Symptoms and Management of Hepatitis A in Pregnancy
In pregnant women with acute hepatitis A, symptoms are similar to non-pregnant individuals, and management should focus on supportive care as the infection is typically self-limiting with no need for special interventions during pregnancy. 1
Clinical Presentation of Hepatitis A in Pregnancy
- Symptoms of acute hepatitis A in pregnancy are similar to those in non-pregnant individuals and may include fatigue, abdominal discomfort, jaundice, and scleral icterus 2
- Laboratory findings typically show elevated transaminases (transaminitis) which may be detected on routine prenatal labs 2
- Mother-to-child transmission (MTCT) of hepatitis A virus (HAV) is extremely rare, with only a few documented cases 1
- In rare cases, transient cholestatic jaundice has been reported in full-term infants born to jaundiced mothers with detectable anti-HAV IgM 1
Diagnosis
- Diagnosis is made through serologic testing for anti-HAV IgM antibodies in symptomatic pregnant women 2
- Screening for hepatitis A is not routinely recommended during pregnancy but should be considered in women with compatible symptoms or risk factors 2
- Consider testing for other viral hepatitis infections (HBV, HCV, HDV, HEV) as co-infections may occur 1
Management Recommendations
- Supportive care is the mainstay of treatment for hepatitis A in pregnancy 1
- No specific antiviral therapy is indicated for hepatitis A infection during pregnancy 2
- Caesarean section is not recommended for women with acute hepatitis A unless there is a specific obstetric indication 1
- Breastfeeding should not be discouraged in women with acute hepatitis A as there is no evidence supporting HAV transmission through breast milk despite detection of very low fluctuating levels of HAV RNA 1
- Active or passive immunization of newborns of mothers with acute hepatitis A is not routinely suggested 1
- Passive IgG immunization to the neonate may be considered if the mother has acute hepatitis A just prior to delivery 1
Prevention
- Vaccination of pregnant women identified to be at risk for HAV infection during pregnancy is recommended 1
- Both hepatitis A vaccine and immunoglobulin for postexposure prophylaxis can be used safely in pregnancy 1
- Pregnant women should be counseled about preventive measures including good hand hygiene and avoiding high-risk foods and water sources 2
Special Considerations
- Unlike hepatitis E, hepatitis A does not appear to have a more severe course during pregnancy 3
- The risk of vertical transmission is significantly lower for hepatitis A compared to other hepatitis viruses like HBV or HEV 4
- Pregnant women with hepatitis A should be monitored for signs of liver failure, though this is rare 2
- Patients with hepatitis A virus, including pregnant women, should be counseled to abstain from alcohol 5
Clinical Course and Prognosis
- Hepatitis A is typically self-limiting and resolves without chronic infection 4
- The course of hepatitis A infection is generally unaffected by pregnancy 3
- Careful monitoring of liver function tests is recommended during the acute phase of infection 2
- Pregnancy outcomes are generally favorable with appropriate supportive care 3