Diagnostik und Therapie der Virushepatitis in der Schwangerschaft

According to the updated German maternity guidelines, determination of the hepatitis B antigen (HBsAg) is recommended as early as the first trimester of pregnancy in cases of a lack of immunity against HBV in order to initiate antiviral treatment of chronic Hep B-infections before the 28th week of gestation to prevent vertical transmission to the fetus. After diagnosis of an HBV infection an additional hepatitis delta virus (HDV) infection always has to be excluded as only HBV positive pregnant women can be simultaneously or subsequently infected with HDV. The incidence of hepatitis C (HC) in Germany is currently under 1%. The most important route of transmission among drug users is still needle sharing. Among HCV positive women the perinatal transmission rate to the neonate is approximately 6–7% of pregnancies. Hepatitis C has been curable since 2014 by an antiviral treatment with RNA polymerase inhibitors lasting 8–12 weeks, which however is contraindicated during pregnancy. Nevertheless, every HCV-infected pregnant woman should be referred prepartal to a specialist for infections for a timely planning of the postpartal antiviral treatment. Hepatitis A (HepA) and E (HepE) are transferred via a fecal-oral route. An inactivated vaccine against HAV is available, which can also be safely applied in pregnancy. Symptoms of an acute Hep E infection cannot be distinguished from Hep A, but the course of the disease is much more severe in Hep E. In our latitudes is transferred (genotype 3) to pregnant women from pigs, sheep and rodents. The mortality in pregnant women who are infected with hepatitis E virus (HEV) genotype 1 in endemic regions (e.g. north India) is 20–50% but this does not apply to pregnant women in Europe and Germany who are infected with HEV genotype 3. In this group not a single maternal death has been caused by HEV.