Hepatitis A infection complicates pregnancy

By David Douglas

NEW YORK (Reuters Health) - Hepatitis A infections in pregnant women are associated with high rates of complications and preterm labor, according to Israeli researchers.

While the disease is the most common type of acute hepatitis, there are few reports of its possible side effects during pregnancy, Dr. Eran Elinav of Hadassah-Hebrew Medical Center, Jerusalem and colleagues note in the medical journal Gastroenterology.

To investigate, the researchers reviewed a database covering 25 years and close to 80,000 pregnancies. The team identified 13 cases of second and third trimester hepatitis A infections.

Nine of the 13 women developed complications. These consisted of premature contractions in four patients, placental separation in two, premature rupture of the membranes in two patients and vaginal bleeding in the remaining patient.

In eight of these patients, the complications also led to preterm labor at an average of 34 weeks of pregnancy.

Overall, 12 of the births were vaginal deliveries. There was one case of fetal distress and meconium was seen in the amniotic fluid in two other pregnancies.

The average birthweight in preterm deliveries was 1778 g (3.92 lbs.) and in full-term deliveries it was 3040 g (6.70 lbs.). Levels of hepatitis A RNA in the blood were checked in four infants, and were found to be negative. Overall mother and infant outcomes were generally favorable.

"Hepatitis A vaccination is considered safe during pregnancy," Dr. Elinav told Reuters Health. We therefore recommend that obstetric and liver specialists conduct further studies to evaluate the implications of adding hepatitis A testing and vaccination to the pre-pregnancy screening examinations in areas with high rates of this infection. "This may prevent this potentially harmful, yet totally avoidable disease."

SOURCE: Gastroenterology, April 2006.