Hepatitis A in Pregnancy and Breastfeeding

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These days it seems like we keep hearing about outbreaks of food-borne illnesses. Salmonella, listeria, and E. coli are all disease-causing pathogens that have made the list. One pathogen we are hearing about more and more is hepatitis A. That is because hepatitis A is on the rise. The disease has made headlines in regard to outbreaks linked to pomegranate seeds (2013), raw scallops (2016), and frozen strawberries (2016). Additionally, as of this writing, Florida is dealing with a hepatitis A outbreak that has affected more than 3,500 people. In Kentucky, that number is close to 5,000. Though the number of people affected by the disease in Florida and Kentucky are among the highest in the US, those two states are not the only ones struggling to protect their citizens from hepatitis A. According to the Centers for Disease Control and Prevention, 28 states are currently dealing with an outbreak.

This may have you worried about how you might protect yourself from the disease, or worse, what would happen if you were to contract hepatitis A during your pregnancy.

What is Hepatitis A?

Hepatitis A is a vaccine-preventable infectious disease caused by the hepatitis A virus (HAV). It mainly affects the liver. It is a self-limited disease usually lasting from four to eight weeks. It can be contracted by consuming contaminated food or water, or by contact with an infected person. Transmission is via the fecal-oral route. That is, feces may be on a person’s hand and is then transferred to a food product or another person’s hand and the virus ends up in or near the second person’s mouth. There is no specific treatment for hepatitis A.

Quick Facts about Hepatitis A

  • Caused by hepatitis A virus (HAV)
  • Self-limited disease, lasting from 4-8 weeks
  • Fecal-oral transmission
  • Contracted by eating contaminated food or drinking contaminated water
  • Can be spread person-to-person
  • No specific treatment
  • Can be prevented with vaccine

What are the Symptoms?

Many people don’t have any symptoms at all. If you do have symptoms they will occur after you’ve been infected with the virus for a couple of weeks (incubation period for HAV is 15 to 50 days). A person can be contagious before they even feel symptoms.

Symptoms are sudden in onset and include:

  • Nausea and vomiting
  • Fever
  • Fatigue
  • Joint pain
  • Abdominal pain (usually felt most under the lower ribs on the right side)
  • Dark urine
  • Jaundice (yellowing of the eyes and skin)
  • Clay-colored stool

How Can I Protect Myself from HAV?

The best thing you can do to protect yourself from the hepatitis A virus is to get vaccinated. The vaccination comes in two forms: monovalent (meaning it offers protection against only the hepatitis A virus) and bivalent (offering protection against both hepatitis A and B). Ideally, you would be vaccinated before you begin your pregnancy but, because the vaccine is made with inactivated virus, it is considered safe during pregnancy.

If you are not vaccinated and you are traveling to a place where HAV is endemic, hygiene is of utmost importance. Washing hands often with uncontaminated water and soap is recommended. Do not rely on hand sanitizers to kill the virus. Be careful not to ingest any untreated water, or ice cubes made from untreated water. Make sure food preparers use proper hygiene and sanitary procedures.

Additional risk factors include working in or attending a day care center, homelessness or working in a homeless shelter, incarceration, IV drug use, and prior history of liver disease, hemophilia, or HIV.

Risk Factors for HAV:

  • Being unvaccinated
  • Traveling to a place where HAV is endemic
  • Not using proper hand-washing and sanitary procedures
  • Working in or attending a day care center
  • Homelessness or working in a homeless shelter
  • Incarceration
  • IV drug use
  • Prior history of liver disease, hemophilia, or HIV

What if I Contract Hepatitis A During My Pregnancy?

There is very little evidence that a mother can transmit HAV directly to her baby. However, maternal infection with Hepatitis A during pregnancy has been associated with preterm labor, especially if HAV is contracted in the second or third trimester. It has also been associated with gestational complications such as placental abruption, premature rupture of membranes, and premature uterine contractions.

HAV During Pregnancy has Been Associated With:

Can I Still Breastfeed My Baby?

 As above, there is very little evidence that a mother can transmit HAV to her baby through her breastmilk. Talk to your doctor about your baby’s HAV vaccination plan.

What are the Most Important Things to Remember about Hepatitis A?

First and foremost, infection with HAV can be prevented with a vaccine. If you are concerned about infection with HAV, limit travel to places where the virus is endemic. HAV can be transmitted person-to-person or by eating contaminated food or drinking contaminated water. Hand-washing with soap and water is the best way to prevent spread of infection. Hepatitis A travels via the fecal-oral route. Symptoms include sudden onset nausea and vomiting, fatigue, fever, abdominal pain, dark urine, clay-colored stools, and jaundice. There is no treatment. The disease is self-limited, lasting from 4 to 8 weeks. Infection with hepatitis A during pregnancy has been associated with preterm labor and gestational complications, but there is little evidence that it can be transmitted directly from mother to baby.

Janette DeFelice
Dr. Janette DeFelice is a writer currently focusing on how the changing environment affects our health. She holds a Doctor of Medicine degree from Chicago Medical School where she taught clinical and diagnostic skills to beginning medical students, and a Master’s degree in Humanities from the University of Chicago. She also has a Bachelor’s degree in Political Science. Her writing can be seen online at BeTheChangeMom, ChicagoNow, and Medium, and she’s very excited to have published her first novel, Delia Rising: A Ballet in Three Acts. She lives in Chicago’s west suburbs with her school-age twins, her husband, and a family cat named Clara Barton.

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