title: Acute hepatitis A infection in pregnancy is associated with high rates of gestational complications and preterm labor.
abstract: OBJECTIVE
  Hepatitis A virus (HAV) infection is the most common cause of acute hepatitis but is rarely reported during pregnancy. Our aim was to evaluate the impact of acute HAV infection on pregnancy outcome.
  
  
  METHODS
  Consecutive admissions of 79,458 pregnant females during a 25-year period were retrospectively reviewed.
  
  
  RESULTS
  Thirteen cases of second and third trimester HAV infection were found and evaluated. Nine of the 13 patients (69%) developed gestational complications, including premature contractions (n = 4), placental separation (n = 2), premature rupture of membranes (n = 2), and vaginal bleeding (n = 1). In 8 of these patients, complications led to preterm labor, at a median of 34 gestational weeks (range, 31-37 weeks). Delivery was vaginal in 12 of the 13 cases; fetal distress was noted in a single case, and meconium in amniotic fluid in 2 cases. Median birth weight was 1778 grams and 3040 grams in preterm and term deliveries, respectively (P < .05). Child outcome was favorable in all cases. In 4 cases, neonatal serum HAV RNA levels were measured and found negative. The presence of fever and hypoalbuminemia were associated with delivery at an earlier gestational week. There was a positive relation between gestational week at diagnosis of HAV infection and birth week (r = 0.68, P = .02), suggesting a causality relationship. All mothers featured full recovery from HAV infection.
  
  
  CONCLUSIONS
  Acute HAV infection during pregnancy is associated with high risk of maternal complications and preterm labor. HAV serology and maternal vaccination during prepregnancy evaluation should be considered in areas of the world in which susceptible adult populations exist.
authors.affiliation: Department of Internal Medicine, Mount Scopus Campus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. eelina97@md.huji.ac.il
authors.forename: Eran
authors.initials: E
authors.lastname: Elinav
authors.forename: Iddo Z
authors.initials: IZ
authors.lastname: Ben-Dov
authors.forename: Yami
authors.initials: Y
authors.lastname: Shapira
authors.forename: Nilli
authors.initials: N
authors.lastname: Daudi
authors.forename: Ruth
authors.initials: R
authors.lastname: Adler
authors.forename: Daniel
authors.initials: D
authors.lastname: Shouval
authors.forename: Zvi
authors.initials: Z
authors.lastname: Ackerman
mesh_terms: D000208:Acute Disease; D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D005334:Fever / Q000382:microbiology; D005865:Gestational Age; D006506:Hepatitis A / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D034141:Hypoalbuminemia / Q000382:microbiology; D007752:Obstetric Labor, Premature / Q000382:microbiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000382:microbiology*; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000175:diagnosis; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third