Scientists have found that Hepatitis, a common cause of liver cirrhosis and cancer, also makes people three to four times more likely to develop Type 2 diabetes. Furthermore, they warn that even in pregnancy, hepatitis is a major reason babies are born with jaundice and in severe cases, born either prematurely or dead, reports Sade Oguntola.

Hepatitis virus is among the major causes of loss of healthy life years in women. It is one of the important causes of liver cancer and acute and fulminant hepatitis in developing countries. Among pregnant women, hepatitis can lead to anaemia (low blood volume), postpartum haemorrhage (bleeding after child birth), organ failure and high death rate during pregnancy and poor outcome of their newborns such as still births, neonatal deaths (NND), liver disease and liver cancer.

Viral hepatitis is the most common cause of jaundice in pregnant women and pregnancy with jaundice (when the skin and whites of the eyes develop a yellowish tint due to a buildup of bilirubin) is considered as a high risk pregnancy. In fact, it is one of the most serious infections that occur in pregnant women and its incidence varies greatly around the world.

In developed countries, the incidence is around 0.1 per cent whereas in developing countries it can range from between three and 20 per cent or higher. For instance, researchers at the University College Hospital (UCH), Ibadan, over a 10-year period span (1992 to 2001), found that viral hepatitis occurred in one in 591.6 pregnancies and was diagnosed in 28 (58.3 per cent) cases of jaundice in pregnancy.

Ironically, if a survey is done in the town asking the people on the most widespread infection on earth, many of them will mention HIV, some people might say whooping cough while some people would name Tuberculosis or measles. But the most widespread infectious disease is hepatitis and it is a silent killer,” stated Professor Ade Ojeniyi, a public health expert and emeritus Chief Physician & Government Medical Adviser to Denmark Government.

Scientists have discovered different forms of viral hepatitis (hepatitis A virus, hepatitis B virus, hepatitis C virus, hepatitis D virus, hepatitis E virus and hepatitis G virus), all of which had preference for the liver. “As soon as they enter the body, the target organ is the liver and that is where they cause infections,” he explained.

Granted, the form of hepatitis that is most prevalent is hepatitis A worldwide. But hepatitis B is the biggest culprit in Africa. In addition, “hepatitis D can be extremely potent and very dangerous. It can be lethal, especially among pregnant women,” Professor Ojeniyi declared.

Hepatitis D can be lethal in terms of its impact on the liver cells, making the organ unable to carry out its four functions as it should–intermediate metabolism; production of heparin, which keeps the blood in its liquid form; detoxification function; and production of bile required for digestion of food.

Due to the functions of the liver imparted by hepatitis, he pointed out that the affected individual may experience such symptoms as yellow skin and eyes, malaise, dizziness, tiredness, unease without any exertion. In addition, Professor Ojeniyi stated that “the upper part of the person’s abdomen would be tend when touched, especially on the left side. Such a person could also be passing out very dark coloured urine due to the destruction of red blood cells.”

Unfortunately, many competing diseases in the community have similar symptoms like hepatitis. Since hepatitis is very common, everybody assumes that it is malaria and as such, start to treat malaria. “They would not know that they are actually dealing with hepatitis, especially if it is a low level hepatitis. Because the immune system was able to curtail it, it would not send the person to the hospital,” he explained.

“If the individual happens to have malaria alongside, intake of amtimalarial medicines will treat the malaria, leaving the body’s immune system to now concentrate on battling hepatitis. Of course, such a person might end up becoming a carrier of this disease even though the symptoms of the disease have disappeared,” Professor Ojeniyi stated. “The situation is different from when the viral load (the number of the active and living hepatitis particles) is high, and the immune system was unable to overcome the infection.”

However, many studies abound supporting the fact that hepatitis does not spare women, even when pregnant. In fact, a 2007 study carried out by Oladokun A, Otegbayo JA, Adeniyi AA, all at the University College Hospital (UCH), Ibadan, Oyo State, corroborated this and indicated also that apart from viral hepatitis causing jaundice in pregnancy, it was also associated with other problems in pregnancy such as anaemia, intrauterine growth retardation, still birth and heart failure (congestive cardiac failure) newborn deaths and systemic hypertension. It was reported in the African Journal of Medicine and Medical Sciences.

Ironically, the same group of researchers also studied the effect of viral hepatitis on newborn babies during a 10-year period in 16, 566 registered pregnancies at the hospital. They reported in the 2009 edition of the Niger Journal of Clinical Practice that over the period, preterm delivery occurred in 39.6 per cent, while still birth or intrauterine fetal death (IUFD) occurred in 8.3 per cent of cases, all occurring in the third trimester.

They stated: “Viral hepatitis, malaria and sickle-cell anaemia are the leading causes of jaundice in pregnancy.

These should be promptly diagnosed, investigated and appropriate management instituted as most of the deaths in unborn children can be avoided by close fetal monitoring, especially in the third trimester and with recourse to early delivery before fetal demise occurs.”

Nonetheless, scientists said that hepatitis B can cross the placenta to infect the unborn baby in about 10 to 20 per cent of cases and as such, hepatitis during pregnancy should be considered seriously. Out of the infected unborn babies, about 10 per cent will become chronic carriers.

If infected by hepatitis B in the first or second trimester, maternal and fetal complications are almost none. If affected during third trimester of the pregnancy, there will be increase chances of the woman developing complications of the infection, including death, liver failure as well as post partum hemorrhage (PPH). There is a high risk of premature delivery and still birth.

Prevention of Hepatitis (A, B, C, D, E) during pregnancy is by practising hygienic measures at home and universal precautions in all hospital procedures. Routing screening of blood donors is essential as hepatitis B, C and D are also transmitted through blood. Giving hepatitis B vaccine to females who are at higher risk of getting infected such as medical doctors and nurses and also vaccinating infants who are born to hepatitis B antigen positive pregnant mothers at birth, between the third month and finally sixth month of life are important measures of prevention. There is no harm in vaccinating all females for hepatitis B in the reproductive age, if they are planning to marry a high risk partner.

In addition, avoiding sharing of nail clippers, razor blades, toothbrushes, syringes or needles is important in the prevention of hepatitis as well as use of condoms whenever having sex (vaginal, anal and oral).

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