Symptomatic reactivation of hepatitis B in pregnancy

Rawal, Bhavin; Parida, Satyen; Watkins, R; Ghosh, P.; Smith, Heather M.

doi:10.1016/0140-6736(91)90993-y

Cited by 36 publications

(13 citation statements)

References 7 publications

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“…26 HBV DNA levels may increase during pregnancy in association with a decrease in ALT levels, consistent with an HBV tolerance phase, followed by a post-partum decline in HBV DNA level that is associated with increased ALT levels and active hepatitis, consistent with a post-partum reconstitution of the immune system. This post-partum HBV reactivation may be associated with HBeAg seroconversion (i.e., clearance of HBeAg, development of hepatitis B e antibody positivity, decline in HBV DNA levels and normalization of ALT level) in 12.5 to 17% of patients.…”

Section: Hepatitis B In Pregnancymentioning

confidence: 91%

Hepatitis B and C in pregnancy: a review and recommendations for care

et al. 2014

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Our objective was to provide a comprehensive review of the current knowledge regarding pregnancy and hepatitis B virus (HBV) or hepatitis C virus (HCV) infection as well as recent efforts to reduce the rate of mother-to-child transmission (MTCT). Maternal infection with either HBV or HCV has been linked to adverse pregnancy and birth outcomes, including MTCT. MTCT for HBV has been reduced to approximately 5% overall in countries including the US that have instituted postpartum neonatal HBV vaccination and immunoprophylaxis with hepatitis B immune globulin. However, the rate of transmission of HBV to newborns is nearly 30% when maternal HBV levels are greater than 200 000 IU ml−1 (>6 log10 copies ml−1). For these patients, new guidelines from the European Association for the Study of the Liver (EASL) and the Asian Pacific Association for the Study of the Liver (APASL) indicate that, in addition to neonatal vaccination and immunoprophylaxis, treating with antiviral agents such as tenofovir disoproxil fumarate or telbivudine during pregnancy beginning at 32 weeks of gestation is safe and effective in preventing MTCT. In contrast to HBV, no therapeutic agents are yet available or recommended to further decrease the risk of MTCT of HCV, which remains 3 to 10%. HCV MTCT can be minimized by avoiding fetal scalp electrodes and birth trauma whenever possible. Young women with HCV should be referred for treatment post delivery, and neonates should be closely followed to rule out infection. New, better-tolerated treatment regimens for HCV are now available, which should improve outcomes for all infected individuals.

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Section: Hepatitis B In Pregnancymentioning

confidence: 91%

Hepatitis B and C in pregnancy: a review and recommendations for care

et al. 2014

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“…If a pregnant woman remains untreated or anti-HBV therapy is discontinued during pregnancy or early after delivery for any reason, close monitoring of the patient is necessary, as there is a risk of hepatic flares, especially after delivery [214,215] (B1).…”

Section: Pregnancymentioning

confidence: 99%

EASL Clinical Practice Guidelines: Management of chronic hepatitis B virus infection

2012

Journal of Hepatology

2,613

1,266

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“…Severe reactivation of hepatitis B after delivery was reported in 1991 (Rawal et al 1991). A more recent study shows that a threefold increase of alanine transaminase (ALT) levels occurred in 45% of mothers within 6 mo after delivery (ter Borg et al 2008).…”

Section: Effects Of Pregnancy On Hepatitis B Carrier Mothersmentioning

confidence: 99%