• Dr Peter Chew

Hep B carrier in pregnancy: Is it serious?

N, a first-time mum, felt much relief when her child had the vaccination for hepatitis B (Hep B) soon after birth.  She was found to be a Hep B carrier during a blood screening test in the first trimester.

Hep B is a common infectious disease affecting about 6% of Singaporeans. It is due to a virus which infects the liver, causing inflammatory changes. If the inflammation persists, liver hardening(cirrhosis), liver failure and cancer may develop.

The virus is usually transmitted from the mother to the new-born during childbirth. It can also spread by direct contact with bodily fluids such as blood, semen, or vaginal secretions of an infected person. This can happen during sexual intercourse or blood transfusions. It does not transmit by coughing, sneezing, casual contact or breastfeeding.

Hep B may be either short-lived (acute) or long lasting (chronic). An acute infection lasts less than six months. The immune system can clear the virus and the patient usually recovers completely without treatment.

A small number of patients—usually newborns or children younger than 5 years of age -- cannot get rid of the virus due to a poorer immune response. They become carriers with chronic infection. They usually do not have symptoms until years later when they become seriously ill from liver malfunction.

To prevent the newborn from getting hep B infection, all pregnant mothers should have their blood tested. Testing is especially important for health care workers and those whose spouses or partners are carriers. This group of women has a higher risk of getting the infection.

If the mother is a carrier, the baby should be vaccinated preferably within 12 hours after the baby is born. In this way, the baby has a more than 90% chance of being protected against the chronic infection.

As for N, I told her that it was safe to breastfeed her baby. I advised her to refrain from taking alcohol and herbal supplements which are toxic to the liver.  After her confinement, she should be seen by a hepatologist for follow up so that her liver functions can be checked and her liver scanned regularly. Her husband should also have his blood tested and vaccination done according to the test results.

Two months after delivery, N was happy to inform me that her baby  had developed immunity against the virus via the blood test.

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