Clinical Characteristics and Gestational Complications Associated with Acute Hepatitis A in Pregnancy

Ho Seong Ryu; Seon Young Park; Sung Ryoun Lim; Hyung Il Kim; Won Ju Kee; Geum Soo Lee; Gun Young Hong; Sung Bum Cho; Sung Kyu Choi; Jong Sun Rew

doi:10.4166/kjg.2010.56.5.307

Journal List > Korean J Gastroenterol > v.56(5) > 1006735

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Ryu, Park, Lim, Kim, Kee, Lee, Hong, Cho, Choi, and Rew: Clinical Characteristics and Gestational Complications Associated with Acute Hepatitis A in Pregnancy

Original Article

Korean J Gastroenterol 2010;56(5):307-313.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.56.5.307

Clinical Characteristics and Gestational Complications Associated with Acute Hepatitis A in Pregnancy

Ho Seong Ryu, M.D., Seon Young Park, M.D., Sung Ryoun Lim, M.D., Hyung Il Kim, M.D., Won Ju Kee, M.D., Geum Soo Lee, M.D.^∗, Gun Young Hong, M.D.^∗, Sung Bum Cho, M.D., Sung Kyu Choi, M.D., Jong Sun Rew, M.D.

Department of Internal Medicine, Gwangju, Korea

^∗Chonnam National University Medical School and Christian Hospital, Gwangju, Korea

Correspondence to: Sung Kyu Choi, M.D. Department of Internal Medicine, Chonnam National University Medical School, 8, Hak-dong Dong-gu, Gwangju 501- 757, Korea Tel: +82-62-220-6203, Fax: +82-62-228-1330 E-mail: choisk@chonnam.ac.kr

Received 2 February 2010 Accepted 9 July 2010

Abstract

Background/Aims

Acute hepatitis A was recently significant increased among women with gestational age in Korea. However, the clinical course and gestational complications have not been fully elucidated in pregnant patients with acute hepatitis A. We evaluated the clinical impact of acute HAV infection in pregnancy.

Methods

Twelve pregnant women out of 85 female patients with acute hepatitis A during 6 years were retrospectively reviewed.

Results

The median age of the pregnant group was 26.5 years old. The number of patient with acute hepatitis A were 5 cases in the 1st trimester, 3 cases in the 2 ^nd and 4 cases in the 3 ^rd. 4 cases had significant gestational complications. One case experienced the abortion in 1st trimester and one fetal distress was noted in 3 ^rd trimester. The latter case was delivered of a low birth weight infant (2,390 g) caused by premature rupture of membrane in 36 weeks of gestational age. Other two cases experienced premature contraction and they had been required tocolytic treatment. But, all mothers featured full recovery from HAV infection. Except one aborted fetus and one premature birth, Newborn babies were not affected by maternal hepatitis A.

Conclusions

Acute HAV infection during pregnancy may be associated with the risk of gestational complications. HAV serology and vaccination for women with gestation age should be considered at high prevalence area of acute hepatitis A.

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Keywords: Hepatitis A, Pregnancy, Vaccination, Gestational complications

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Table 1.

Clinical Characteristics of the Pregnant Patients with Acute Hepatitis A

	First trimester (n=5)	Second trimester (n=3)	Third trimester (n=4)	All patients (n=12)
Age, year (range)	25 (23-27)	29 (28-31)	25.5 (22-29)	26.5 (22-31)
Parity(range)	1	1 (1-2)	1 (1-4)	1 (1-4)
Gestational age at admission, week	7 (5-12)	27 (15-27)	30.5 (28-35)	21 (5-35)
Gestational age at delivery, week		40	39	40
Newborn birth weight, g (range)		3,200 (3,000-3,900)	3,535 (2,390-3,800)	3,300 (2,390-3,900)
Gestational complication
Abortion	1	0	0	1
Premature contraction	0	0	2	2
PROM	0	0	1	1
Newborn complications
Low birth weight	0	0	1	1
Clinical manifestations
Jaundice	3	2	2	6
Nausea	3	1	0	3
Abdominal pain	3	1	0	4
Prutitis	1	0	0	1
Diarrhea	0	0	2	2
Laboratory parameters
Highest level during admission
AST, U/L	296 (71-2,124)	119 (55-969)	1,605 (93-10,080)	213 (55-10,080)
ALT, U/L	953 (189-2,660)	369 (209-720)	1,179 (277-3,220)	545 (209-3,220)
ALP, U/L	304 (100-375)	185 (146-201)	219 (153-305)	193 (100-375)
Total bilirubin, mg/dL	6.3 (2.78-13.1)	2.8 (1.1-4.1)	6.1 (1.6-7.2)	6.1 (1.1-13.1)
PT, sec	11.8 (10.3-13.7)	10.1 (9.9-10.6)	14.0 (10.4-21.3)	11.1 (9.9-21.3)
Hemoglobin, g/dL	12.9 (12.3-13.8)	12.9 (12.4-13.2)	12.2 (10.6-14.8)	12.9 (10.6-14.8)
WBC, 10³/mm³	6.70 (6.3-9.0)	8.40 (7.7-9.1)	10.6 (9.8-18.2)	8.70 (6.3-18.2)
Platelet, 10³/mm³	393 (199-530)	269 (239-452)	228 (181-380)	268 (181-530)
CRP, mg/dL	0.5 (0.37-1.0)	1.0 (1-1.7)	2.7 (2-12.6)	1.0 (0.37-12.6)
Lowest level during admission
Albumin, g/dL	3.4 (2.8-3.8)	2.9 (2.9-3.3)	2.8 (2.7-3.2)	3.0 (2.7-3.8)

PROM, premature rupture of membrane; WBC, white blood cell.

Table 2.

Gestational Complications and Laboratory Findings in Pregnant Patients with Acute Hepatitis A

	1st trimester	3rd trimester
	Patient A	Patient B	Patient C	Patient D
Age, year	25	29	26	25
Parity	1	4	1	1
Gestational age at diagnosis, week	5	29	28	35
Gestational age at gestational complication, week	6	29	31	36
Gestational complications	Threatened abortion	Premature contraction	Premature contraction	PROM
Delivery type	-	Vaginal delivery	Vaginal delivery	Vaginal delivery
Newborn birth weight/sex, g	-	3,770/♀	3,300/♀	2,390/♀
Fetal complications	Abortion			Meconium stain low birth weight
Laboratory parameters
AST, U/L	156	10,080	130	46
ALT, U/L	790	3,220	277	99
ALP, U/L	121	148	152	215
Total bilirubin, mg/dL	5.8	2.7	1.6	6.19
PT, sec	11.8	19.8	10.4	10.4
Albumin, g/dL	3.0	2.8	3.2	3.2
Hemoglobin, g/dL	12.9	10.8	10.6	13.5
WBC, 10³/mm³	8.3	7.4	5.7	16.0
Platelet, 10³/mm³	305	124	181	160
CRP, mg/dL	0.6	2.5	2.0	2.3

PROM, premature rupture of membranes; WBC, white blood cell.

Table 3.

Comparison of Clinical Course between Pregnant and Non-pregnant Patients in Acute Hepatitis A

Parameters	Non-pregnancy (n=24)	Pregnancy (n=12)	p-value
Age, years	26.5±2.3	26.3±2.7	0.846
Hospital days	12.9±5.0	9.2±5.2	0.044
Highest level during admission
AST, U/L	3,290±2,576	1,532±2,863	0.071
ALT, U/L	2,866±1,925	1,144±1,118	0.007
Total bilirubin, mg/dL	6.2±3.3	5.4±3.3	0.545
PT, sec	15.3±2.9	12.5±3.5	0.018
Lowest level during admission
Hemoglobin, g/dL	11.6±1.1	11.2±1.1	0.331
WBC, /mm³	3,157±1,195	6,458±1,625	0.000
Platelet, 10³/mm³	141±66	223±107	0.028
Albumin, g/dL	3.6±0.5	3.1±0.4	0.002

WBC, white blood cell.

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