Treatment and prevention of viral hepatitis in pregnancy.
Antiviral Agents
/ therapeutic use
Female
Hepatitis A
/ chemically induced
Hepatitis B
/ diagnosis
Hepatitis B Vaccines
Hepatitis B virus
Hepatitis B, Chronic
/ diagnosis
Hepatitis C
/ drug therapy
Humans
Immunoglobulin G
Infant, Newborn
Infectious Disease Transmission, Vertical
/ prevention & control
Lactation
Pregnancy
Pregnancy Complications, Infectious
/ diagnosis
Viral Load
hepatitis A
hepatitis B
hepatitis C
perinatal hepatitis
viral hepatitis in pregnancy
Journal
American journal of obstetrics and gynecology
ISSN: 1097-6868
Titre abrégé: Am J Obstet Gynecol
Pays: United States
ID NLM: 0370476
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
received:
06
06
2021
revised:
03
09
2021
accepted:
07
09
2021
pubmed:
14
9
2021
medline:
27
4
2022
entrez:
13
9
2021
Statut:
ppublish
Résumé
Viral hepatitis in pregnancy may be caused by many types of viruses that cause systemic infection or target hepatocytes in their pathogenesis. Because viral hepatitis during pregnancy may represent acute or chronic infection or the reactivation of a prior infection, a high clinical suspicion, medical history review, and awareness of risk factors for the acquisition of infection are important management principles. The route of infection varies widely and ranges from fecal-oral transmission for the hepatitis A and E viruses to vertical transmission for hepatitis B, blood-borne transmission for hepatitis C, and sexual transmission for the herpes simplex virus. For this reason, the exposure details about travel, food preferences, drug use, and sexual contacts are important to elicit. Although routine prenatal screening is recommended for chronic viral hepatitis caused by hepatitis B and C, most other causes of viral hepatitis in pregnancy are detected in the setting of compatible signs and symptoms (fatigue, abdominal discomfort, jaundice, scleral icterus) or incidentally noted transaminitis on routine labs. Serologic testing is helpful for diagnosis with molecular testing as indicated to guide the management of hepatitis B and C. Preventive vaccines for hepatitis A and B with established safety of use in pregnancy are recommended for women who are at risk of acquisition. Postexposure prophylaxis for hepatitis A is a single dose of immunoglobulin and vaccination can be used if immunoglobulin G is not available. Antiviral therapy with tenofovir disoproxil fumarate is recommended as prophylaxis in pregnant women with active hepatitis B and an elevated viral load (>200,000 IU/mL) during the third trimester to prevent vertical transmission. The neonate exposed to hepatitis B at birth should receive immunoglobulin G and a monovalent birth dose vaccine within 12 hours, followed by completion of the 3-dosage vaccine series. The prevalence of hepatitis C in women of reproductive age has increased in the United States, and the role of antiviral therapy during pregnancy is of great interest. Cesarean delivery is not currently recommended for the sole purpose of reducing vertical transmission risk in pregnant women with viral hepatitis. Breastfeeding is recommended in women with hepatitis A, B, and C. New and promising prevention and treatment options for hepatitis B and C are under investigation. Investigators and regulatory authorities should ensure that these clinical trials for promising antivirals and vaccines are designed to include pregnant and lactating women.
Identifiants
pubmed: 34516961
pii: S0002-9378(21)00998-4
doi: 10.1016/j.ajog.2021.09.002
pmc: PMC8907340
mid: NIHMS1741173
pii:
doi:
Substances chimiques
Antiviral Agents
0
Hepatitis B Vaccines
0
Immunoglobulin G
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
335-346Subventions
Organisme : NICHD NIH HHS
ID : R01 HD101545
Pays : United States
Organisme : NCATS NIH HHS
ID : TL1 TR001864
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
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