Hepatitis B and reproductive health
Abstract
The aim of review. To present recent literature data on features of course of hepatitis B during pregnancy and major risk factors of infection of children via vertical route.
Original positions. Course of chronic hepatitis B during pregnancy was studied in several cohort studies which demonstrated , that activity of serum transaminases in this period, as a rule, remains normal. At the same time, clinical cases of HBsAg-positive pregnant women indicating deterioration of liver function down to development of fulminant liver failure are described. Received results dictate necessity of careful monitoring of level of serum transaminases and functions of liver at women during pregnancy and puerperal period. The vast majority of cases of virus conduction occur immediately during delivery, this issue is not completely clear. Some researches showed that the risk of infection of the child has positive relation to level of mother’s viral load. As one of the concepts an option of infection of fetus at amniocentesis is considered. However HBV DNA is rarely present at umbilical blood and it is not found in amniotic fluid. It testifies for the benefit of that intra-uterine virus transfer takes place rarely, the risk of infection by hepatitis virus at amniocentesis looks to be low. Correctly immunized children can have breast feeding. Treatment of pregnant women with high viremia level at the last month of pregnancy can reduce number of newborns with ineffective vaccination. Among the nucleoside analogues registered in Russian Federation for treatment of chronic hepatitis B only telbivudine (Sebivo) has “B” category that means absence of risk for fetus on animal model. However, results of controlled studies in pregnant women up to now are inaccessible.
Conclusion. The best prophylaxis of vertical conduction of hepatitis B virus is combination of active and passive immunization of babies. Level of viremia at mother is associated with risk of conduction of hepatitis B virus to a child. Planning of pregnancy should be discussed with the genital age woman before onset of antiviral treatment.
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Review
For citations:
Mayevskaya M.V. Hepatitis B and reproductive health. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2009;19(5):4-9. (In Russ.)
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