Infections in Pregnancy: Hepatitis A
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Infections in Pregnancy: Hepatitis A

What is hepatitis A?

Hepatitis A is a highly contagious liver disease caused by the hepatitis A virus (HAV). However, unlike hepatitis B and C, it does not cause chronic liver disease and is rarely fatal.

Hepatitis A infection occurs in random cycles. However, it has been decreasing in the United States over the past 40 years. According to the Centers for Disease Control and Prevention (CDC), this is partly due to the introduction of the hepatitis A vaccine in 1995.

In 2013, there were an estimated 3,473 cases of acute hepatitis A infection reported in the United States. However, many hepatitis A infections don’t show symptoms, so the actual number of infections in this country is thought to be higher.

The HAV is more widespread in overpopulated areas with poor sanitation. Also, hepatitis A infection occurs with equal frequency in pregnant women as in the general population.

What are the symptoms and consequences of hepatitis A?

Symptoms of hepatitis A infection are broad and range from none to severe. According to the World Health Organization (WHO), most children under 6 years old with hepatitis A don’t have any symptoms. However, adults do tend to exhibit symptoms. For example, about 70 percent of adults with hepatitis A develop jaundice.

Although the majority of hepatitis A cases last one to four weeks, some cases may last for several months. An infected person is most contagious just before the symptoms appear and last for the duration of the infection.

Common symptoms of hepatitis A infection include:

  • fatigue
  • nausea and vomiting
  • pain around the capsule surrounding the liver.  
  • change in the color of bowel movements
  • loss of appetite
  • low-grade fever
  • dark urine
  • joint pain
  • jaundice or yellowing of the skin and eyes

In the majority of patients, long-term consequences of infection don’t exist. After a person recovers they have antibodies to hepatitis A that provide lifelong immunity to the disease. However, there have been rare cases of relapsing hepatitis A within months of the initial infection. About 80 people a year die in the United States from hepatitis A infections.

Who's at risk?

People with the highest risk for hepatitis A infection are those who engage in personal contact with an infected person. Other risk factors include:

  • traveling to countries with high or intermediate rates of hepatitis A, especially Africa, Asia (except Japan), Eastern Europe, the Middle East, South and Central America, Mexico, and Greenland
  • having oral-anal sexual contact with an infected person
  • using illegal drugs
  • having chronic liver disease
  • working with hepatitis A in a laboratory setting
  • having a blood clotting disorder or receiving clotting factor concentrates
  • living in communities with high rates of hepatitis A — this applies to children in day care centers
  • handling food
  • caring for the chronically ill or disabled
  • having a weakened immune system due to cancer, HIV, chronic steroid medications, or organ transplantation

What causes hepatitis A?

The HAV is shed through the feces of infected individuals. It is spread mostly through direct person-to-person contact and exposure to contaminated water and food supplies. Hepatitis A may also be transmitted through direct blood contamination, such as sharing a needle with an infected person.

In most other types of viral hepatitis a person carries and transmits the virus without having symptoms. However, this isn’t true for hepatitis A.

Hepatitis A usually doesn’t pose a special risk to a pregnant woman or her baby. Maternal infection doesn’t result in birth defects, and a mother typically doesn’t transmit the infection to her baby.

Hepatitis A and pregnancy

During pregnancy hepatitis A infection can be associated with a higher risk of preterm labor, especially if infection occurs during the second or third trimester. Other increased risks associated with hepatitis A infection may include:

  • premature uterine contractions
  • placental abruption
  • premature rupture of membranes

However, contracting hepatitis A during pregnancy is rare. Although there is an increased risk for complications, they are usually not serious. Also, hepatitis A has not been shown to cause death in either the mother or child, and babies born to mothers with hepatitis A rarely contract it.

Prevention

Hepatitis A has no cure. To prevent getting hepatitis A, try to avoid high-risk activities. Also, be sure to wash your hands after handling raw foods and after using the toilet.

A common vaccine is available for the HAV, and it is easy to get. The vaccine is administered in two injections. The second shot is given 6 to 12 months after the first.

Outlook

Hepatitis A can be difficult to detect because there may be no symptoms. Be sure to get tested when you find out you’re pregnant so you can be aware of any risks to your pregnancy.

Passing hepatitis A on to your baby is rare, but it can lead to complications during pregnancy.

If you are diagnosed with hepatitis A, your doctor is required by law to notify the local public health authority. This helps to identify the source of the infection and to prevent further outbreaks of the disease.

There are several things you can do to prevent or avoid a hepatitis A infection. Avoid risky behaviors, practice good hygiene, and be sure to talk over vaccination with your doctor.

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