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Obstetrics| Volume 9, ISSUE 4, P216-223, December 1999

Hepatitis B and C in pregnancy

DOI:https://doi.org/10.1054/cuog.1999.0038
Hepatitis B and C in pregnancy
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      Abstract

      In general, pregnancy does not influence the course of hepatitis B (HBV) and C (HCV) infection. Most neonates born to mothers who suffer from acute viral hepatitis B and C are asymptomatic. Chronic hepatitis B and C infections can be transmitted to neonates. This route of transmission of HBV is a major contributing factor to the high carrier rate in endemic countries where 80–95% of infants born to HBsAg/HBeAg-positive (hepatitis B surface antigen and hepatitis B e antigen respectively) mothers are infected. Despite the availability of a immunoprophylactic vaccine, 10–15% of these infants are still infected. The possible reasons for vaccine failure include the ability of HBV antigens to induce immunotolerance and the existence of HBV variants. The factors contributing to vertical transmission of HBV and HCV are also discussed. These factors include viral load, virus variants and sensitivity of diagnostic tests. The rate of vertical transmission of HCV of less than 5% is lower compared to HBV in HCV-ribonucleic-acid-positive mothers. However, the risk of HCV transmission is increased to about 23% if the pregnant women are also human immunodeficiency virus (HIV) positive.
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      References

      REFERENCES

        • Vranckx R.I.
        • Alisjahbana A.
        • Meheus A.
        Hepatitis B virus vaccination and antenatal transmission of HBV markers to neonates.
        J Viral Hep. 1999; 6: 135-139
        • Hunt C.M.
        • Carson K.L.
        • Sharara A.I.
        Hepatitis C in pregnancy.
        Obstet Gynecol. 1997; 89: 883-890
        • Mandelbrot L.
        Vertical transmission of viral infections.
        Curr Opin Obstet Gynecol. 1998; 10: 123-128
        • Michielsen P.P.
        • van Damme P.
        Acta Gastroenterol Belg. 1999; 62: 21-29
        • Eriksen N.I.
        Perinatal consequences of hepatitis C.
        Clinical Obstet Gynec. 1999; 42: 121-133
        • Blumberg B.S.
        Australia antigen and the biology of hepatitis B.
        Science. 1995; 197: 17-25
        • Maynard J.E.
        Hepatitis B: global importance and need for control.
        Vaccine. 1990; 8 (Suppl): S18-S20
        • Beasley R.P.
        • Hwang L.Y.
        • Lin C.C.
        • Chien S.C.
        Hepatocellular carcinoma and HBV: a prospective study of 22 707 men in Taiwan.
        Lancet. 1981; ii: 1129-1133
        • Choo Q.L.
        • Kuo G.
        • Weiner A.J.
        Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome.
        Science. 1989; 244: 359-362
        • Alter M.J.
        Epidemiology of hepatitis C in the West.
        Semin Liver Dis. 1995; 15: 5-14
        • Carman W.F.
        • Jacyna M.R.
        • Hadziyannis S.
        • Karayiannis P.
        • McGarbey M.J.
        • Makris A.
        • Thomas H.
        A mutation preventing formation of hepatitis B e antigen in patients with chronic hepatitis B infection.
        Lancet. 1989; 2: 588-591
        • Brunetto M.R.
        • Giarin E.
        • Oliveri F.
        Wild type and e antigen-deficient hepatitis B viruses and course of chronic hepatitis.
        Proc Natl Acad Sci USA. 1991; 88: 4186-4190
        • Simmonds P.
        • Holmes E.C.
        • Cha T.A.
        Classification of hepatitis C virus into six major genotypes and a series of subtypes by phylogenetic analysis of the NS-5 region.
        J Gen Virol. 1993; 74: 2391-2399
        • Takada N.
        • Takase S.
        • Takada A.
        • Date T.
        Differences in the hepatitis C virus genotypes in different countries.
        J Hepatol. 1993; 17: 277-283
        • Dusheiko G.
        • Schmilovitz-Weiss H.
        • Brown D.
        Hepatitis C virus genotypes: an investigation of type-specific differences in geographic origin and disease.
        Hepatology. 1994; 19: 13-18
        • Mieli-Vergani G.
        Hepatitis B virus.
        in: Greenough A. Osborne J. Sutherland S. Congenital, perinatal and neonatal infections. Churchill Livingstone,, New York1992
        • Zeldis J.B.
        • Crumpacker C.S.
        Hepatitis.
        in: Remington J.S. Klein J.O. Infectious diseases of the fetus and the newborn infant, 4th edn. Saunders, Philadelphia1995: 805-834
        • Goudeau A.
        • Yvonned B.
        • Lesage G.
        Lack of anti-HBc IgM in neonates with HBsAg carrier mother argues against transplacental transmission of hepatitis B virus infection.
        Lancet. 1983; 2: 1103-1104
        • Alexander G.J.M.
        • Eddleston A.L.W.F.
        Does maternal antibody to core antigen prevent recognition of transplacental transmission of hepatitis B virus infections?.
        Lancet. 1986; Feb 8: 296-297
        • Lin H.H.
        • Lee T.Y.
        • Chen D.S.
        Transplacental leakage of HbeAg positive maternal blood as the most likely route in causing intrauterine infection with hepatitis B virus.
        J Pediatr. 1987; 111: 877-881
        • Ohto H.
        • Lin H.H.
        • Kawana T.
        • Etoh T.
        • Tohyama H.J.
        Intrauterine transmission of hepatitis B virus is closely related to placental leakage.
        J Med Virol. 1987; 1: 1-6
        • Beasley R.P.
        • Stevens C.E.
        • Shiao I.S.
        • Meng H.C.
        Evidence against breast-feeding as a mechanims for vertical transmission of hepatitis B.
        Lancet. 1975; ii: 740-741
        • Tseng R.Y.M.
        • Lam C.W.K.
        • Tam J.
        Breastfeeding babies of HBsAg-positive mothers.
        Lancet. 1988; Oct 29: 1032
        • Tang S.
        Study on the HBV intrauterine infection and its rate.
        Chung Hua Liu Hsing Ping Hsueh Tsa Chih. 1990; 6: 328-330
        • Lazizi Y.
        • Badur S.
        • Perk Y.
        • Ilter O.
        • Pillot J.
        Selective unresponsiveness to HBsAg vaccine in newborns related with an in utero passage of hepatitis B virus DNA.
        Vaccine. 1997; 15: 1095-1100
        • Yan Y.P.
        • Xu D.X.
        • Wang W.L.
        • Liu B.
        • Liu Z.H.
        • Men K.
        • Zhang J.X.
        • Xu J.Q.
        The role of placenta in hepatitis B virus intrauterine transmission.
        J Gastroent hepatol. 1997; 12: S141
        • Choo K.B.
        • Wu T.C.
        • Ng H.T.
        • Han S.J.
        Hepatitis B virus infection of cord blood leukocytes.
        J Med Virol. 1987; 22: 211-216
        • Bart P.A.
        • Jacquier P.
        • Zuber P.L.F.
        • Lavanchy D.
        • Frei P.C.
        Seroprevalence of HBV (anti-HBc, HBsAg and anti-HBs) and HDV infections among 9006 women at delivery.
        Liver. 1996; 16: 110-116
        • Xu D.
        • Yan Y.
        • Xu J.
        A molecular epidemiologic study on the mechanism of intrauterine transmission of hepatitis B virus.
        Chung Hua Liu Hsing Ping Hsueh Tsa Chih. 1998; 19: 131-133
        • Ramia S.
        • Al-Frayh A.R.
        • Bakir T.M.
        Lack of evidence for transplacental transmission of HBV infection by HBsAg-carrier mothers.
        Ann Trop Paediatr. 1988; 8: 141-144
        • Poovorawn Y.
        • Chongsrisawat V.
        • Theamboonlers A.
        • Vimolkej L.
        • Yano M.
        Is there evidence for utrauterine HBV infection in newborns of hepatitis B carrier mothers?.
        Southeast Asian J Trop Med Public Health. 1997; 28: 365-369
      32. MMWR Morbidity Mortality Weekly Report. 1991; 40(RR–13): 1-17
        • Stevens C.E.
        • Beasley R.P.
        • Tsui J.
        • Lee W.C.
        Vertical transmission of hepatitis B antigen in Taiwan.
        N Engl J Med. 1975; 292: 771-774
        • Stevens C.E.
        • Neurath R.A.
        • Beasley R.P.
        • Szmuness W.
        HBeAg and anti-HBe detection by radioimmunoassay: correlation with vertical transmission of hepatitis B virus in Taiwan.
        J Med Virol. 1979; 3: 237-241
        • Burk R.D.
        • Hwang L.Y.
        • Ho G.Y.
        • Shafritz D.A.
        • Beasley R.P.
        Outcome of perinatal hepatitis B virus exposure is dependent on maternal virus load.
        J Infect Dis. 1994; 170: 1418-1423
        • Chang M.H.
        • Hsu H.Y.
        • Huang L.M.
        • Lee P.I.
        • Lin H.H.
        • Lee C.Y.
        The role of transplacental hepatitis B core antibody in the mother-to-infant transmission of hepatitis B virus.
        J Hepatol. 1996; 24: 674-679
        • Hasegawa K.
        • Huang J.
        • Wanda J.R.
        • Obata H.
        • Laing J.
        Association of hepatitis B viral precore mutations with fulminant hepatitis B in Japan.
        Virology. 1991; 185: 460-463
        • Liang T.J.
        • Hasegawa K.
        • Rimon N.
        • Wands J.
        • Ben-Porath E.
        A hepatitis B virus mutant associated with an epidemic of fulminant hepatitis B.
        N Engl Med. 1991; 324: 1705-1709
        • Sato S.
        • Suzuki K.
        • Akahane Y.
        Hepatitis B virus strains with mutations in the core promoter in patients with fulminant hepatitis.
        Ann Intern Med. 1995; 122: 241-248
        • Pollicino T.
        • Zanetti A.
        • Caccioloa I.
        Pre-S2 defective hepatitis B virus infection in patients with fulminant hepatitis.
        Hepatology. 1997; 26: 495-499
        • Sterneck M.
        • Kalinina T.
        • Otto S.
        Neonatal fulminant hepatitis B: Structural and functional analysis of complete hepatitis B virus genomes from mother and infant.
        J Infect Dis. 1998; 177: 1378-1381
        • Friedt M.
        • Gerner P.R.
        • Ganschow R.
        • Burdelski M.
        • Wirth S.
        Selection of HBV-variants after perinatal transmission is associated with fulminant hepatitis B in infants.
        J Ped Gastroent Nut. 1999; 28: 579
        • Hasegawa K.
        • Huang J.
        • Rogers S.A.
        • Blum H.E.
        • Liang T.J.
        Enhanced replication of a hepatitis B virus mutant associated with an epidemic of fulminant hepatitis.
        J Virol. 1994; 68: 1651-1659
        • Ngui S.L.
        • Teo C.G.
        Hepatitis B virus genomic heterogeneity: variation between quasispecies may confound molecular epidemiological analysis of transmission incidents.
        J Viral Hep. 1997; 4: 309-315
        • Nainan O.V.
        • Cromeans T.L.
        • Margolis H.S.
        Sequence-specific, single primer amplification and detection of PCR products for identification of hepatitis viruses.
        J Virol Methods. 1996; 61: 127-143
        • Milich D.R.
        • Jones J.E.
        • Hughes J.L.
        • Price J.
        • Ranay A.K.
        • McLachlan A.
        Is a function of the secreted hepatitis B e antigen to induce immunologic tolerance in utero?.
        Proc Natl Acad Sci USA. 1990; 87: 6599-6603
        • Hsu H.Y.
        • Chang M.H.
        • Lee C.Y.
        • Chen J.S.
        • Hsu H.C.
        • Chen D.S.
        Spontaneous loss of hepatitis B surface antigen in children with chronic hepatitis B infection.
        Hepatology. 1992; 15: 382-386
        • Barin F.
        • Goudeau A.
        Immune response in neonates to hepatitis B vaccine.
        Lancet. 1982; i: 251-253
        • Lee G.C.Y.
        • Hwang L.Y.
        • Beasley R.P.
        • Chen S.H.
        • Lee T.Y.
        Immunogenicity of hepatitis B vaccine in healthy Chinese neonates.
        J Infect Dis. 1983; 148: 526-529
        • Prozesky O.W.
        • Stevens C.E.
        • Szmuness W.
        Immune response to hepatitis B virus vaccine in newborns.
        J Infect Dis. 1983; 7 (Suppl 1): 53-55
        • Ip H.M.H.
        • Lelie P.N.
        • Wong V.C.W.
        • Kuhns M.C.
        • Reesink H.W.
        Prevention of hepatitis B virus carrier state in infants according to maternal serum levels of HBV DNA.
        Lancet. 1989; i: 406-410
        • Hsu H.Y.
        • Chang M.H.
        • Ni Y.H.
        • Lin H.H.
        • Wang S.M.
        • Chen D.S.
        Surface gene mutants of hepatitis B virus in infants who develop acute or chronic infections despite immunoprophylaxis.
        Hepatology. 1997; 26: 786-791
        • Carman W.F.
        • Zanetti A.R.
        • Karayiannis P.
        Vaccine-induced escape mutant of hepatitis B virus.
        Lancet. 1990; 336: 325-329
        • Tai P.C.
        • Banik D.
        • Lin G.I.
        Novel and frequent mutations of hepatitis B virus coincides with a major histocompatibility complex class I-restricted T-cell epitope of the surface antigen.
        J Virol. 1997; 6: 4852-4856
        • He J.W.
        • Lu Q.
        • Zhu Q.R.
        • Duan S.C.
        • Wen Y.M.
        Mutations in the ‘a’ determinant of hepatitis B surface antigen among Chinese infants receiving active postexposure hepatitis B immunization.
        Vaccine. 1998; 16: 170-173
        • Ngui S.L.
        • Andrews N.J.
        • Underhill G.S.
        • Heptonstall J.
        • Teo C.G.
        Failed postnatal immunoprophylaxis for hepatitis B: characteristics of maternal hepatitis B virus as risk factors.
        Clin Infect Dis. 1998; 27: 100-106
        • Thursz M.R.
        Host genetic factors influencing the outcome of hepatitis.
        J Viral Hep. 1997; 4: 215-220
        • Martinetti M.
        • Cuccia M.
        • Daielli C.
        Anti-HBV neonatal immunization with recombinant vaccine.
        Part II. Molecular basis of the impaired alloreactivity. Vaccine. 1995; 6: 555-560
        • Floreani A.
        • Paternoster D.
        • Zappala F.
        Hepatitis C infection in pregnancy.
        Br J Obstet Gynecol. 1996; 103: 325-329
        • Mazza C.
        • Ravaggi A.
        • Rodella A.
        Prospective study of mother-to-infant transmission of hepatitis C virus (HCV) infection.
        J Med Virol. 1998; 54: 2-19
        • Resti M.
        • Azzari C.
        • Mannelli F.
        Mother to child transmission of hepatitis C virus: prospective study of risk factors and timing of infection in children born to women seronegative for HIV-1.
        Bri Med J. 1998; 317: 437-441
        • Ohto H.
        • Terazawa S.
        • Sasaki N.
        Transmission of hepatitis C virus from mothers to infants.
        N Engl J Med. 1994; 330: 744-750
        • Zuccotti G.V.
        • Ribero M.L.
        • Giovannini M.
        Effect of genotype on mother-to-infant transmission of virus.
        J Pediatr. 1995; 127: 278-280
        • Kudo T.
        • Yanase T.
        • Ohshiro M.
        • Yamamoto M.
        • Morita M.
        • Shibata M.
        • Moroshima T.
        Analysis of mother-to-infant transmission of hepatitis C virus: quasispecies nature and buoyant densities of maternal virus populations.
        J Med Virol. 1997; 51: 225-230
        • Maggiore G.
        • Ventura A.
        • de Giacomo C.
        • Silini E.
        • Cerino A.
        • Mondelli M.U.
        Vertical transmission of hepatitis C.
        Lancet. 1995; 345: 1122-1123
        • Zuckermann M.A.
        • Aitken C.
        Acute hepatitis C viral infection during pregnancy: failure of mother to infant transmission.
        J Med Virol. 1997; 52: 161-163
        • Khuroo M.S.
        • Kamili S.
        • Shahid J.
        Vertical transmission of hepatitis E virus.
        Lancet. 1995; 345: 1025-1026
        • Hussaini S.H.
        • Skidmore S.
        • Richardson P.I.
        • Sherratt L.M.
        • Cooper B.T.
        • O’Grady J.G.
        Severe hepatitis E infection during pregnancy.
        J Viral Hep. 1997; 4: 51-54
        • Fischler B.
        • Lara C.
        • Chen M.
        • Sonnerbeorg A.
        • Nemeth A.
        • Sallberg M.
        Genetic evidence for mother-to-infant transmission of hepatitis G virus.
        J Infect Dis. 1997; 176: 281-285

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      DOI: https://doi.org/10.1054/cuog.1999.0038

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      © 1999 Published by Elsevier Inc. All rights reserved.

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