, Volume 7, Issue 1, pp 12-17

Management of the pregnant hepatitis B patient

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Chronic hepatitis B virus (HBV) infection is an important cause of chronic liver disease worldwide. It affects a disproportionate number of individuals from areas of high endemicity, where perinatal transmission is the predominant mode of infection. Introduction of a safe, effective hepatitis B vaccine has led to universal infant vaccination, resulting in a reduced rate of perinatal HBV infection from infected mothers. Because of appropriate hepatitis B vaccination and passive immunoprophylaxis with hepatitis B immune globulin (HBIG) in infants of mothers with HBV infection, perinatal transmission has been reduced to less than 5% to 10%. Management of pregnant women with chronic HBV infection should be aimed at counseling on maternal risk of infection, rates of vertical transmission, and preparation for neonatal vaccination. Limited data suggest that intrauterine infection may occur at higher rates in mothers with high serum HBV DNA levels, leading to failure of standard passive-active immunoprophylaxis with HBIG and vaccine. Thus, treatment of these individuals with an oral HBV antiviral agent in the third trimester may be considered after discussion with the mother regarding the risks and benefits of therapy.