Infection with hepatitis B virus is a special problem for pregnant women. Not only does a pregnant woman face the risks of hepatitis herself, she also can pass the virus to her baby. About 1 in every 500–1,000 pregnant women has hepatitis when she gives birth. More pregnant women may be infected but not show any signs. This pamphlet will explain:

This pamphlet will explain:

How the hepatitis B virus can affect your pregnancy How testing is done How the virus can be prevented

All pregnant women should be tested for the hepatitis B virus.

Effects of Hepatitis B Virus Infection

Hepatitis B virus is one of a number of viruses that attack and damage the liver. (Other types include hepatitis A, hepatitis C, and hepatitis D.) The liver is an organ located in your upper abdomen.

Hepatitis B virus is passed from person to person by way of infected body fluids. These body fluids include:

• Blood
• Semen
• Vaginal fluids
• Saliva

The virus can be spread through sexual contact. The virus also can be passed to someone who comes in contact with the blood of an infected person. This can occur in many different ways, for instance by sharing needles with someone who is infected with the virus. It also can be passed during childbirth.

Infected persons are at risk for many health problems. The virus infects the liver and can cause chronic (long-term) hepatitis. Chronic hepatitis can be life threatening. Persons with chronic hepatitis have a greater chance of getting certain types of liver disease, such as cirrhosis (hardening) of the liver and cancer of the liver.

The symptoms of hepatitis can include:

• Fatigue
• Loss of appetite
• Nausea
• Jaundice (yellowing of the skin and eyes)
• Dark urine
• Soreness in the liver
• Muscle aches

Some people infected with the virus do not become immune to it, but show no sign of infection. Such people are called carriers. They still can pass the virus to someone else even though they do not have any symptoms. A woman who is a carrier can pass the virus to her baby at birth. Carriers sometimes become sick later in life.

Effects During Pregnancy

When a pregnant woman is infected with hepatitis B virus, there is a chance she will infect her fetus. Whether the baby will get the virus depends on when infection occurred. If it was early in pregnancy, the chances are less than 10% that the baby will get the virus. If it was late in pregnancy, there is up to a 90% chance that the baby will be infected.

Hepatitis can be severe in babies. It can threaten their lives. Even babies who appear well may be at risk for serious health problems.

Infected newborns have a high risk (up to 90%) of becoming carriers. They, too, can pass the virus to others. When they become adults, these carriers have a 25% risk of dying of cirrhosis of the liver or liver cancer.

Testing for the Virus

A blood test can show whether someone has been infected with hepatitis B virus. For the test, a small sample of blood is taken and tested for a special protein—called an antigen—that is found in blood infected with the virus.

If your test result is negative, it means you were not infected with the virus at the time the test was done. If your test result is positive, it means you have been infected with the virus and can infect others. This includes your baby if you are pregnant. Your doctor will want to do more tests to learn whether your liver is still healthy. A positive test result means that your children, your sexual partner(s), and others living in your household are at risk of infection. They should be told about testing and vaccination. They will need to decide whether to have them done.

All pregnant women should be tested for the virus. The test should be done early enough in pregnancy to allow time to prepare treatment for the baby and to test family members if your test result is positive.

Prevention of Hepatitis B Virus

There are steps you can take to try to prevent being infected with hepatitis B virus. One thing you can do is practice safe sex. The use of condoms during sex helps to prevent infection with hepatitis B virus and other sexually transmitted diseases (STDs), such as human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS).

Do not share needles used to inject drugs. Sharing needles greatly increases your chances of getting the virus.

Another way to prevent the virus is to get the hepatitis B virus vaccine. A vaccine is a type of medicine you are given—as a shot in most cases—to keep you from getting a certain type of disease. The hepatitis B virus vaccine triggers the body's immune system to make antibodies. These antibodies then fight off the virus when you are exposed to it. The vaccine will not protect against other types of hepatitis and will not help people who already are infected with hepatitis B virus.

The vaccine is safe for use during pregnancy. There is no risk of getting hepatitis or other diseases, such as AIDS, from the vaccine. It is given in three doses: the first dose is followed by a second dose in 1 month and a third dose in 6 months.

In some cases, your doctor also may give you hepatitis B immune globulin (HBIG). It contains antibodies to the virus. This will protect you against the virus until the vaccine triggers your body to make its own antibodies. HBIG also can be used in pregnancy.

Anyone can become infected with hepatitis B virus. Some people, though, are at increased risk of infection (see box). All teenagers aged 13–18 years who have not already been vaccinated should get the vaccine to protect themselves, their sexual partners, and any children they may have later.

All infants should get the hepatitis B virus vaccine. If you are pregnant and have the virus, your baby will receive HBIG soon after birth. Your baby also will receive the first dose of vaccine. Two more doses of the vaccine will be given later—one at 1–2 months of age and one at 6 months of age. This plan is an effective way to prevent babies from becoming hepatitis B virus carriers.

If you had a negative test result, your baby should get the first dose of vaccine before you leave the hospital. If it cannot be given by then, it should be given within 2 months of birth. Check with the baby's doctor to find out when the second and third dose should be given.

If you were not tested, your baby should get the first dose of vaccine and then you should be tested. The rest of your baby's treatment depends on whether your test results are positive or negative.

Finally...

Infection with hepatitis B virus can damage your health. The test is a safe, easy way to learn whether you have been infected with the virus. If your test results are negative, but you are at increased risk for getting the virus, you should receive the hepatitis B virus vaccine to protect you.

Infection with the virus also can harm your baby. For that reason, all pregnant women should be tested for the virus. If you have a positive test result, your baby will be treated right after birth. All newborns should receive the vaccine.

Who Is at Risk? Some people are at increased risk for hepatitis B virus. You may need to be vaccinated if you have one or more of these risk factors: Inject illegal drugs Are seeking care for a sexually transmitted disease Are infected with HIV Have had multiple sexual partners within the past 6 months Are a health care or public safety worker Live or have sex with someone who is infected with the virus Work or live in a home for the disabled Have certain types of liver or kidney problems. Have received treatment (clotting factors) for a bleeding disorder Travel to countries where HBV infection is common Are in prison

Glossary

Antibodies: Proteins found in the blood produced in reaction to foreign substances, such as bacteria and viruses that cause infection.

Antigen: A substance, such as an organism causing infection or a protein found on the surface of blood cells, that can induce an immune response and cause the production of an antibody.

Cirrhosis: A disease caused by loss of liver cells, which are replaced by scar tissue that impairs liver function.

Hepatitis B Immune Globulin (HBIG): A substance given to provide temporary protection against infection with hepatitis B virus.

Sexually Transmitted Diseases (STDs): Diseases that are spread by sexual contact, including chlamydial infection, gonorrhea, genital warts, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).