Jaundice is a yellowing of the skin and, commonly, the whites of the eyes. Usually jaundice is indicative a problem with the functioning of the liver. The most common cause of jaundice during pregnancy is acute viral hepatitis. However, jaundice can be the result of one of a number of disease states so accurate diagnosis is important before any course of treatment can be decided upon. If jaundice is apparent during pregnancy and hepatitis is suspected, blood tests will be arranged to rule out other causes such as gall bladder pathology, mononucleosis (glandular fever) and pre-eclampsia.
What is Hepatitis? Who is at Risk of Contracting It?
Pregnant women may be affected by any of types of hepatitis These are, predominantly, hepatitis A, B and C. Essentially, hepatitis is an inflammation of the liver as the result of infection by the hepatitis virus. Hepatitis A is the most common of the three hepatitis viruses and is contracted by what is charmingly known as the faecal oral route. In other words, hepatitis A is spread when infected faecal matter enters the digestive tract via the mouth.
As disgusting as this sounds, it is a very common route of entry for a number of viruses and bacteria including the norovirus. Hepatitis A can be contracted through improperly sanitised or unsanitary water (including water used to wash food – a good reason for pregnant women to avoid salad bars), cutlery that has been poorly washed in such water or handled by unwashed hands that have come into contact with the virus. Many people in occupations where they regularly come into contact with faecal matter such as nurses and carers are recommended to receive vaccinations to reduce the risk of contracting this disease.
Hepatitis B is contracted via contact with infected blood and bodily fluids for example through tattooing or body piercing with poorly sterilised equipment or unprotected sexual intercourse. Hepatitis B can also be transmitted in saliva. Though certain lifestyle choices put people at greater risk of contracting Hepatitis B, it is worth noting that close contact e.g., a kiss can expose a baby to infection. The hepatitis B virus can also survive outside of the body for around seven days and can cause infection. Living or working closely with an infected individual puts one at greater risk of contracting this strain of the disease.
Hepatitis B vaccination is recommended at birth in the USA and within the first six months of life in most other countries. This virus can cause permanent liver damage and many carriers of the disease can be without symptoms for many years so, unknowingly spread the infection. In infants, hepatitis B is often deadly. Hepatitis C is transmitted in similar ways to hepatitis B though contracting the virus through sexual contact is rare and it cannot be passed on via saliva. There is no vaccine against hepatitis C. There are also rarer forms of the virus, hepatitis D, E and G.
How Do I Know if I Have Hepatitis
If you are planning to have a baby and believe you are in a group with an increased risk of catching hepatitis it is wise to ask your doctor to be tested for the disease and ensure you are up to date on vaccinations against it. For most people, hepatitis has no obvious symptoms for around ninety days but this period can be much longer and mild symptoms mistaken for other diseases, for example gastric problems. Jaundice, is perhaps, the most obvious symptom of acute hepatitis but others include fatigue, muscle and joint pain and diarrhoea. If you have reason to believe you have become infected during pregnancy you must consult your doctor.
Most women will be tested for hepatitis during their pregnancy through routine blood tests. Should the virus be detected or a woman knows herself to be infected with any strain of the hepatitis virus then the condition can be managed throughout the pregnancy and, for most women and babies the outcome is good. Pregnancy, in general, will not alter the course of the disease with the exception of hepatitis E which is similar in nature and transmission to hepatitis A. This rare form of the disease tends to progress more quickly during pregnancy. Partners and close contacts of any woman testing positive for hepatitis should also be tested themselves.
I Have Hepatitis. How Will This Affect My Baby?
The health of the foetus, the unborn baby, is not usually affected by his or her mother carrying the hepatitis virus however, precautions must be taken to protect the baby from becoming infected with the virus during birth. Even though hepatitis carriers may have few or no symptoms of infection, the consequences for infants infected with the virus are far more serious. Babies born to women carrying the hepatitis virus should be vaccinated against it immediately. Though no vaccine offers guaranteed protection the hepatitis B vaccine has been shown to reduce transmission to babies born to infected mothers by 95%.
I Have Hepatitis. How Will This Affect Me During Pregnancy?
For the most part, hepatitis is managed with diet, rest and abstaining from alcohol. Your doctor will prescribe a suitable diet to help your liver recover from the infection. You will require more blood tests than most pregnant women to monitor your liver function (liver function tests or LFTs). Naturally, pregnancy puts extra strains and demands on a woman’s body and women with hepatitis may have extra complications during their pregnancies.
Cholelithiasis, or gall stones occur in around 6% of pregnant women who carry the hepatitis virus. Should these stones not drop into the bowel of their own accord, surgery may be necessary to remove them depending upon their severity and when in pregnancy they occur. Cholestasis of pregnancy, that is abnormal itching of the hands and feet is relatively more common in women who are carriers of the hepatitis virus.
Acute fatty liver of pregnancy is a very rare but potentially fatal condition that women infected with hepatitis are at increased risk of developing. If detected, you may be advised to deliver your baby prematurely.