Hepatit B Enfeksiyonu ve Gebelik
Özet
Küresel ve ulusal düzeyde önemli bir halk sağlığı sorunu olan Hepatit B enfeksiyonunun (HBV) gebelik dönemindeki yönetimi, tarama programları ve perinatal bulaşın önlenmesi büyük önem taşımaktadır. Karaciğer yetmezliği ve primer karaciğer kanserine yol açabilen HBV açısından Türkiye orta risk kategorisinde yer almaktadır. Gebelik süreci genel olarak enfeksiyonun klinik seyrini değiştirmese de immüntoleran yapısı nedeniyle akut enfeksiyonlarda kronikleşme riskini artırabilmektedir. Anneden bebeğe geçiş çoğunlukla doğum esnasında anne kanı ve vajinal salgılarla temas yoluyla gerçekleşmekte olup, yüksek viral yüke (HBV DNA >200.000 IU/ml) sahip annelerde bulaş riski %90'a kadar çıkabilmektedir. Bu bulaşı önlemek amacıyla tüm gebelerin ilk trimesterde HBsAg yönünden taranması, riskli hastaların belirlenmesi ve yüksek viremi saptanan gebelerde 24-28. haftadan sonra Tenofovir (TDF) profilaksisine başlanması önerilmektedir. Doğumdan sonraki ilk 12 saat içinde bebeğe Hepatit B aşısı ve immünglobulini (HBIG) uygulanması dâhilinde dahi başarısızlık riski yüksek viral yükle ilişkilidir. Antiviral profilaksi alan veya almayan annelerin emzirmesi kontrendike değildir. Doğum sonrası dönemde ise annede gelişebilecek olası karaciğer enzim alevlenmeleri yakından takip edilmelidir.
Management, screening programs, and prevention of perinatal transmission of Hepatitis B virus (HBV) infection during pregnancy carry vital importance as it remains a significant global and national public health issue. Placing Turkey in the intermediate-risk category, HBV can lead to liver failure and primary liver cancer. Although pregnancy generally does not alter the clinical course of the infection, its immunotolerant nature can increase the risk of chronicity in acute cases. Mother-to-child transmission occurs primarily during delivery through contact with maternal blood and vaginal secretions, with the transmission risk escalating up to 90% in mothers with a high viral load (HBV DNA >200,000 IU/ml). To prevent this transmission, screening all pregnant women for HBsAg in the first trimester, identifying risk-bearing patients, and initiating Tenofovir (TDF) prophylaxis after the 24th-28th weeks of gestation in patients with high viremia are recommended. Even when the Hepatitis B vaccine and immunoglobulin (HBIG) are administered to the newborn within the first 12 hours of delivery, the risk of immunoprophylaxis failure is closely linked to a high maternal viral load. Breastfeeding is not counterindicated for HBsAg-positive mothers, whether they receive prophylactic antiviral therapy or not. Postpartum, mothers must be closely monitored for potential hepatic enzyme flares.
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