Hepatitis B in Pregnancy
Rates of mother-to-child transmission of HBV can be reduced greatly if the current guidelines for screening and immunization are universally followed. All pregnant women should be screened for chronic HBV in the first trimester, and all infants born in the United States should be vaccinated with the HBV vaccine at ages 0, 1 to 2 months, and 6 months. All infants born to HBsAg-positive mothers should be given HBIG within 12 hours of birth in addition to vaccination. The use of lamivudine, telbivudine, or tenofovir should be considered in HBsAg-positive/HBeAg-positive mothers with high levels of viremia (>10–10 copies per milliliter or >200,000–20 million IU/mL) to decrease the risk of vertical transmission, with the understanding that safety and efficacy data of this strategy are limited. Finally, there are no contraindications to breast-feeding for mothers with chronic HBV who are not taking antiviral medications.
Conclusions
Rates of mother-to-child transmission of HBV can be reduced greatly if the current guidelines for screening and immunization are universally followed. All pregnant women should be screened for chronic HBV in the first trimester, and all infants born in the United States should be vaccinated with the HBV vaccine at ages 0, 1 to 2 months, and 6 months. All infants born to HBsAg-positive mothers should be given HBIG within 12 hours of birth in addition to vaccination. The use of lamivudine, telbivudine, or tenofovir should be considered in HBsAg-positive/HBeAg-positive mothers with high levels of viremia (>10–10 copies per milliliter or >200,000–20 million IU/mL) to decrease the risk of vertical transmission, with the understanding that safety and efficacy data of this strategy are limited. Finally, there are no contraindications to breast-feeding for mothers with chronic HBV who are not taking antiviral medications.