Hepatitis ( inflammation of the liver ) in pregnancy : how can we take care ?
Background : setting the stage :
World Hepatitis Day is celebrated world over with the purpose of preventing this very serious disease of the liver.
Liver is the most important vital organ of the body. not only is it the food store of our body but it also produces enzymes for digestion and also produces important factors for blood clotting.
Liver is a strong organ but may get diseases due to infection with viruses. These infections, if not prevented or curbed with strong immunity, can cause hepatitis which is called the inflammation of the liver. These are easily preventable and all efforts must be taken to prevent liver’s inflammation, hepatitis.
If hepatitis affects pregnant mother, it can lead to life-threatening complications.
I remember in the old days when I was working as a resident doctor in the B.J. Medical College and the Sassoon General Hospitals some 25 years back, women reporting with hepatitis in pregnancy used to be very sick and death was imminent as they used to bleed to death and we use to watch helplessly like wounded war soldiers . The reason was there was no blood component therapy available as it is today and women were hugely neglected till they became extremely sick.
All those deaths I witnessed has inspired me to write this blog.
I feel if I write about hepatitis and its prevention, women and their families will know how to prevent this disease and be safe.
Later when I worked in the university medical college during my tenure as the associate professor, I witnessed a mother with hepatitis survive with massive transfusions and aggressive treatments. Things have come around and we are much in the know-how and have amenities to save lives. But prevention is always better than cure.
Here is a small excerpt to empower all those who are connected to a pregnant mother, with information on hepatitis during pregnancy.
How does hepatitis feel like ?
Fever, malaise, tiredness, excessive vomiting, yellow pigmentation of the eyes, skin, tongue and nails, these are signs of jaundice which point towards hepatitis. Hepatitis can also occur due to obstruction to the internal ductal system within the liver and is called as obstructive jaundice. Hepatitis can be so severe that people affected may bleed to death or have so much of bilirubin that it will enter the brain and cause coma which is called as hepatic encephalopathy
What type of hepatitis is commonly seen in pregnancy ?
All the five viruses from A to the E virus can affect the pregnant mother. Vomiting during the first trimester( read more here https://drgirijawagh.com/?s=nvp ) of pregnancy is quite common. Excessive vomiting sometimes can be due to hepatitis and clinical assessment to rule out is always done. Additionally, as the pregnancy advances due to pregnancy hormones and compounded by obesity the duct systems within the liver get obstructed giving rise to hepatitis which is called as obstructive hepatitis or Cholestasis of pregnancy. Cholestasis of pregnancy or obstructive hepatitis is associated with body itching and is usually seen after 32 weeks of pregnancy. Blood tests help in diagnosis of this condition and some medications help. The baby has to be monitored closely for jeopardy and the baby may have to be delivered deliberately in some situations. Acute Fatty Liver of Pregnancy is a pregnancy-specific rare disorder but is know to be a grave pregnancy complication and is life-threatening. Diseases such as raised blood pressure ( preeclampsia ) can cause liver damage ( HELLP syndrome ).(some more info about pregnancy blood pressure here https://drgirijawagh.com/?s=blood+pressure+. https://drgirijawagh.com/?s=bp+in+pregnancy
How can we prevent hepatitis ?
Infective hepatitis caused by viral infections can be prevented by various measures as mentioned under
Food hygiene : clean food , adequately cooked should be consumed
Consumption of healthy and clean water
Avoiding street foods and drinks
Avoiding unclean water : filtration and boiling of water ensures it is clean and potable
Hand hygiene is very important : Hands to be washed with soap and water and dried after ablutions and before consumption of food or before handling food
Avoiding unsafe sex
Avoiding street drugs
Vaccinations : https://drgirijawagh.com/?s=vaccinations
Maintaining healthy habits which in turn help in maintaining good immunity
Hepatitis is acquired through food, water, physical contact and sexual contact. It can be transferred from mother to the baby. Food and water hygiene go a long way in preventing the occurrence of hepatitis. Cholestatis of pregnancy, acute fatty liver of pregnancy and hepatitis ( HELLP syndrome ) associated with raised blood pressure ( preeclampsia ) can be prevented by lifestyle modification such as early detection, weight control etc.
Hepatitis B can be prevented by vaccination and this has to be taken as a part of :
pre-marriage (https://drgirijawagh.com/pre-marriage-couple-testing-checklist/ )
pre-conceptional preparation (https://drgirijawagh.com/pregnancy-planning-swift-checklist/ ) .
If not taken Hepatitis B vaccine can be safely taken during pregnancy.
You can refer to details of vaccination in another blog
What are the complications of hepatitis ?
High grade fever, dehydration, starvation, ketosis, liver damage, liver failure, blood thinning leading to bleeding, brain damage leading to brain damage or death are the complications of hepatitis. The long-standing complication can be a permanent injury tot he liver rendering it nonfunctional requiring liver transplant surgery.
What are the signs that I must seek medical advice ?
During pregnancy excessive vomiting ( read more here https://drgirijawagh.com/?s=nvp ), fever, malaise, fatiguability, yellow skin, eyes or nails, itching all should be considered as symptoms of hepatitis and clinical examination and laboratory tests help in correctly establishing the diagnosis.
Concerns experienced by me in my day to day practice
Extremely poor nutritional intake by pregnant mothers make me wonder how will they find the strength to fight such infective diseases such as hepatitis https://drgirijawagh.com/second-trimester-nutritional-norms/
Food cravings which reflect inadequate dietary consumption and promotes unhealthy fast food or street food consumption
Access to clean drinking water is deficient and there is no awareness, lack of immunisation before pregnancy planning
Lack of awareness regarding diabetes and hypertension in pregnancy (https://drgirijawagh.com/?s=diabetes+in+pregnancy+)
Excessive weight gain, again due to improper dietary habits (https://drgirijawagh.com/weight-during-pregnancy/ )
So let us pledge on the occasion of #worldhepatitis day to ensure that we protect ourselves, our families from hepatitis and make everyone aware about this dreaded disease.