Hepatitis B in pregnancy
Hepatitis B virus (HBV) infection is one of the fastest growing global health problems. The World Health Organisation (WHO) estimates that more than 2 billion people have been infected with Hepatitis B (HBV) while 350 million people across the world carry chronic hepatitis B virus of which an estimated 1 million people die annually from HBV-Related liver disease.
How does mother- to- child transmission of Hepatitis B occur?
The transmission of infections from mother to offspring is traditionally known as perinatal infection. By definition, the perinatal period begins at 28 weeks of gestation and ends at 28 days after delivery.
Theoretically, there are 3 possible routes for transmission of HBV from an infected mother to her infant:
a. Trans-placental transmission of HBV in the womb: These can be caused by placental infection and vaginal secretion
b. Natal transmission during delivery: This is the most important route of HBV transmission from mother to child. During the process of delivery, new-born are likely to be exposed to maternal body fluids or blood that contains HBV at the time when they pass the maternal genital tract.
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Also in cases of threatened preterm labor, the contractions of the uterus may cause the laceration of the placenta and subsequently result in entering of maternal blood into fetal circulation
C. transmission during care is only possible through breast milk if the mother has an injury/ bleeding nipples on her breast or interaction with body fluids, blood or other close contacts between new-borns and mothers after delivery.
How serious is Hepatitis B in babies?
When babies become infected with Hepatitis B, they have a 95% chance of developing a lifelong, chronic infection. As many as 1 in 4 people with chronic Hepatitis B develop serious health problems. Hepatitis B can cause liver failure, liver cirrhosis, and liver cancer.
How do I prevent my baby from having Hepatitis B?
If you test positive for hepatitis B, there are chances your baby could become infected before birth. However, when tested positive for Hepatitis B, there should be further checks to know whether the individual has a high level of hepatitis B in the blood. If it is high your doctor will refer you to a specialist.
To protect your new baby, your baby must be given two injections immediately after delivery. The two injections are:
• The Vaccine – The first dose of the hepatitis B vaccine which helps the baby make their own antibodies.
• Hepatitis B immunoglobulin – A dose of hepatitis B immunoglobulin (HBIG) which provides antibodies that protect against the hepatitis B virus right away. This is necessary only for babies born to Mothers who were tested positive for Hepatitis B.
The two injections must be given within 12hours of birth which will give your baby a 95% chance of being protected against hepatitis B infection.
Additional two doses of vaccine are required within the first 6months of birth. The additional doses are very important likewise as they are to be given at 4weeks and 6months to ensure long-term protection. It is advisable to do a blood test at 9 months of age to make sure the child is fully protected from the infection.
However, whether a mother is Positive or Negative for HBV, the Hepatitis B Vaccine must be given to every New-born baby.
Does my baby need all the vaccination shots?
All the Hepatitis B shots are necessary to help keep your baby from getting Hepatitis B. As the Vaccine remains effective for a very long time (20 years to a lifetime) it is important to get all of it and for mothers who have hepatitis B, it is very important that Hepatitis B immunoglobulin (HBIG) is given to the new-born baby at birth.
Can I breastfeed if I have Hepatitis B?
Breastfeeding does not increase the risk of mother to baby transmission of hepatitis B. The only situation where breastfeeding may carry a potential risk of transmission is when the mother has cracked or bleeding nipples. Where a baby has been taken care of properly (has received HBIG + Vaccine) this is no longer a concern.