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There is no evidence that Hepatitis B leads to miscarriage, preterm labour or even stillbirth. The devastating effects are to the newborn. If miscarriage, preterm labour or stillbirth happens to a Hepatitis B carrier mother, hepatitis is unlikely to be the cause.
Very rarely, if infection is acquired during pregnancy and if symptoms are severe, uterine activity may be provoked.
So how can the baby of a mother with Hepatitis B be protected?
Soon after birth, the baby is given an injection of HBIG. This is a protein that confers passive but temporary protection against Hepatitis B. To be effective it should be given within twelve hours of birth. This is combined or followed soon after with vaccination against Hepatitis B (this may be given the same day, but not on the same body site).
The vaccination will be repeated one or two more times in the next few months. Of course, the parents would have been thoroughly counseled about all this in the time leading to delivery, once the Hepatitis B carrier status has been established.
Do these measures protect all newborns?
No, but up to 90 per cent will be protected. It is assumed that the small proportion who do not benefit from the vaccination are those who acquired the infection from the mother long before delivery and it had plenty of time to establish itself.
Since there is a small risk of vaccination at birth not being effective, can this not be given to the mother during pregnancy, to cover this prospect?
No. That will not be effective at all.
We have discussed Hepatitis B; what about Hepatitis A and its risk to the unborn child?
Hepatitis A is not transmitted through body fluids but through eating contaminated food. Hepatitis A infection acquired by the mother during pregnancy poses no risks to the baby and cannot be passed on to her or him. As in all such cases, if symptoms are severe, they may lead to uterine activity and threatened preterm labour, but the infection itself poses no direct risk. Hepatitis A infection is always self-limiting and there is no chronic carrier status.
The vaccination will be repeated one or two more times in the next few months. Of course, the parents would have been thoroughly counseled about all this in the time leading to delivery, once the Hepatitis B carrier status has been established.
Do these measures protect all newborns?
No, but up to 90 per cent will be protected. It is assumed that the small proportion who do not benefit from the vaccination are those who acquired the infection from the mother long before delivery and it had plenty of time to establish itself.
Since there is a small risk of vaccination at birth not being effective, can this not be given to the mother during pregnancy, to cover this prospect?
No. That will not be effective at all.
We have discussed Hepatitis B; what about Hepatitis A and its risk to the unborn child?
Hepatitis A is not transmitted through body fluids but through eating contaminated food. Hepatitis A infection acquired by the mother during pregnancy poses no risks to the baby and cannot be passed on to her or him. As in all such cases, if symptoms are severe, they may lead to uterine activity and threatened preterm labour, but the infection itself poses no direct risk. Hepatitis A infection is always self-limiting and there is no chronic carrier status.
If an expectant mother suspects that she has been exposed to the HIV virus, what should she do?
It is important that her doctor is informed at once, and she will be given thorough counseling. This will normally lead to an offer for a test to check whether the infection has been passed on to her.
What is the importance of screening for the HIV infection in pregnancy?
Apart from the obvious longer-term benefit of the mother knowing whether she has the infection or not, there is the immediate issue of the newborn baby. Some expectant mothers, on learning that they are HIV positive, opt for termination of pregnancy. Those who opt to continue will need to explore the options available.
What are the options available to an HIV positive expectant mother who wishes to carry on with the pregnancy?
The mother will carry on with normal antenatal care until delivery. She will be advised to go on medication which has been shown to significantly reduce the chances of the baby acquiring the infection from the mother. For obvious reasons, the short- and long-term effects of these drugs to the baby are not fully understood, even though so far children exposed to them in the womb have shown no ill effects. There is a lot of research going on in this area and new management strategies are being developed all the time.
What is the importance of screening for the HIV infection in pregnancy?
Apart from the obvious longer-term benefit of the mother knowing whether she has the infection or not, there is the immediate issue of the newborn baby. Some expectant mothers, on learning that they are HIV positive, opt for termination of pregnancy. Those who opt to continue will need to explore the options available.
What are the options available to an HIV positive expectant mother who wishes to carry on with the pregnancy?
The mother will carry on with normal antenatal care until delivery. She will be advised to go on medication which has been shown to significantly reduce the chances of the baby acquiring the infection from the mother. For obvious reasons, the short- and long-term effects of these drugs to the baby are not fully understood, even though so far children exposed to them in the womb have shown no ill effects. There is a lot of research going on in this area and new management strategies are being developed all the time.
What percentage of babies acquire the infection from their mothers?
Figures differ from different centres but roughly a third of all babies will be infected when they are born. Antiviral medication to the HIV infected expectant mother is estimated to cut this risk by over two-thirds.