Hepatitis B can cause some nasty symptoms. For the acute form of the infection, they can include fever, intense fatigue, nausea, vomiting, abdominal pain, dark urine, pale stools, and jaundice. People who develop chronic hepatitis B can eventually end up with serious liver diseases such as cirrhosis and liver cancer.
These are symptoms nobody wants — but experiencing them can, in some ways, be incredibly helpful. Many people who contract hepatitis B don't notice any physical changes to warn them something's wrong, you see, and that means they may have no clue they're got hepatitis B at all. The CDC estimates that around 850,000 US residents live with chronic hepatitis B, quickly adding that the real number may — once you include people who remain undiagnosed — exceed two million.
First things first: What's hepatitis B?
Hepatitis B is one of five viral kinds of hepatitis. Hepatitis means "liver inflammation", and all the different kinds of hepatitis viruses affect the body slightly differently though they often present with similar symptoms. Hepatitis B can occur in two forms. You have acute hepatitis B after you contract the virus, and may experience some of the symptoms listed above. Some people's bodies spontaneously manage to eliminate the virus, after which they're not only free from it but also immune from getting it again. Others develop chronic hepatitis B, and the risk of that is higher the younger a person is.
Hepatitis B can be transmitted through unprotected sexual intercourse with an infected person, or direct contact with the blood of someone who has it. When you hear that, unsafe IV drug use is the first thing that comes to mind, but you're also at risk of you have shared toothbrushes, razors, or similar items with someone (who is infected or whose status you're unaware of). Even something like performing first aid if you happen to have a cut on your hand can mean you end up with hepatitis B.
(Just in case there was any doubt, hugging, shaking hands, sharing a glass of water, and breastfeeding do not pose a threat, and neither do sneezes or coughs.)
I'm pregnant: Do I need to worry about hepatitis B?
There is a safe and effective vaccine to protect against hepatitis B. It is currently recommended for all newborns, young people under 19 who haven't had it yet, and adults at risk. This includes people who use drugs, work in healthcare, diabetics, prison inmates, people who travel the world, and anyone who is HIV positive. If you have been vaccinated against hepatitis B, you will still be screened during pregnancy, but you do not need to worry.
If you are currently thinking about trying to conceive and there is any chance at all that you could have been exposed to hepatitis B or other sexually transmitted diseases, ask for testing.
What if you are diagnosed with chronic hepatitis B during your pregnancy?
The diagnosis will come as a shock, of course, but being diagnosed with hepatitis B is actually good news — knowing that you have hepatitis B, your medical team can take steps to protect you and your baby that would be impossible if they remained unaware of the infection.
For you:
- Treatment for chronic hepatitis B can be delayed until after you are no longer pregnant if you have mild to moderate disease. You will be monitored for flares (which can be symptomless) to make sure this option remains viable.
- You should be referred to a liver specialist if you have severe disease, to discuss treatment options. In this case, you are likely to be offered enofovir or entecavir, medications that seem to be safer during pregnancy than interferon alpha and pegylated interferon-alpha.
- If you were already diagnosed with hepatitis B before you became pregnant, your doctor and you should discuss whether you can stop your treatment during pregnancy, or you should continue it. The options in this case are the same as those above, except you'll be facing the decision of whether to come off your meds rather than whether to start them.
- Regardless of what else happens during the rest of the pregnancy, you will be advised to start antiviral therapy (again) as your due date approaches, to minimize the risk of transmitting hepatitis B to your baby.
For the baby:
- Hepatitis B immune globulin, which protects the baby against hepatitis B, should be given within 12 hours of their birth.
- They should also get the first dose of the hepatitis B vaccine, recommended for all newborns, within this time frame.
- Two or three additional doses of the vaccine should follow in the first six months of your baby's life in accordance with your doctor's recommendations.
- Tests should be conducted to confirm that the baby doesn't have hepatitis B.