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Hepatitis in Pregnancy: New Indian Study Reveals Risks to Mothers and Families
Introduction
A groundbreaking study by the Department of Medical Gastroenterology and Obstetrics & Gynecology at PGIMS, Rohtak, has shed new light on the impact of hepatitis on maternal and family health in India. With hepatitis B and C posing significant threats during pregnancy—including increased risks of miscarriage, preterm birth, and intra-family transmission—the study’s findings underscore the urgent need for enhanced prevention, screening, and treatment strategies. As viral hepatitis remains a leading cause of maternal and perinatal complications globally, this new research provides vital data for both healthcare providers and policymakers, marking a pivotal contribution on World Hepatitis Day.
Major Findings: Hepatitis B and C in Maternal and Familial Health
Alarming Miscarriage Rates and Vertical Transmission Control
The PGIMS study found a 26% miscarriage rate among pregnant women with hepatitis C—a figure substantially higher than that seen in the general population. In hepatitis B cases, a 13% familial prevalence was noted, indicating significant spread within families. Importantly, prompt vaccination and early initiation of antiviral therapy in pregnant women led to near-total elimination of vertical transmission of hepatitis B, protecting newborns from perinatal infection. The study team credited these results to a rigorous protocol of maternal antiviral treatment combined with immediate newborn immunization, reflecting the latest recommendations from the World Health Organization (WHO).
Broader Health Risks in Pregnancy
Beyond direct transmission, hepatitis B and C during pregnancy have been linked to:
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Increased risk of gestational diabetes (relative risk: 1.16 for hepatitis B)
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Higher rates of preterm delivery (up to 17% higher for hepatitis B, 20–26% higher in large cohort studies)
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Elevated chances of pre-eclampsia, intrahepatic cholestasis, and placental abruption
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Higher frequency of caesarean delivery, postpartum hemorrhage, and low birth weight infants
These findings align with established global research linking hepatitis infection in pregnancy to perinatal morbidity and infant mortality.
Familial and Community Transmission: Prevalence and Prevention
The study reported a 5–6% rate of sexual transmission for both hepatitis B and C between partners. Proactive measures—such as vaccinating all hepatitis B-negative family members and expanding vaccination to healthcare workers—were central to containment. At PGIMS, over 26,000 patients with hepatitis C and 12,000 with hepatitis B have been treated, largely free of cost, under the National Viral Hepatitis Control Programme.
India’s Public Health Response
Screening and Vaccination
India faces a hepatitis B prevalence of 2–7.7% among pregnant women, with significant regional variation. National and WHO guidelines recommend universal screening during pregnancy, hepatitis B immunoglobulin and vaccine at birth, and close follow-up. Targeted public health campaigns at PGIMS resulted in the vaccination of 8,000 healthcare workers and distribution of over 24,000 doses of the hepatitis B vaccine.
Innovations in Care and Equity
PGIMS’s model emphasizes free access to antiviral therapy, broad outreach for early case detection, and point-of-care viral load testing for efficient treatment initiation. These steps, now echoed in updated WHO guidelines, focus not only on reducing transmission but also on cutting the risk of cirrhosis, liver cancer, and long-term disability.
Persistent Challenges
Despite advances, challenges remain:
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Stigma and lack of awareness persist, especially regarding mother-to-child transmission and preventive opportunities.
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Rural areas and marginalized groups remain at higher risk due to limited access to screening and vaccination.
Quotes and Expert Perspective
Dr. Parveen Malhotra, Senior Professor at PGIMS, stated:
“Rigorous preventive protocols and community action have nearly eliminated vertical hepatitis B transmission in over 500 pregnant women. This achievement is a model for the country and demonstrates that timely intervention saves both mothers and babies.”
The study’s lead researchers note a continuing need for education, outreach, and resource allocation to maximize the benefits observed in Rohtak nationwide.
Conclusion: Implications for Policy and Practice
The PGIMS, Rohtak study has crucial implications for India’s hepatitis control strategy. With maternal hepatitis now recognized as a significant factor in poor pregnancy outcomes and family health risks, the evidence supports:
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Expanding universal screening and early treatment for hepatitis B and C in pregnancy;
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Ensuring immediate vaccination of newborns and at-risk family members;
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Strengthening community-based interventions and public health awareness;
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Aligning national policies with WHO’s new 2024 guidelines for hepatitis management.
As India marks World Hepatitis Day, the Rohtak findings offer hope and a blueprint: With proper protocols, vertical transmission of hepatitis can be all but eliminated, and maternal and child health outcomes markedly improved. Sustained investment and vigilance are essential for achieving the goal of hepatitis elimination in India by 2030.