Hepatitis B Risk in Pregnancy

Posted On: October 12, 2017 By Daniel Saltzman, MD

Hepatitis B virus (HBV) infection during pregnancy presents unique management issues for both the mother and the fetus. These include the effects of HBV on maternal and fetal health, the effects of pregnancy on the course of HBV infection, treatment of HBV during pregnancy, and prevention of mother-to-child transmission. Prevention of mother-to-child transmission (vertical transmission) is an important component of global efforts to reduce the burden of chronic HBV since vertical transmission is responsible for approximately one-half of chronic infections worldwide. The risk is as high as 90 percent in those babies exposed at birth without vaccination, while the risk is much lower (about 20 to 30 percent) in those exposed during childhood. Maternal screening programs and universal vaccination of infants have significantly reduced transmission rates.

Testing for HBsAg should be performed on all women at the first prenatal visit. This blood test will determine whether a woman has current HBV infection and is at risk of transmitting HBV to her infant. However, there is a safe and effective vaccine for Hepatitis B available that can prevent both infection and disease. If a woman has not been previously vaccinated against HBV, it is completely safe and effective to have administered during pregnancy.

Acute hepatitis B virus (HBV) infection during pregnancy is usually mild and not associated with increased mortality or birth defects.

Treatment of acute infection is mainly supportive. Antiviral therapy is possible but usually unnecessary. However, the risk of HBV transmission has been significantly reduced with the introduction of universal maternal HBV screening, hepatitis B vaccination of all newborns, and the use of prophylactic hepatitis B immune globulin (HBIG) for infants of HBsAg-positive mothers. As an example, perinatal HBV infection occurred in 1.1 percent of newborns born to HBsAg-positive mothers in the United States.

The benefit of cesarean delivery in protecting against HBV transmission has not been clearly established Thus, cesarean delivery should not be routinely recommended for carrier mothers for the purpose of reducing HBV transmission.

The number one approach to preventing transmission between the mother and infant is administering a blend of passive and active immunoprophylaxis therapy at the time of delivery. This is a type of therapy that helps the baby’s immune system to become stronger by adding antibodies to help fight infection. Once this is given to the baby, an HBV vaccine series will also be administered for long-term protection.

The benefit of cesarean delivery in protecting against HBV transmission has not been clearly established Thus, cesarean delivery should not be routinely recommended for carrier mothers for the purpose of reducing HBV transmission.

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Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!

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