Hepatitis B in pregnancy: screening, treatment, and prevention of vertical transmission

Diagnosis/definition: 

• The diagnosis of the chronic carrier state is confirmed with persistence of HBsAg and the absence of hepatitis B surface antibody (HBsAb).
• HBsAg and HBsAb do not coexist.
• Start with maternal HBsAg.
• HBV core ab is produced secondary to infection (never from immunization).

Epidemiology/Incidence: 

In the United States, vertical transmission is responsible for up to 50% of HBV infection worldwide.o In pregnancy, prevalence 0.7-0.9% for chronic HBV

Management: 

Screening/Work-up:

• HBV viral load in the third trimester (28-32 weeks)
• If> 6-8 log 10 copies /mL – antiretroviral Rx to decrease risk of intrauterine transmission
• To convert viral load from IU/mL to copies /mL multiply x5.6
• Tenofovir (first line) 300 mg/day till delivery
• Lamivudine (high rate of resistance) if used as a single agent
• Indications for antiretroviral: Copies > 106-8; Pos HBeAg
• The use of lamivudine and tenofovir in the postpartum period is not currently recommended solely for HBV prevention until additional data are available.

Last Reaffirmed: Aug 1, 2020