Hepatitis B virus (HBV) infection in pregnancy: Nursing

Hepatitis B virus, or HBV, is associated with hepatitis, or inflammation of the liver, which is often self-limiting, but in some cases, can result in extensive liver damage. During pregnancy the virus can be transmitted to the baby, potentially causing adverse health effects.

Now, let’s quickly review some anatomy and physiology. The liver is a large, solid organ located in the right upper quadrant of the abdomen, which has several functions, including the production of bile, cholesterol, and certain blood proteins like albumin and clotting factors. The liver is also involved in helping with glucose, fat, and bilirubin metabolism, as well as detoxification of certain toxins.

Now, HBV infection is caused by hepatitis B virus which is a DNA enveloped virus that belongs to the Hepadnavirus family. Hepatitis B virus is primarily transmitted through blood and other body fluids; so the main risk factors include blood transfusions, hemodialysis, IV drug use, working as a healthcare professional, as well as high-risk sexual behavior, such as having multiple partners or not using protection.

Now, hepatitis B virus can also be transmitted vertically from the mother to the baby. This can happen as the virus travels across the placenta; during invasive procedures like amniocentesis or chorionic villus sampling; if the amniotic membranes rupture prematurely; and during labor, as the newborn passes through the birth canal.

In terms of pathology, the virus causes progressive damage to the liver. Eventually, fibrosis and scarring occurs, which can progress to cirrhosis, as well as complications like hepatic encephalopathy, where toxins like ammonia build up in the blood. Chronic HBV also increases the risk of hepatocellular carcinoma.

Now, in the case of vertical HBV transmission, the baby can be at risk for certain complications. Most neonates infected with HBV are asymptomatic at birth, but eventually will develop a chronic infection. Those born to clients with chronic hepatitis may have additional complications such as low birthweight, jaundice, lethargy, poor feeding, and failure to thrive.

Okay, moving on to clinical manifestations of HBV infection during pregnancy. In the case of acute hepatitis, these typically include fatigue, malaise, nausea, and vomiting. Additionally, clients can present with a low-grade fever, jaundice, skin rash, itching, particularly on the palms and soles of the feet, as well as dark urine. They may also have right upper quadrant tenderness, as well as hepatomegaly.

On the flip side, pregnant clients with chronic hepatitis B can be asymptomatic, or they could present with mild symptoms like malaise and fatigue. However, progressive liver damage can, over time, lead to problems like jaundice; as well as ascites, or fluid accumulation in the peritoneal cavity, on account of reduced albumin production; and easy bruising or bleeding because of reduced clotting factors.

Diagnosis of HBV infection during pregnancy starts with the client’s history and physical assessment. Laboratory tests typically reveal elevated liver enzymes like aspartate transaminase, or AST and alanine aminotransferase or ALT; as well as elevated bilirubin levels; and prolonged bleeding time.

Additionally, lab tests can reveal specific serologic findings. So, acute HBV infection presents with hepatitis B surface antigen or HBsAg; as well as IgM antibodies against hepatitis B core antigen. Clients with chronic HBV infection present the same serologic markers, but instead of IgM antibodies, they have IgG antibodies against hepatitis B core antigen. Finally, to confirm the diagnosis of HBV infection, PCR can be performed to detect the presence of viral DNA.

The treatment of acute hepatitis caused by HBV infection during pregnancy primarily involves supportive care to relieve the symptoms. Antiviral therapy with tenofovir or lamivudine should be administered in severe cases or when the PCR test shows a high level of HBV DNA.