Ep98: Hepatitis in Pregnancy and Birth with Dr. Keisha Reddick

Dr. Keisha Reddick is back with us on the podcast! This is her third time joining us to share her expertise, and this time we are talking all about hepatitis and what you need to know about how it could affect your pregnancy and birth. 

Dr. Reddick is a Maternal Fetal Medicine doctor who works in high-risk obstetrics. She has been in practice for over a decade offering total care: delivering babies, giving prenatal care and consults, and directing protocols for her labor and delivery unit. 

I have received a few questions over the years about hepatitis in pregnancy, so we are going to talk about what exactly hepatitis is, the different types, how common it is, how it is transmitted, and much more.  We'll then talk about how hepatitis can affect your prenatal care, labor & deliver, and the postpartum period.

We also talk a bit about the importance of keeping up to date with vaccinations and your overall health before and between pregnancies. This episode is absolutely packed with great information!

In this Episode, You’ll Learn About:

  • What hepatitis is and how hepatitis A, B and C differ from one another
  • How common hepatitis is in pregnant people and how it is transmitted
  • Risk factors for contracting hepatitis
  • What to know about hepatitis vaccines and when you will likely receive them
  • Why it is important to know your hepatitis status and why there shouldn't be any stigma around the diagnosis
  • How your prenatal care might change if you have hepatitis and how it will affect your labor & delivery
  • Why you should have a preconception consultation if you know you have hepatitis and are going to start trying to conceive


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Transcript

Ep98: Hepatitis in Pregnancy and Birth with Dr. Keisha Reddick

Nicole: In this episode, you're going to learn about hepatitis in pregnancy.

Nicole: Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OB GYN who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, competent, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it. Well, hello there. Welcome to another episode of the podcast. This is episode number 98. Thank you for being here with me today. So in today's episode, you're going to learn about hepatitis in pregnancy. I've actually had this episode on my list to do for a long time after I received the following email last year. And I will say, I'll just say that it's from M and the email says I just finished episode 48 on STI's. I'm curious when you will be covering the hepatitis viruses, I'm currently 11 weeks pregnant and just got my blood work lab results back. It turns out my doctor's office found antibodies for Hep C in my blood. It's so bizarre and scary because I'm not a drug user and never have been. Although I do have several tattoos, one of which was done in a private home. My mind is absolutely spinning right now with so much anxiety wondering if my baby and I are going to be okay.

Nicole: PS, a podcast episode on Hep A, B and C with Dr. Keisha Reddick would be a really good one. So at the time I gave her some resources that she could look into. And now here is the episode with Dr. Keisha Reddick. For those of you who've listened to the podcast for a while, or you binge listen to the podcast after you find it. I know a lot of folks do that. Then the name Dr. Keisha Reddick will sound familiar. She is a high-risk pregnancy doctor and a good friend of mine. She and I did residency training together at Duke, and she's been on the podcast twice before, she is my go-to person for all things related to high risk pregnancy. And she knows the topic of hepatitis in pregnancy very well. So in this episode, you will learn what hepatitis is, including the different types, how it is transmitted, what are risk factors for having hepatitis, how common it is, and pregnancy spoiler alert:

Nicole: It's not very common. What are the recommendations for screening for hepatitis, how it can affect pregnancies for moms and babies, including pregnancy care and labor management, how to reduce the risk and what a person should do if they have hepatitis and they are thinking about getting pregnant. As you can see, this episode is jam packed with some really important and useful information, and you are going to learn a lot. Now, one of the things Dr. Reddick will emphasize in the episode is the importance of being prepared and an important part of being prepared is childbirth education. The Birth Preparation Course is my signature online childbirth education class, that ensures you are calm, competent, and empowered to have a beautiful birth. Here's what one student had to say about the course. I love how the Birth Preparation Course is very informative and empowers me to make decisions that are best for my baby.

Nicole: I also really love how you present factual information in a way that isn't judgmental of anyone. I wanted someone who was experienced and could just tell me information. Well, that is exactly what you get with me. And as good as the course is, I'm actually working on making it even better. I've updated the entire course with new information and new visuals. It is even that much more amazing. I'm releasing the new course at the end of this month. So now's a good time to snag it because the course price will probably go up a bit with the new release. And if you buy it now you get access to the new release as well. When you enroll in the course, you get access to all future updates. So you can check out the details at drnicolerankins.com/enroll. Okay, let's get into the episode on hepatitis with Dr. Keisha Reddick.

Nicole: Thank you, Dr. Reddick, for coming back on to the podcast. For those of you all who have listened, this will be her third time. Besides me, she's the person who's been on the podcast the most. Um, and that's of course, because you're one of the best maternal fetal medicine doctors I know.

Keisha: Well, thank you for having me again. I look forward to continuing our podcast relationship, so I'm excited.

Nicole: Yeah. So, um, for those of you who may not know you already, just tell us a little bit about yourself, your work and your family, if you'd like.

Keisha: Sure. I am a maternal fetal medicine doctor. So I am double boarded in OB GYN and maternal fetal medicine, which is high risk obstetrics. Um, I have been in practice for out of training for well over a decade. Um, I currently practice in Savannah, Georgia. Um, I do total care, meaning I do deliveries and I take care of patients for during their prenatal visits, as well as consults. I, um, also serve as the medical director for our labor and delivery unit. So I am able to participate in protocols, which is great. Um, I love the area that I practice in. I'm married. Um, my husband's a physician, so our life is really interesting and, um, I have three children. Um, so I think I've said this before in your podcast, I have a teen, a preteen and a toddler. So, um, it's really fun.

Nicole: Yes, she, she does all the stages.

Keisha: So yeah. So all the stages of childhood are going on in my life right now, in addition to working full time. Yes. Um, but I don't know any other way to do it.

Nicole: Yeah. Yeah. And y'all I will also say like, this is, um, Keisha is a little bit unique in that a lot of high risk pregnancy doctors MFMs don't necessarily do deliveries anymore. A lot of them do a lot of work in the office, but she does the full spectrum of things. And, um, I think it's okay for me to also throw in that she has the experience of having a preterm baby as well and having preeclampsia as well. So she has a full well, like the whole gamut of experience, which is why I love having her on the show.

Keisha: Well, this is what I always tell patients, anything that I've done to you all it has been done to me pretty much. So I really do have a perspective from, you know, as a patient, um, to talk to, you know, my own patients who are high risk, um, which, you know, I don't always give people my personal story, but sometimes I think is helpful for people to realize that, you know, yes, I am a physician, but I'm just a regular mom. I'm a human being who has gone through some medical complications. So I can completely relate to what our patients are going through.

Nicole: 100%. And y'all, she was also there at my first C-section as well. So we've known each other for a long time. All right. So today we are talking about hepatitis. And I w what I decided to do to this topic after having somebody actually more than one person reach out and ask about it, just wondering about it. And then also a couple of people who had it during pregnancy and, um, you know, were just wanting to know what to do, so we will get into all of that today. So let's start off with just a general overview of like, what hepatitis is and how is it transmitted.

Keisha: So hepatitis is basically a viral infection of the liver. And, um, you know, typically when we see patients we're talking about hepatitis B and hepatitis C, so the more common ones altogether would be hepatitis A, B and C. So I kind of call it the ABCs of hepatitis. Um, there are a couple other types of hepatitis. There are, you know, typically more rare in pregnant patients. Um, and there's one that can be pretty serious for pregnant women, but we typically don't see those, and I've never seen those other two types, which is D and E I've never actually had a patient with that. Um, but the more common things that we will see in the general population is A, B and C. And I think maybe the people who've reached out to you through your podcast are probably individuals who have had hepatitis B or C.

Nicole: Yeah, yeah, yeah. That's definitely the most common. And then how is it transmitted?

Keisha: So hepatitis A is probably the one that people hear about on the news when certain restaurants are closed. Um, so that one is, is one that is food contamination, it's fecal oral transmission. So it's really kind of has to do with hygiene. Um, most people were recover from hepatitis a, you know, it, it will make you feel like you have like a bad viral illness or a bad food poisoning, but most people who are otherwise healthy will, you know, be ill for a while and then they'll get better. Um, only a very small percentage of patients with hepatitis A will be sick for a longer period of time in general. And pregnancy is the same type of, um, duration. So, you know, maybe a few days of feeling ill, but those patients typically bounce back. Hepatitis B and C on the other hand are bloodborne pathogens.

Keisha: So when I say that, I mean, they are transmitted through secretions. Um, so you can get hepatitis B or C through blood. Um, so for patients who are individuals who are struggling with substance abuse or needle sharing, uh, if you have patients that are, um, sexual with sexual intercourse, you can get hepatitis B or C. Um, so and also, you know, if you're having patients who are having exposure to needles through maybe tattoos that are not sanitized, those are the methods that your hepatitis B and C that you can get transmitted either pregnant or non-pregnant.

Nicole: Got it. Got it. So then some risk factors. You mentioned like needle sharing, tattoo, sex, obviously. Are there other like characteristics or patient risk factors that make you at higher risk for potentially getting hepatitis or having hepatitis?

Keisha: So interestingly with hepatitis B, um, I actually have seen quite a few patients that have gotten it perinatally. Um, so those are patients who may have gotten it from their mother. So I have some patients that did not even know, you know, until that they, until they were pregnant, um, that they were a carrier of hepatitis B. You guys, you, you know, most people aren't necessarily tested for that, uh, in general. Um, so, but they are tested during pregnancy. So some people, yeah, I've actually had a patient who she couldn't recall why her mother had passed away. And then when we did a little bit of digging and turned out, her mother had hepatitis. So she presumably got it from her mom. Um, in terms of, you know, other characteristics with patients, you know, individuals who were exposed to IV drugs, or even, you know, the risk factor for things like blood products is pretty low. So for example, for, you know, uh, transfusions I know patients get concerned about that, but that risk is actually really low for, um, hepatitis B and C.

Nicole: Yeah I always tell folks, you have a better chance of being struck by lightning than getting hepatitis from a, from a blood transfusion. Yeah. Okay. So can hepatitis be prevented?

Keisha: Uh, yes it actually can be prevented. There is a hepatitis B vaccine and anyone, and everyone should be vaccinated against hepatitis B. Most children are vaccinated early in life. It is a two series shots. So you get two injections for the vaccine. It is a safe vaccine to get while you are pregnant. So actually pregnancy is a nice time to capture patients to get up to date with vaccinations. The ones that are at least are approved and that are safe for you to do. But hepatitis B is one of them. So patients who are not immune to hepatitis B, you can get a vaccine for that. There is a vaccine for hepatitis A, so most people are getting treated or getting immunizations against hepatitis A. In the past, it used to be that if someone was traveling to certain areas, they may get it, but it is pretty much a commonplace, a vaccine for patients to get. So for hepatitis a, it is actually a two series shot. And I think I misspoke for hepatitis B is actually three series shot. Um, so those two, you can have immunizations, but for hepatitis C, there is nothing except for usual precautions, but not a vaccine.

Nicole: Got it, got it. So that I knew that there was a hepatitis A vaccine. And I remember getting it way back when, when I studied abroad, of course, that was like 20 years ago. So it was a long time ago. So I didn't know it was offered more commonly now to folks. And I know hepatitis, I should say, we should say, like, it's actually not most folks who are reproductive aged women people probably have had the hepatitis B vaccine at this point. Would you say that's fair?

Keisha: I would say that's fair. Um, because I, you know, I'm even thinking about when I had the hepatitis B vaccine was actually closer 20 years ago. I think it was right when I was getting, going into med school. Um, so now most patients have gotten it. Some OB providers carry those vaccines in their office. Um, our practice does not. So what I typically will instruct patients to go to the health department. So for example, even if I have a patient that has hepatitis B or C, they should still be vaccinated against hepatitis A, uh, because for someone who is otherwise healthy and has a healthy liver, remember those patients may have like a food poisoning illness, but if you already have an underlying liver disease, then you may actually get sicker from hepatitis A. So I will instruct those patients to go and get the vaccine while they're pregnant.

Nicole: Got it. Got it. That makes a lot of sense. Yeah. I actually had to do the hepatitis series over again because like I did two, and then I missed the third one and then I wasn't immune. So I did, I think I got like five, I had to do it all over again, but yeah. So, so for most people you will be vaccinated against hepatitis B but not hepatitis C?

Keisha: Correct. Correct. Correct. And that's the one that's a little bit more challenging because there are trials for, but there's not a treatment that you can give patients during pregnancy and even the treatment that is available, you have to be at a certain facility to be able to receive it for the hepatitis C.

Nicole: Yeah. And actually hepatitis C I guess treatment in general is fairly new. I mean, for a long time, it was like a, I shouldn't say a death sentence, but it was bad.

Keisha: Yeah, correct. So it is fairly new. It is very expensive for hepatitis C treatment, but there are some clinics that are doing early trials with, um, some antiviral medications, but that's not necessarily the common place situation for hepatitis C. The good thing about hepatitis C, I should say one positive thing is that, you know, out of the patients who are exposed about 15% of those patients might just clear it altogether. Okay. So, you know, not everyone who gets exposed to hepatitis C will have it forever. The majority of them might, but there is a small percentage of patients who might clear it just on their own. So not everyone will, you know, result in, you know, the, the things we get concerned about with hepatitis C, such as, you know, cirrhosis and carcinoma of the liver. Those are things that, you know, may, that those patients might not encounter at all.

Nicole: Got it. Got it. That's good to know. It just because you get it doesn't mean it's going to be awful for you. Exactly, exactly. Yeah, exactly. Yeah. And I guess we should talk about that. Like, so, or maybe we can talk about a specific to pregnancy, some of the things that happens with it. So let's first start off with how, how common is hepatitis in pregnancy.

Keisha: For hepatitis C. It's not very common. I mean, it's about 4%. Um, I think we've seen slightly increasing rates in these last few years, you know, that may be due to just substance abuse increases and opioid use increase. Um, but overall we don't see a lot of hepatitis C. In terms of hepatitis B it's very much, I, you know, I really don't have a lot of patients that I would say that prevalence rate is probably similar. Um, and that we don't have that many patients with it. Um, most of those patients again are, you know, they're pretty staple and chronic carriers.

Nicole: Got it. Got it. So not something that people don't need to be walking around, like overly worried that, Oh my goodness, I may have hepatitis in pregnancy.

Keisha: No, no, no. It's not, not very common.

Nicole: And then how do we screen for it?

Keisha: Very good question. Um, so for hepatitis C, we used to just not screen at all. Um, and then a couple of years ago there was a paper that talked about specific indications for screening patients. So if a patient had a history of any substance abuse or if a patient has ever been incarcerated or, you know, if they've had other, um, multiple STIs or if they showed up for, um, testing or screening for sexually transmitted infections, but more recently, we're seeing there's the trend to actually screen everyone. So any patient that is in our practice, they're all get screened for hepatitis C and we're testing basically a hepatitis C antibody. And interestingly, you know, sometimes we pop up and see someone who didn't know that they had had exposure or that there may be a chronic carrier for hepatitis C. For hepatitis B, all patients are universally screened and we're actually testing for a hepatitis B antigen. Um, so once we see that's positive and we confirm that that patient has never been vaccinated and doesn't have an antibody, then we know that that patient is at least a chronic carrier. I don't see a lot of patients with acute hepatitis meaning that's a very new infection that they've gotten. I've had a couple of patients that we've treated with that, but the majority of patients are folks who've gotten it at some point in their life and is just a chronic carrier.

Nicole: Got it. So the things that we're kind of looking for, like for hepatitis C, because there's no vaccine, you're actually looking to see if there's been some exposure to it before, but the testing for hepatitis B essentially is a little different because most of us have been vaccinated essentially. Correct? Correct. Um, and yeah, I didn't realize that we were testing more and more people are testing for hepatitis C until recently. It's been a minute since I've been in the office doing prenatal care. So, um, recently, like within the last couple months we were talking about it in a, in a meeting and I was like, Oh, I didn't know that this was kind of a new thing in prenatal care that we test everybody for hepatitis C as well, just like we do for HIV, which we've been doing for years and hepatitis B for years.

Keisha: Right. We actually have a grant at our hospital where anyone who comes through our emergency room gets screened. Uh, and I think it helps to take away the stigma, you know, um, you know, years and years ago, you might remember where for HIV, you had to sign a consent form to get tested for HIV. And that just adds a layer of, uh, you know, the stigma to this. And so, as opposed to saying well, we got to test you for this. So I need your signatures. Like, you know, these are all the things we need to know what's going on with your health, because if we know this now, then we can take care of you. We can treat you appropriately during your pregnancy. We can make sure your baby is screened. So I try to take that approach with patients, as opposed to the, is this scary virus that we're going to have different thoughts, because I think patients get concerned that, you know, wow, if I have this condition then what are you going to think about me? And it's like, it's no different in diabetes. You know, if, if you have diabetes, I want to treat that. I need to know it. So hepatitis and HIV is no different to me then you having any other medical complications.

Nicole: That as it very well should be. I think that's a really important point of trying to like, de-stigmatize it, it doesn't mean anything about you as a person. So let's talk about if a woman has hepatitis in pregnancy, what are the risks for her pregnancy and what is, what is the care going to be like?

Keisha: Great. So for hepatitis C your care really doesn't change a whole lot. Um, I think the number one thing moms are concerned about is will my baby get this? Absolutely. And so the risk of transmission is about 5%. Okay. Now, if a mom has hepatitis C and HIV, that risk is doubled to about 10%. So, you know, you're going to have a higher risk if you have the two viruses, cause they're kind of act synergistically. Um, during the pregnancy, there's not, like I say a whole lot of things we do differently. We used to do serial liver function tests. So those are labs that assess your liver function. I think it's reasonable to do that at the initial part of the pregnancy, but unless they're abnormal, there's not a strong recommendation to keep doing that throughout the whole pregnancy. You know, one of the things that I counsel patients about is protecting their partners.

Keisha: So, you know, if you are positive for hepatitis B or C, that you need to have barrier methods and you need to alert your partners of your status, there isn't anything specifically about, you know, screening the baby or anything during the pregnancy. Because again, there's not a treatment that you can do during pregnancy that's safe to use or that's available. Um, patients can still have a vaginal delivery, if they have hepatitis C, they don't have to have a C-section that hasn't been shown to decrease the risk of transmission. So, you know, we would only do a C-section for the usual obstetric indications. Ideally, you know, if the patient just comes in and labor is the best thing, because then they're not in labor for an extended period of time. And actually with hepatitis C, patients can breastfeed. The only patients who wouldn't be able to, you know, if they have cracked or bleeding nipples, but there isn't anything that says that those patients cannot breastfeed.

Keisha: The most important thing is really making sure patients have good follow-up after they're delivered. Um, and so, you know, in some areas that's kind of hard because the patients don't have the resources to get to facilities that will treat them depending on their insurance status. Uh, we are fortunate here that we have a couple of clinics that will take patients who are either uninsured or are publicly insured through the state for following them and doing things like liver scans after they're delivered, but ultimately during the whole pregnancy they're pregnant, you know, we besides them making sure they're abstaining from alcohol. Um, I review over with patients like the maximum dose of Tylenol, which is less than what is written on a regular Tylenol bottle. The remainder of it is pretty much the same as a, you know, other high risk pregnancy. We just kind of keep a close eye on those patients.

Nicole: Interesting. So anything about issues with growth for the baby or anything like that?

Keisha: So there's some studies that show there could be a slight increased risk for low birth weight. Um, the only other concern is that there's a higher risk for something called cholestasis in pregnancy. That's where women get bile acids on their skin. So they end up being very itchy during their pregnancy. So I will counsel patients like, Hey, these are things we should be looking out for during your pregnancy. But besides maybe a growth scan in the third trimester, there isn't a lot of other screening that we need to do unless the mom has had abnormal liver function tests at the beginning of the pregnancy.

Nicole: Gotcha. And then in that case, you just kind of monitor and see how things are?

Keisha: Exactly. Exactly. And if there's a provider that, you know, will be amendable to seeing the patient while they're pregnant, then I would try to get them looped in with them. Um, because I always prefer to do that during pregnancy, as opposed to waiting to afterwards, but sure. You know, it's just really just going to depend on your area and if you have GI specialist or, you know, someone who's an internal medicine or even family medicine, that's comfortable with seeing the patient while they're pregnant.

Nicole: So yeah, this is interesting. So it sounds like it's really more of, we can, that pregnancy is a good time to capture these patients because we otherwise wouldn't necessarily, uh, check and then, um, get them connected in systems if they can't. This brings up a systems issue, which is a whole other thing about after pregnancy, um, Medicaid, which is the public or government insurance that covers like 40% of pregnant people runs out after delivery. So it's hard to sometimes get specialized care afterwards.

Keisha: Exactly, exactly.

Nicole: It's one of the reasons, guys, why I believe, and I'm sure Dr. Reddick as well, believes like things like with the affordable care act and extending care for people and for up to a year after pregnancy, at least, and just in general unique care between pregnancies in order to have healthy pregnancies. So that's a whole nother like,

Keisha: Right. We can go on all day about that way. Yes, yes,

Nicole: Yes, yes. Like really, really important. Um, okay. So how is labor managed differently?

Keisha: Um, so really, you know, I am just like I do most patients, I'm like less is more. Okay. Um, can we say that one more time, less is more, we do not need to keep checking you and touching you. Um, so, you know, ideally if you have a patient with, um, some type of virus that could be transmissible to the baby, you don't want their water broken too long. So, you know, things like breaking their water super early in the game, I would not do that. Um, we try to avoid internal monitoring. I try to avoid internal monitoring on most patients, um, because I don't, you know, if I can monitor your baby from external monitors, then that's all I need. Um, so, so, you know, you want to avoid doing things that will, you know, internalize it, anything that's going to have to go inside the uterus.

Keisha: Um, and then last, you know, the last thing is avoiding episiotomy, which that's a whole nother subject about if women even they don't need those at all. But, uh, but if you're doing those, you're going to actually increase the risk for transmission in particular for hepatitis B and C. So again, you don't need to do a C-section and I know patients, you know, are they think, well, gosh, I would just want to do it anyways. I'm like, well, it doesn't change the transmission, but we certainly don't need to do much during your labor. We just need to allow you to labor.

Nicole: See, well, I mean, we can just say that in so many ways that we sometimes do a lot, but yeah, it's just basically just let the body do what it does. Yeah. And if we need, if we need to help things along, we can, but in general, just, you know, we don't need to be checking every now, you know, frequently the bag of water kind of acts as a protectant around the baby. And then once we break it, that increases those things. So just like, let folks be.

Keisha: Just let them be, let them be. I should add, you know, you get asked about hepatitis B and C and I spoke a little bit about hepatitis C, but for hepatitis B, again, this is a situation where there can be transmission to the baby. And it depends on the different antigens they have. But on the flip side of this is after the baby is born, the baby is given two things, the vaccine and something called H big H B I G, which is an immunoglobulin. And those two together will actually decrease the risk of transmission for hepatitis B by 85 to 95%. Oh, wow. Yeah. So it's actually very encouraging for moms. Um, and if those babies have been vaccinated and receive H big, then the moms can still breastfeed. So nice. Yeah. So again, that, that's a huge leap for treatment for those babies born to moms who have hepatitis B.

Nicole: Yeah. That's that's good. And hepatitis B is given at birth anyway for the vaccine, the vaccine for for all babies. So it's really the H big that's different and in a, is a way to describe that, is that essentially like trying to, I guess, a simplified way trying to bind up any virus that may have gotten into the baby system. Yeah.

Keisha: Exactly, exactly. And that even that alone is like 75% decreases the risk by saying it is protective about 75%. So that's great. But then you add that vaccine on top of it, and you're at an I almost a 95% rate decrease rate for transmission.

Nicole: Okay. Okay. So those are the things that really to reduce the risk. This is just like a really good example of just like it just once you, once you know where things are, and you're kind of empowered with that information there it's, you can very easily make a plan and things for them almost all the time will turn out. Well, you just have to be prepared for it. And there's no stigma, there's no anything associated with it. We just, we just deal with it.

Keisha: Right, right. Uh, that again, which is why screening is helpful. You know, it's just like, you know, if I was screening a patient for diabetes, I want to know because if her blood sugars are high, then she's going to have a poor outcome. Right. So similar to this, if we know this in advance, then you know, the baby can be treated because the key here is that it's not just that they're given this after birth. So I don't want people to think, Oh, well, it's a couple of days later, it's really done within 12 to 24 hours. So it's very immediate that those babies are given those two treatments. So is key for us to know this because otherwise we don't want to have a delay in treatment.

Nicole: Got it. Got it. But then unfortunately there's not much that we can do for hepatitis C. This is mostly for hepatitis B. Correct. Okay. Okay. All right. So what about for a mom who's she knows that she has hepatitis and they are thinking about getting pregnant. What would you say for them?

Keisha: You know, I think the first thing I would do is have a preconception consult and a preconception consult is where you meet with a maternal fetal medicine doctor. And they go over all of this in detail and they go over your risk. And, you know, in particular with hepatitis B, there is treatment for hepatitis B there's, um, antivirals. And there's actually been a few trials that looked at three or four different medications. Um, it hasn't been so mainstream, that is a hard, fast recommendation at this point for all pregnant women. But I think for patients, you know, who maybe have higher viral loads, it would be important for us to know that before they get pregnant, because maybe those women can be treated prior to pregnancy and therefore have a lower risk for transmission. So, um, for your audience, you know, for the higher, the amount of virus, the higher the chance you can have transmission. So if those are patients, um, prior to pregnancy, if they have higher viral loads, well then Hey, we can get you in with a GI specialist and let's get your account style something low before you decide to conceive.

Nicole: That makes a lot of sense, a lot of sense. And I guess the same thing for hepatitis C as well. I mean, hepatitis C has like revolutionized treatment in the last few years.

Keisha: Right. Right. So the same thing, you know, if we, at least as you know, again, I always use diabetes as my way of, as an example of, you know, if a patient has high blood sugars before pregnancy, um, that can be detrimental to their pregnancy. So, you know, we want to optimize your health so that you and your baby are doing well throughout your pregnancy.

Nicole: Yup. For sure. For sure. Well, anything else that you can think of in relation to hepatitis and pregnancy before I asked my question that I ask everyone, like your favorite piece of advice, anything that we missed?

Keisha: I don't think so. I think, you know, we've covered quite a bit. The only thing I guess, to add for, um, procedures during the pregnancy. Um, so, you know, we, I do, um, prenatal diagnosis and then we do genetic testing. Majority of our patients do genetic testing and screening through a blood draw on the mom. But occasionally we have, you know, some patients that may have an abnormal screening test or they, we may find some abnormalities on ultrasound. And we used to tell patients, you know, the risk for transmission is negligible. When, if you have hepatitis B or C. Um, that's still pretty true for hepatitis C in terms of things like an amniocentesis, uh, which is preferred over a CVS or chorionic villi sampling for hepatitis B. Um, the risk for transmission may be dependent on their viral load that they have during the pregnancy. So it's not that it's completely off the table, but it may kind of alter some of my counseling depending on your viral load, if there's a risk for transmission.

Nicole: That makes sense. Okay. That makes a lot of sense. And y'all, we had a, we did an episode talking about genetic testing and amniocentesis and CVS and all that in pregnancy. So I will link to that in the show notes as well. So then what would be your final piece of advice that you would give to someone who is pregnant and just recently found out they had hepatitis or they know they have they have hepatitis, what would you say?

Keisha: I would say, you know, there are people out here to take care of you and that, you know, is nothing to be ashamed of. You know, I, it is a medical condition, just like any other medical condition and that I would encourage them to seek out care early and get as much information so that they are empowered because I think, you know, sometimes patients are ashamed and embarrassed. And so a lot of it has to do with the fact that you don't know all the information that's available for you. And so when we are able to empower you and give you that information, we can say, you know what, yes, you have this, but this is something that we can handle. And this is something we can take care of, um, as opposed to, you know, saying, well, gosh, I just didn't want anybody to know about it. You know, I, I certainly don't look at my patients that way. I literally look at them like, Hey, we have this ahead of us, but we can, we can work this out. We can figure it out. So that's probably my best piece of advice for your, for those patients.

Nicole: Yep. And that's exactly, exactly how it should be. Only if all maternal fetal medicine doctors could be like you, not that they're bad, you know, there are, there are plenty of good MFM doctors out there, but, um, Dr. Reddick is a special one as as I say all the time. Yeah. Yeah. All right. So where can people find you if they're interested in y'all she has on her Instagram, she is all about the fashion and the budget fashion as well. She's never paying full price for anything. So if you want to follow her for fabulous fashion, and she also does cooking and you're like, wait, didn't you just say she was like a high risk pregnancy doctor, but yet she does all this fun stuff. So where can people find you?

Keisha: Um, so I practice at Memorial Hospital in Savannah, Georgia. So my practice name is actually High-Risk OB Care. Um, so for those who are seeking high risk OB care, whether it's a consult or total care, we are located in Savannah and I am on Instagram as Dr. Keisha Lynn. And that's my alter ego, I guess, the person who outside of medicine and enjoys baking things that are high calories and high carbohydrate intake and who enjoys working out. And yes, I enjoy finding, um, fashion steals that, um, most people can't find. Yeah.

Nicole: Yes. Yeah. Y'all her shoe game is unparalleled unmatched. And I ha I don't know how I can forget about working out, because even though you may cook like high carb, but you know, you certainly like balance it all to stay healthy, so, Oh, well, thank you again for coming onto the podcast as always, it is a pleasure having you here, and I'm going to say, I know you'll be back cause I know you'll be back.

Keisha: Well, thank you. And I look forward to coming back.

Nicole: Well, as always that was another informative episode with Dr. Reddick. Now, you know, after every time I have a guest on the podcast, I do something called Nicole's Notes where I do my top three or four takeaways from the conversation. So here are my Nicole's Notes from my conversation with Dr. Reddick, number one, I think this goes, or it's important to say again that knowing about your hepatitis status is really just about being prepared. As you heard, the risks are actually low. Labor and birth are pretty much the same. But it's important to know because there are things that can be done at birth to help reduce the risk of you giving it to your child. And it helps you get connected with ongoing care. So really this is just about being prepared, which is so, so important. Number two pregnancy can be a great time to get caught up on healthcare.

Nicole: That happens quite a bit. So sometimes it's the first time somebody has gotten a pap test in a while, or diabetes screening in a while, or a screening for any sexually transmitted infections. So pregnancy in general can just be a good time to like reset, get caught up on health care and then move forward in a really positive direction for your health. And then the final thing I want to say is I'm going to put on my advocacy hat a bit here so much about having a healthy pregnancy is being healthy, going into pregnancy or between pregnancies and an important part of being healthy, at least in the United States and the way our health insurance or healthcare system is set up is to have health insurance. And the way it works with pregnancy, Medicaid covers over 40% of all births in this country. And in many States that Medicaid insurance runs out after 60 days.

Nicole: And it's just so much more difficult to maintain health when you don't have access to health insurance. So we get caught in this cycle where for some people Medicaid related to pregnancy is the only insurance that they ever have. And then they lose it when they're not pregnant. And then they potentially enter another pregnancy unhealthy because they didn't have insurance in between to stay healthy. And then that can often lead to worse outcomes for pregnancy. Now that is of course, costly to that individual, but it is also more costly financially as a society, it's much less expensive to pay for trying to prevent problems from occurring than to treat problems when they happen. Treatment is expensive. So that is why I advocate for healthcare coverage for everyone. And at a minimum pregnant people should have access to insurance for a year after birth. All right.

Nicole: So there you have it, be sure to subscribe to the podcast in Apple Podcast or wherever you are listening to me right now, Spotify, Google Play, Stitcher, whatever you use for your podcasts. And I would really love it if you leave that review in Apple Podcast in particular, that helps other women to find the show and helps the show to grow. I also do shout outs from those reviews from time to time. And don't forget to check out the Birth Preparation Course. You can learn all the details at drnicolerankins.com/enroll. That's my signature program to ensure you are calm, confident, and empowered to have a beautiful birth. So that is it for this episode, do come on back next week. And until then, I wish you a beautiful pregnancy and birth.

Nicole: Thanks so much for listening to this episode of the All About Pregnancy & Birth podcast. Head to my website, drnicolerankins.com to get even more great information, including free downloadable resources on how to manage pain and labor and warning signs to look out for after birth. You'll also find information on my free online class, on How To Make A Birth Plan That Works as well as everything you need to know about my signature online childbirth education class, the Birth Preparation Course. Again, that's drnicolerankins.com and I will see you next week.

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