Hepatitis B in pregnancy

Definition

• Hepatitis B in pregnancy denotes acute or chronic infection of the pregnant woman with hepatitis B virus (HBV), a small enveloped DNA virus.

Classification

• The infection is chronic if HBsAg remains detectable in serum for more than 6 months.

Occurrence & epidemiology

Epidemiology

• Germany is among the countries with relatively low prevalence; it is highest in sub-Saharan Africa and East Asia.

Aetiopathogenesis

Aetiology and pathogenesis

• Perinatal infection of newborns of HBsAg-positive mothers is a major cause of chronic HBV infection worldwide; the risk of transmission is particularly high with HBeAg positivity.
• After infection during birth, the infection becomes chronic in about 90%, in adults in only up to 10%.

Clinical features

Clinical features and complications

• Acute hepatitis B begins with non-specific symptoms such as loss of appetite, joint pain, nausea and fever; an icteric phase with dark urine may follow.
• Chronic hepatitis B can lead to liver cirrhosis and hepatocellular carcinoma; co-infection with hepatitis D takes a severe chronic course in 70–90%.

Diagnosis

• Diagnosis of chronic infection requires HBsAg, anti-HBc and quantitative HBV DNA, and in pregnant women additionally HBeAg and anti-HBe.
• Anti-HBc IgM indicates acute infection but is not always conclusive, as it also occurs during flares of chronic hepatitis B.

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Further reading (selection)

1. Robert Koch Institute, RKI-Ratgeber (German): Hepatitis B und D

Cross-references