.

The only caution when breastfeeding is with the mother. The fact is that during feeding, trauma to the nipples is possible, and such contact can provoke an exacerbation of hepatitis in the mother.

In general, hepatitis C in pregnant women does not affect the pathology of the fetus.

Compliance with doctors' orders and constant medical supervision will reduce the risk of infection to a child to a minimum.

The first time a person fell ill with the hepatitis C virus was 300 years ago. Today, about 200 million people in the world (3% of the total population of the Earth) are infected with this virus. Most people do not even suspect they have the disease because they are hidden carriers. In some people, the virus multiplies in the body for several decades, in such cases they speak of a chronic course of the disease. This form of the disease poses the greatest danger, as it often leads to cirrhosis or liver cancer. As a rule, infection with viral hepatitis C in most cases occurs at a young age (15-25 years).

Of all known forms, viral hepatitis C is the most severe.

The mode of transmission is from person to person through blood. Infection often occurs in medical institutions: during surgical operations, during blood transfusions. In some cases, infection is possible through household means, for example, through syringes from drug addicts. Transmission through sexual contact, as well as from an infected pregnant woman to her fetus, cannot be excluded.

Symptoms of hepatitis C

For many infected people, the disease does not make itself felt at all for a long period of time. At the same time, irreversible processes occur in the body, leading to cirrhosis or liver cancer. For such insidiousness, hepatitis C is also called the “gentle killer.”

20% of people still notice a deterioration in their health. They feel weakness, decreased performance, drowsiness, nausea, and decreased appetite. Many of them are losing weight. There may also be discomfort in the right hypochondrium. Sometimes the disease manifests itself only as joint pain or various skin manifestations.

Detecting the hepatitis C virus using a blood test does not present any difficulties.

Treatment of hepatitis C

Today there is no vaccine for hepatitis C, but it is quite possible to cure it. Please note that the earlier the virus is detected, the greater the chance of success.

If a pregnant woman is infected with the hepatitis C virus, she must be examined for characteristic signs of chronic liver disease. After the baby is born, a more detailed hepatological examination is carried out.

Treatment of hepatitis C is complex, and the main drugs used in treatment are antiviral drugs.

Fetal infection

In most cases, the hepatitis C virus does not have any negative effect on the course of pregnancy. In fact, the possibility of infecting a child with hepatitis C exists only in 2-5% of the total number of infected expectant mothers. If a woman is also a carrier of HIV, the risk of infection increases to 15%. In addition, there are a number of conditions and conditions under which a child may become infected. Among them, first of all, hypovitaminosis and poor nutrition are distinguished. The majority of cases of fetal infection with hepatitis C occur at the time of childbirth or the immediate postpartum period.

How to give birth?

It has been proven that the frequency with which the hepatitis C virus is transmitted from mother to child does not depend on whether the baby was born naturally or by caesarean section. There is a category of medical workers who claim that during a cesarean section the risk of infection is lower. Which route of delivery to choose in a particular case is up to the woman and her attending physician to decide. In some cases, when the patient is also infected with other viruses (for example, hepatitis B or human immunodeficiency), a planned cesarean section is recommended.

Child

During pregnancy, antibodies to hepatitis C are transmitted to the baby through the placenta. After birth, they can circulate in the blood for one and a half years, and this is not a sign that the baby was infected from the mother.

Examination of the child for possible infection during childbirth should be carried out at 6 months after birth (blood test for HCV RNA) and at 1.5 years (blood test for anti-HCV and HCV RNA).

Immediately after birth, doctors closely monitor the health of the newborn.

Breast-feeding

It is not prohibited, but it is necessary to ensure that the baby does not injure the mother’s nipples, otherwise the risk of infection increases. It is believed that the benefits to a child's body from breastfeeding far outweigh the risk of contracting the virus. The mother must carefully ensure that ulcers and aphthae do not form in the child’s mouth, since infection can occur through them during breastfeeding. If a woman is also infected with the human immunodeficiency virus, then breastfeeding is contraindicated.

Prevention of hepatitis C

To avoid becoming infected with the hepatitis C virus, you must remember the following. Under no circumstances should you use other people's things: razors, toothbrushes, manicure and pedicure clippers, nail files or other objects that may come into contact with blood. If you have to use the services of tattoo artists, make sure that the instruments are properly sterilized. It is better if disposable needles are used for these purposes.

During sexual intercourse (especially casual sex), you can reduce the risk of infection by using condoms.

Especially for- Elena Kichak

From Guest

Found antibodies to hepatitis C at 5 weeks. There were so many experiences that words could not express. The LCD gave me a referral to an infectious disease specialist. He laughed, diagnosed me as a carrier of hepatitis C and said “don’t worry, if you give birth, then come.” The LC ordered the analysis again. Negative.

From Guest

Today at the appearance they said that they may have found Hepatitis C... there are signs that have not yet been fully identified. On December 30th they said they’ll definitely say.... here I sit and torment myself... where did I get this from... and I’m very nervous... 27 weeks pregnant

What is Hepatitis C in pregnant women

Infection of the population with hepatitis C virus (HCV), isolated in 1989, is high throughout the world, and a further increase in incidence is currently observed. Hepatitis C is characterized by a tendency to develop chronically, with limited clinical symptoms and a poor response to antiviral therapy. Most cases of hepatocellular carcinoma are associated with this virus.

What causes Hepatitis C in pregnant women?

The causative agent of hepatitis C- RNA virus. Its peculiarity is the existence of a large number of different genotypes and subtypes (about 30), differing from each other by different nucleotide sequences. In Russia, the most common subtypes are 1b, 3a, 1a, 2a. It is subtype 1b that correlates with the maximum incidence of hepatocellular carcinoma, and subtype 3a is most often detected in drug addicts.

HCV is capable of persistence. The most popular explanation for this today is the phenomenon of "immunological trapping", in which the virus undergoes changes in the genome. The rapid adjustment prevents the immune system from attacking the virus with neutralizing antibodies. There is an assumption that such changes may be provoked by the influence of the host's immune system. In addition, like other RNA viruses, HCV is characterized by errors in replication, which causes a large number of mutations in the synthesis of surface proteins of daughter virions.

In Europe, the carriage rate of HCV is 0.4-2.6 per 1000 people. Sources of infection are patients with chronic and acute forms of hepatitis C, as well as latent carriers of the virus. Transmission routes are parenteral and vertical from mother to fetus. Due to the mandatory screening of blood donors for HCV and the disinfection of all blood products, the transfusion route of infection practically does not occur today, but is still possible due to the long incubation period of infection, during which anti-HCV is not detected in the blood, and blood can be taken from infected donor. This period ("window") averages 12 weeks, but can last up to 27 weeks. At this time, the presence of the virus can be confirmed by detecting the HCV antigen using PCR. Contact-household and sexual routes of infection are rare. Sexual partners of HCV-infected individuals rarely become infected, even after prolonged contact. The risk of infection from injections with contaminated needles is no more than 3-10%. Therefore, the main route of infection in children remains the vertical route. Risk factors for HCV infection among pregnant women are:

• history of intravenous drug and drug use;
• history of blood transfusion;
• having a sexual partner who used drugs;
• history of STIs;
• tattoos and piercings;
• dialysis;
• antibodies to hepatitis B or HIV;
• having multiple sexual partners;
• detection of HCV in mothers of pregnant women.

Symptoms of Hepatitis C in pregnant women

The incubation period lasts from 2 to 27 weeks, averaging 7-8 weeks. The disease is divided into three phases - acute, latent and reactivation phase. Acute infection caused by HCV occurs without clinical manifestations in 80% of cases and in approximately 60-85% of cases it develops into a chronic form of hepatitis with the risk of developing liver cirrhosis and hepatocellular carcinoma.

In most cases, the acute phase remains unrecognized. Jaundice develops in 20% of patients. Other symptoms are mild and characteristic of all viral hepatitis. 1 week after infection, HCV can be detected using PCR. Antibodies appear several weeks after infection. In 10-20% of cases, a transient infection with elimination of the virus may develop, in which the patient does not acquire immunity and remains susceptible to reinfection with the same or a different strain of HCV. Acute hepatitis C, both latent and clinically manifest, in 30-50% of cases can result in recovery with complete elimination of HCV. However, in most cases it is replaced by a latent phase with long-term persistence of the virus. The latent phase is shortened in the presence of underlying liver disease and other intercurrent diseases. During the latent phase, infected persons consider themselves healthy and do not make any complaints.

The reactivation phase corresponds to the beginning of the clinically manifest stage of hepatitis C with the subsequent development of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. During this period, viremia with a high level of HCV-RNA and anti-HCV in the blood is clearly expressed.

Cirrhosis develops in 20-30% of chronic carriers within 10-20 years. Hepatocellular carcinoma occurs in 0.4-2.5% of patients with chronic HCV infection, especially in patients with cirrhosis. Extrahepatic manifestations of HCV infection include arthralgia, Raynaud's disease, and thrombocytopenic purpura.

In patients with chronic hepatitis C, anti-HCV is found in the blood not only in free form, but also as part of circulating immune complexes. Anti-HCV-IgG is determined in screening studies to confirm seroconversion and monitoring during interferon treatment. Only 60-70% of anti-HCV positive patients are HCV RNA positive. Detection of HCV in the blood confirms viremia, indicating ongoing active replication of the virus.

If replicative activity is confirmed, treatment outside pregnancy is carried out with α-interferon, which inhibits the introduction of the virus into hepatocytes, its “undressing” and the synthesis of mRNA and proteins. There is currently no vaccine against hepatitis C due to the rapid mutagenicity of the virus and insufficient knowledge about the interaction of HCV and the immune system.

Diagnosis of Hepatitis C in pregnant women

The detection rate of HCV-RNA in pregnant women is 1.2-4.5%. Pregnancy does not have any negative impact on the course of viral hepatitis C. All women are screened for HCV three times during pregnancy. Very little is known about the effect of HCV infection on pregnancy. In most women, the infection is asymptomatic and approximately 10% experience elevated aminotransferase levels. According to some data, HCV infection does not correlate with an increased incidence of adverse complications and outcomes of pregnancy and childbirth.

Although vertical transmission of the virus to the fetus is possible, hepatitis C is not a contraindication to pregnancy. The risk of intrauterine infection with hepatitis C does not depend on the time of infection of the mother and is approximately 6%. But the decisive thing is that vertical transmission of infection in a newborn is observed with a high degree of virus replication in the mother’s body. Both antenatal and intranatal transmission of the virus is possible. Recent studies have shown that only those fetuses whose mothers have HCV-infected lymphocytes are susceptible to intrauterine infection. The combination of hepatitis C with HIV infection increases the risk of vertical transmission of HCV, since against the background of immunosuppression there is greater activation of the virus (the risk is 10-20%). The lowest risk of intrauterine infection occurs with HCV seroconversion during pregnancy.

Screening for HCV is carried out, but in many countries such studies are considered inappropriate due to the lack of management and prevention measures in pregnant women. If there are markers of hepatitis C, pregnant women should be observed by a hepatologist. After an additional examination, the hepatologist gives a conclusion about the possibility of delivery in a regular maternity hospital in the absence of signs of infection activation.

There is no consensus on the optimal method of delivery for pregnant women with HCV infection. Some experts believe that cesarean section reduces the risk of fetal infection, while others deny this. Premature rupture of membranes and a long anhydrous interval increase the risk of transmission of infection.

If an infection is detected in the mother, the umbilical cord blood can be examined for the presence of markers of hepatitis C, although even with an established diagnosis, the age of the child under two years is a contraindication for currently existing antiviral therapy.

HCV is found in breast milk, and therefore discussions about the safety of breastfeeding are still ongoing. The concentration of virus in milk depends on the level of viral replication in the blood, so breastfeeding can be maintained in cases without viremia.

Neonatal HCV infection. All children born to anti-HCV-positive mothers will also be anti-HCV-positive for an average of the first 12 months of life due to transplacental transfer of maternal IgG. If antibodies persist more than 18 months after birth, this confirms that the child is infected with hepatitis C. About 90% of vertically infected children are HCV-RNA positive by 3 months of life, the remaining 10% become positive by 12 months.

Treatment of Hepatitis C in pregnant women

Artificial termination of pregnancy is contraindicated in the acute stage of all viral hepatitis; if there is a threat of termination, every effort is made to maintain the pregnancy. Specific antiviral treatment of hepatitis with interferon and ribavirin during pregnancy is strictly prohibited. This is due to the fact that ribavirin has teratogenic properties, and the effect of interferons on fetal development has not been studied. Conception is recommended no earlier than six months after completion of the course of treatment. During pregnancy, such women are prescribed safe hepatoprotectors (Essentiale, Chofitol, Karsil). Particular attention is paid to a special diet.

Births for women in labor with viral hepatitis are carried out in specialized maternity hospitals or specialized departments of maternity hospitals with strict adherence to anti-epidemiological measures.

The likelihood of a baby becoming infected with hepatitis is slightly lower during a planned caesarean section than during a natural birth. To prevent a child from becoming infected with hepatitis B, vaccination is carried out on the first day after birth, and gamma globulin against HBV is administered already in the delivery room. These measures prevent the development of viral hepatitis B in 90% of cases. Unfortunately, similar measures against hepatitis C have not been developed.

Children from mothers with viral hepatitis C are observed by pediatric infectious disease specialists. It is possible to definitively determine whether a child was infected during pregnancy and childbirth only by the age of two years.

Prevention of Hepatitis C in pregnant women

Prevention of hepatitis C comes down to timely examination of women planning pregnancy for markers of hepatitis and precautions during medical procedures (injections, operations, blood transfusions). Of course, we must not forget about the high risk of injecting drug use and promiscuity.

Which doctors should you contact if you have Hepatitis C in pregnant women?

Gynecologist Hepatologist Infectious disease specialist

Hepatitis C during pregnancy is diagnosed in approximately 5% of expectant mothers. And this is no coincidence. It is during pregnancy that a woman undergoes a large number of laboratory tests and undergoes a comprehensive medical examination, so there are no difficulties in identifying her disease (even if it occurs in a “erased” form).

Hepatitis C during pregnancy

You can become infected with hepatitis C in three ways:

• sexual. The pathogen enters the body of the expectant mother during unprotected sexual intercourse with an infected partner;
• parenteral (through blood). The virus enters the blood during injection of drugs, when using unsterile medical instruments, during blood transfusions, when applying tattoo patterns, etc.;
• vertical. Infection occurs during natural childbirth.

Signs that may indicate the presence of the disease

Symptoms of hepatitis C during pregnancy may be absent or mild. Usually the disease does not make itself felt for a long time. A woman notices that she often feels sick and vomits, and her appetite has worsened. Her weight is gradually decreasing.

At the same time, pain occurs in the right hypochondrium. Sometimes the disease affects the joints. Then the expectant mother complains of pain in her limbs.

Symptoms of hepatitis C during pregnancy

How does pregnancy proceed with hepatitis C?

All expectant mothers who have been diagnosed with hepatitis C are interested in the question of how pregnancy proceeds with this diagnosis. It should be noted that liver damage does not have a negative effect on the course of pregnancy. On the contrary, for many pregnant women, the progression of the pathological process is suspended while carrying a child.

Pregnancy and hepatitis C, contrary to rumors, are compatible. But the mother needs to be prepared for the fact that after childbirth the disease may begin to progress rapidly. Hepatitis C cannot harm a child, provided the necessary safety measures are followed.

Hepatitis C during pregnancy - consequences for the child

The biggest fear of pregnant women infected with hepatitis C is infecting their baby. The risk of infection really exists and it is impossible to reduce it to nothing. According to statistics, transmission of the disease to a newborn ranges from 3 to 10%.

The ways of transmitting the virus to a child are as follows:

• intranal. Infection occurs during childbirth if the blood of an infected mother enters the newborn's body. This happens quite rarely. During pregnancy itself, the fetus almost never becomes infected;
• prenatal and postnatal. Doctors include all cases of infection that occurred after the baby was born as these routes of infection. This can be avoided if the mother carefully follows safety measures.

How to treat hepatitis C while pregnant

Hepatitis C is treated with Ribavirin and Interferon-α. But these medications have a negative effect on the body of a pregnant woman. This is why the woman stops treating her illness for 9 months. Only after giving birth can she begin therapy.

If the patient suffers from severe pain and her tests are very poor, doctors draw up an individual hepatitis C treatment regimen for her.

Hepatitis C in a pregnant woman: how to treat and what to do?

Childbirth with chronic hepatitis C

Today it has been proven that the risk of fetal infection is approximately the same during natural childbirth and during caesarean section. If liver test results are poor, a decision is made to perform elective surgery. In other cases, a woman can give birth on her own.

Whether to breastfeed the baby or not – a young mother must decide for herself. Babies rarely become infected through breast milk. But it is important to ensure that there are no cracks in the nipples through which the mother’s blood can enter the baby’s body.