Ms A consulted me with her husband. Ms A is now 16 weeks pregnant. As a father myself, I can sense their excitement. But they consulted me for a specific purpose. Ms A is a hepatitis B carrier. She probably got it from her mum, who is also a hep B carrier. As a matter of fact, according to a study performed about 20 years ago, 4% of Singaporeans were hepatitis B carrier. The carrier status dropped to 2.8% few years ago. But among those older than 30years of age, hepatitis B is not uncommon. Ms A and her husband are understandably worried about safety of her pregnancy, their unborn child, as well as future of her child. After much history taking and examination, I went through their lab tests. |
But how about her unborn child and her pregnancy?
- I spent some time explaining to Ms A and her husband the followings:Hep B mothers can have a normal pregnancy as other healthy mother. Hepatitis B itself does not adversely affect the mother’s pregnancy
- Risk of transmission from a hep B mother to her child is about 90% several decades ago. But about 20 years ago, we routinely give hep B vaccines and hep B immunoglobulins to newborns from hep B mother. So current risk of getting hep B from a hep B mother is about 10%
- Risk of transmission remains at 5-10% despite vaccination at birth and is due to “in utero” transmission. This means the hep B virus can pass through the placenta to reach the fetus even before he/she is born. So administration of vaccines after birth will not help
- To reduce risk of in utero transmission, we can give antiviral agents to pregnant hep B mother during last trimester to drop their viral load. Many studies have showed that such strategy could effective reduce risk of transmission to almost zero.
- Mode of deliver, either via normal vaginal deliver or caesarean section, have not been consistently proven to increase or decrease risk of transmission. Hep B mothers should not decide on mode of delivery based on risk of vertical transmission
- Similarly, hep B transmission is not related to breastfeeding. I encourage Ms A to breastfeed her child as much as possible.
Dr Desmond Wai
Gastroenterologist and Hepatologist
Mt E Novena Specialist Center #06-35
Tel : (+65)67343554
Email: dr_desmond_wai@yahoo.com.sg
www.drdesmondwai.com
Facebook: Doc Desmond Wai
+6594380070