Sana* was excited and a little anxious as she sat in the hospital waiting area. This was her first
pregnancy and today was her first visit to the doctor. She hoped the doctor would be able to
tell her about the baby. She quickly said a little prayer for the child’s health. As the doctor
started speaking, she strained to hear and remember every word; it was for her baby’s health
after all. Nothing could have prepared her for what the doctor revealed. The baby was fine but
she, the mother, was not! Her reports showed she had Hepatitis B. Sana* was devastated.
What would happen to her baby now?
The Human Liver
One of the largest organs in the body, the human liver is important in maintaining the internal
chemical balance of the body. It produces proteins and helps in production of vitamins. It also
stores energy and releases it when required. The liver also produces substances essential for
digestion and absorption of food from the gut. The liver cleanses the blood of potentially toxic
substances and is important part of the immune system.
Any inflammation of the liver is called Hepatitis and when caused by the Hepatitis B or C
viruses, it is commonly referred to as Hepatitis B and C.
Hepatitis B and Hepatitis C
The Hepatitis B virus was first detected in 1967 and the Hepatitis C virus in 1989.
12.3 million people in Pakistan are affected by these viruses.
A survey conducted by Pakistan Medical Research Council (PMRC) revealed that 2.5 per cent of
the healthy population suffers from Hepatitis B while Hepatitis C affects 4.9 per cent of
Pakistan’s healthy population.
Hepatitis B virus causes 600,000 deaths a year
The main factor that makes these viruses so dangerous is that these viruses cannot be cleared
out of the body. Many of the people, once affected, carry the virus for life.
While an effective vaccine does exist for Hepatitis B, there is none for Hepatitis C.
These viruses attack the liver replacing the healthy parts of the liver with useless scar tissue.
This impairs all the functions of the liver necessary to sustain a healthy body. Apart from
attacking the liver, these viruses may also act on the brain, nerves, kidneys and other vital
organs of the body.
Transmission of Hepatitis B and Hepatitis C
The most common routes of transmission of these infections are sexual contact and through
blood products. People with multiple sexual partners and men who develop relations with
other men are at higher risk for acquiring and transmitting the disease. Another common route
of transmission is through sharing of needles by intravenous drug abusers. Overall, less than 5%
of Hepatitis B and C patients acquire the disease from their mothers.
However, mothers suffering from Hepatitis B have a very high risk of passing it on to their
offspring. Without treatment, the transmission rate can vary from 10-90%.
If the mother receives treatment during pregnancy then the risk of transmitting the infection to
her baby can be reduced by half. Similarly, if the baby receives the vaccine and an active form
of the antibody at birth, the risk of transmission can again be reduced. However, even using this
combination strategy there is a residual risk of maternal transmission – namely, about 3 %.
On the other hand, Hepatitis C infection is associated with a non-negligible rate of maternal
transmission (about 3%–5%).
Breastfeeding is considered safe for these mothers with negligible risk of transmission from the
mother to the baby.
Risk Factors for Transmission of Virus from Mother to Child
The most important risk factor is the severity of infection that the mother is suffering from.
Various blood tests can be used to diagnose exactly how severe the maternal infection is and
the risk estimated accordingly.
The risk of transmission of infection while the child is in the womb is very small. Usually babies
at this point are safe from infection.
During delivery, on exposure to body fluids, the child is at the highest risk of contracting the
infection and this is the stage where extreme precautions need to be taken, both for the safety
of the child and of the healthcare workers. There have been several researches and debates on
what mode of delivery is safest. While some authorities advise elective caesarean section, most
doctors are of the view that the delivery should be allowed to take its natural course so long as
protective measures are taken and treatment of mother and child is initiated.
During lactation, the risk of transmission is negligible.
Reduction of Transmission of The Virus from Mother to Child
The first and most important step is to assess the mother and start treatment. Several trials
have been carried out with different medicines used to treat viral hepatitis. Treatment for
Hepatitis B is safe during pregnancy and can halve the risk of transmission of the virus to the
child.
Unfortunately, Hepatitis C cannot be treated during pregnancy as the drugs used to treat it
cause abnormalities in the child.
The second step is to ensure that the child is delivered in a good hospital setup with special
attention to protocols for managing a patient with viral hepatitis.
The third step is to start treatment of the child immediately and also give him vaccination (In
case of Hepatitis B). Hepatitis C has no vaccine available at the moment.
All these steps, if performed correctly and timely, can reduce the risk of transmission to 3%
from a maximum risk of 90%.
What About Sana*?
Sana* was treated with medicines during and after her pregnancy. Her newborn son was also
given treatment and vaccination. He is now 6 months old and shows no signs of Hepatitis B
although he will be checked for this continuously. Sana is continuing her treatment and is
responding well to it. Her husband was also checked for the disease and his results came out to
be negative and he was immunized against Hepatitis B. They are taking necessary precautions
in their intimate relations.
Conclusion:
In conclusion, the universal screening of pregnant women for Hepatitis B and Hepatitis C,
treatment of mothers during pregnancy and prophylaxis to newborns from HBV-positive
mothers are effective measures through which to prevent maternal transmission of the
infection.
*Fictitious name
