Hepatitis A virus (HAV) is present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food. Certain sex practices can also spread HAV.
Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. However, HAV infections can also be severe and life threatening. Most people in areas of the world with poor sanitation have been infected with this virus. Safe and effective vaccines are available to prevent HAV.
Hepatitis A infection is the most common cause of acute viral hepatitis in the general population but it is infrequently reported among pregnant women. Hence, data on the incidence and outcome of HAV infection during pregnancy are scarce.
HAV infection during pregnancy is not associated with serious adverse outcomes. However, the available data show a causal relationship between HAV infection and preterm labour, especially if infection occurs in the second or third trimester. Hepatitis A virus infection has also been reported to be associated with other gestational complications such as increased premature
uterine contractions, placental abruption, and premature
rupture of membranes. The markers for a more aggressive course of the disease are fever and hypoalbuminemia (low serum protein). Overall, no mortality was reported among mothers and infants exposed to HAV infection, with full resolution of the infection.
Most infants born to mothers with HAV infection were not affected and had normal antibody and liver enzyme levels. However, in the rare cases in which mother-to-child HAV infection occurs, it can be associated with fetal ascites, meconium peritonitis, neonatal icteric HAV infection, and distal ileum perforation.
Overall, infection with HAV is a result of poor hygiene and can be prevented through appropriate food handling and water sanitation. Hepatitis A virus infection is preventable with a vaccine and has a largely favourable expected outcome with regard to the mother and the fetus.
However, infection in the second and third trimesters has been associated with preterm labour and other complications. Breastfeeding should not be discouraged in mothers with HAV infection. Infants should be protected by administration of either immunoglobulin and/or the inactivated HAV vaccine.