Hepatitis A vaccine

(Date of issue: September 2016. Version: 3)

This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.

What is hepatitis A?

Infection with the hepatitis A virus can cause temporary liver damage, nausea and vomiting, itching, a high temperature, yellowing of the skin and eyes, and aches and pains. The effects of the virus are usually short-lived but can occasionally last for many months, and in rare cases result in liver failure. Hepatitis A is mainly passed on through the consumption of contaminated food and drink, and is linked to poor hygiene.

Hepatitis A infection in pregnancy is not thought to affect the baby’s development, although infection in the second and third trimesters has been linked to pregnancy complications including preterm labour.

Hepatitis A is uncommon in the UK and high income countries, but is common in India, Pakistan, Bangladesh, Nepal, sub-Saharan and North Africa, parts of the Far East (excluding Japan), South and Central America, and the Middle East.

Should I be vaccinated against hepatitis A if I am pregnant?

Hepatitis A vaccines (Avaxim®, Epaxal®, Havrix®, Vaqta®) are given to reduce the risk of a person catching hepatitis A. UK guidelines recommend that pregnant women can be vaccinated against hepatitis A if they are at risk of catching the illness. If you are travelling to a high risk area it is advisable to ask your doctor about having the hepatitis A vaccine before you travel.

Do I need to do anything if I had a hepatitis A vaccination but didn’t realise I was pregnant at the time?

There are currently no known risks to the mother or her unborn baby from being vaccinated against hepatitis A during pregnancy.

It is, however, always a good idea to let your doctor know that you are pregnant if you have been vaccinated or are taking any medicines. You and your doctor can then decide together whether you still need the medicines that you are on and that you are taking the lowest dose that works. Your doctor will also be able to assess whether you need any additional monitoring during your pregnancy.

Can being vaccinated against hepatitis A in pregnancy cause my baby to be born with birth defects?

A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects.

No large studies have investigated whether birth defects are more common in babies born to women vaccinated against hepatitis A in pregnancy. So far the only published scientific information is from case reports of 134 babies born to women who received the hepatitis A vaccine in pregnancy. Only two of these babies had birth defects, which is no greater than would be expected in the same number of women in the general population. However, before we can say that exposure in the womb to hepatitis A vaccine does not cause birth defects in the baby, large, well-designed studies of the pregnancy outcomes of many more women vaccinated against hepatitis A in pregnancy are required. 

Can being vaccinated against hepatitis A in pregnancy cause miscarriage?

A single study showed that women receiving a hepatitis A vaccine in the three months before conceiving were less likely to miscarry compared to women who were given a different vaccine. A study of 160 pregnant women who were vaccinated against hepatitis A in pregnancy also did not indicate that they had a higher chance of having a miscarriage compared to women in the general population. However, large studies of many more pregnant women vaccinated against hepatitis A in pregnancy are required to confirm this.

Can being vaccinated against hepatitis A in pregnancy cause stillbirth, preterm birth, or my baby to be small at birth (low birth weight)?

No large studies have investigated whether stillbirth, preterm birth, and low birth weight in the baby are more common following exposure to hepatitis A vaccine in pregnancy. A review of reported side effects in 134 pregnant women who were vaccinated against hepatitis A in pregnancy did not show that stillbirth or a preterm delivery was more common than in women in the general population. However, large, high quality scientific studies that measure the likelihood of all of these pregnancy outcomes following hepatitis A vaccination in pregnancy are required to accurately answer these questions.

Can being vaccinated against hepatitis A in pregnancy cause learning and behavioural problems in the child?

A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy could have a lasting effect on a child’s learning or behaviour.

No studies have investigated learning and behaviour in children who were exposed in the womb to hepatitis A vaccines. Research into this subject is therefore required.

Will my baby need extra monitoring during pregnancy?

As part of their routine antenatal care most women will be offered a scan and blood tests from around 11 weeks of pregnancy, and a further scan at around 20 weeks to look for birth defects in the baby. Being vaccinated against hepatitis A in pregnancy is not expected to cause problems that would require extra monitoring of your baby.

Are there any risks to my baby if the father has been vaccinated against hepatitis A?

No studies have specifically investigated whether hepatitis A vaccine used by the father can harm the baby through effects on the sperm, however most experts agree that this is very unlikely. More research on the effects of medicine use in men around the time of conception is needed.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.

General information 

Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks.  They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.

Medicines use in pregnancy

Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby.  There are, however, some medicines that can harm a baby’s normal development.  How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.

If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.

When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.   

Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.

   

www.medicinesinpregnancy.org

Disclaimer: This information is not intended to replace the individual care and advice of your health care provider. New information is continually becoming available. Whilst every effort will be made to ensure that this information is accurate and up to date at the time of publication, we cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes following decisions made on the basis of this information. We strongly advise that printouts should NOT be kept for any length of time, or for “future reference” as they can rapidly become out of date.

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