Hepatitis B Infection In Pregnancy

Clinical description

Pregnant women who are actively infected with hepatitis B virus (HBV) may transmit HBV to their offspring (10- 20% of HBsAg-positive women and 90% of HBsAg/HBeAg- positive women).

Vertically acquired HBV can result in a chronic carrier state in up to 90% of infected infants with progression to cirrhosis and/or hepatic carcinoma.

Non-pharmacological

• Testing for HBsAg should be performed at the first prenatal visit if available.

Signs and symptoms

For known HBV exposure in susceptible patient

• If known HBV exposure, then immunoprophylaxis with hepatitis B immunoglobulin(HBIG) if available

and Hepatitis B vaccine.

For HBsAg-positive women

• Send blood for expanded hepatitis B serology and ALT to evaluate for activeHBV infection.
• No specific antiviral treatment available for acute HBV infection; 90-95% of adults will recover

spontaneously and develop immunity.

• Consult physician regarding lamivudine 100mg OD for chronic HBV infection.
• Decision to initiate therapy is dependent on presence of cirrhosis, HBeAg, Hepatitis B e antibody

(anti-HBe), ALT >2x the upper limit.

• During pregnancy, ALT should be monitored every 3 months
• Prevent neonatal infection (85-95% effective): give HBIG and vaccine (1st inseries of 3 injections) to

newborn within 12 hrs of birth; alert paediatricians.

• Breastfeeding is permissible but not when the mother has cracked nipples.