You must surely understand that an expectant mother should be ultra-careful about her health. Unfortunately, certain infections likely hepatitis are highly contagious, and extremely dangerous for the fetus. Ideally, every woman should test for hepatitis B virus (HBV) infection before conception. If she tests negative, or non-reactive, then she should get HBV vaccine before planning a family to ensure that she does not get infected during pregnancy. Otherwise, she should certainly screen for HBV infection as soon as she realizes that she has conceived as the infection can be passed to the unborn child. Further, the probability of her infecting other members of the family are high, especially if it is a recent infection.
In case you were not tested for HBV infection during your pregnancy, you must ensure that you are tested before delivery. The doctor will check for viral load to determine whether it is a new infection, and to what degree you might be infected. The degree of inflammation of the liver will also be checked to measure to what degree the infection has damaged the health of your liver. To ensure that your baby is not infected with HBV at birth, your doctor will give the newborn a dose of HBV immune globulin (known as HBIG) within 12 hours of birth. Subsequently, depending on the birth weight, and the brand of the vaccine, the little one will be given three or four rounds of HBV vaccinations. The HBIG and HBV vaccine shots are given only to newborns whose mothers are infected with HBV. The last shot should be given when the baby is six months old. When the baby is between nine months to a year old, s/he should be tested for HBV infection to verify that the vaccine has worked.
In most infectious diseases, the body builds its own immunity to the infection after the patient has run the gamut of the illness, and has been treated with the appropriate antiviral drugs. This is because when the infection has just attacked the cells, the body induces an innate immune response mediated by production of interferons (IFNs), which in turn generate hundreds of IFN-stimulated genes (ISGs). Unfortunately, the stealth properties of HBV prevent an innate immune response, because it is not detected by pattern recognition receptors of the body. In most people, symptoms of HBV infection do not show up for years, preventing early detection. Left undetected, chronic liver infection could lead to cirrhosis of the liver, rupture of splenic aneurysms, or even liver cancer.
The mother is likelier ― almost 90 percent chances ― to pass on HBV infection to the fetus if her own infection is still at the acute stage, i.e., less than six months. However, if it is a chronic HBV infection, the probability decreases dramatically to as low as 20 percent. Add to that, the probability of the HBV crossing the placenta is almost non-existent. The infection is likelier to occur during delivery, whether it is a natural, vaginal delivery, forceps delivery, or a cesarian section delivery. Remember, if your baby tests positive for HBV infection, it means s/he will need on-going treatment all their life.
The aspects which impact the unborn child most are the potential viral transmission from mother to newborn, its possible prevention through antiviral drugs, and the potential teratogenic effect of these drugs, which might lead to birth defects like spina bifida. Unfortunately, babies can be severely affected by HBV infection, which could even be fatal. The upside is that HBV infection in pregnancy will not automatically result in mortality. It is important to note that anyone who is infected with HBV after the age of five rarely develops chronic infection.
The greatest irony about hepatitis B is that it is vaccine preventable, but there is no known cure for it yet. This is because the antiviral drugs are unable to destroy the virus reservoir hiding inside cells. Most people get well soon by eliminating the virus from their body. Such people can never be infected again, as their system become immune. However, some people never completely get rid of the infection. Such people become carriers of HBV infection. Therefore, the expectant mother needs to be watchful that the infection is not transferred to the newborn baby. By following the doctor’s guidance, she can ensure that neither she nor her baby suffer from long term liver damage.
Preventing mother-to-child transmission of HBV presents a staggering challenge for the doctors under whose care the expectant mother is. The World Health Organization (WHO) issued certain guidelines in 2020 on the the use of peripartum antiviral prophylaxis in HBsAg-positive pregnant women as an additional measure to prevent mother-to-child transmission of HBV. WHO also pointed out that, “only a small proportion of women of childbearing age would be eligible for long-term treatment”. It also suggests in a study that “the use of antivirals may suppress HBV DNA levels, and reduce transmission of HBV to infants of HBsAg-positive women”.
If you, or any member of your family is infected with HBV during pregnancy, you would be well advised to pay close attention to diet. Keep it as healthy as you can by loading up with fruits, vegetables, whole cereals, lean meats, healthy fats, low fat, or non-fat dairy products, and drink plenty of water to ensure that your liver stays healthy, and the embryo receives proper nutrition. Avoid alcohol, fried food, added sugar, refined flours, extra salt, and red meats like poison.