LAUSR

Viral hepatitis in pregnancy can be caused by a list of viruses that cause systemic infection or target hepatocytes in their pathogenesis. Since viral hepatitis during pregnancy may represent acute, chronic or reactivation of a prior infection, a high clinical suspicion, medical history review, and awareness of risk factors for acquisition of infection are important management principles. The route of infection varies widely from fecal-oral transmission for hepatitis A/E virus to vertical transmission for hepatitis B to bloodborne transmission for hepatitis C to sexual transmission for herpes simplex virus. For this reason, exposure details about travel, food preferences, drug use, and sexual contacts are important to elicit. Although routine prenatal screening is recommended for chronic viral hepatitis caused by hepatitis B and C, most other causes of viral hepatitis in pregnancy are detected in the setting of compatible signs and symptoms (fatigue, abdominal discomfort, jaundice, scleral icterus) or incidentally noted transaminitis on routine labs. Serologic testing is helpful for diagnosis with molecular testing as indicated to guide the management of hepatitis B and C. Preventive vaccines for hepatitis A and B with safety established in pregnancy are recommended in women who are at risk of acquisition. Post exposure prophylaxis for hepatitis A is a single dose of immunoglobulin (IG) and vaccination can be used if IG is not available. Antiviral therapy with tenofovir disoproxil fumarate is recommended as prophylaxis in pregnant women with active hepatitis B and an elevated viral load (>200,000 IU/mL) during the 3rd trimester to prevent vertical transmission. The neonate exposed to hepatitis B at birth should receive IG and monovalent birth dose vaccine within 12 hours, followed by completion of the 3-dose vaccine series. The prevalence of hepatitis C in women of reproductive age has increased in the US and the role of antiviral therapy during pregnancy is of great interest. Cesarean delivery is not currently recommended for the sole purpose of reducing vertical transmission risk in pregnant woman with viral hepatitis. Breastfeeding is recommended in women with hepatitis A, B, and C. New and promising prevention and treatment options for hepatitis B/C are under investigation. Investigators and regulatory authorities should ensure that these clinical trials for promising antivirals and vaccines are designed to include pregnant and lactating women.