Hepatitis A infection is usually not more severe during pregnancy than at other times, and does not affect the outcome of pregnancy. There have been reports, however, of acute fulminate conditions in pregnant women during the third trimester, when there is also an increased risk of premature labor and fetal death. These events have occurred in women from developing countries, and may have been related to underlying malnutrition. The hepatitis A virus is rarely transmitted to the fetus, but this can occur during viremia or from fecal contamination at delivery (Tanaka 1995). ^^
Hepatitis A vaccine contains inactivated hepatitis A viruses that are cultivated from human cell cultures. Its use in pregnancy has EJ not been systematically investigated. However, there is no indica- ^^ tion of developmental toxicity.
Recommendation. Pregnant women without immunity to hepatitis A need protection before traveling to developing countries. Based on the experience with other inactivated viral vaccines, hepatitis A vaccine can be given to the pregnant woman at high risk of infection. Immune globulin is safe and effective in preventing hepatitis A, but immunization with one of the hepatitis A vaccines gives a more complete and prolonged protection.
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