Skip to main content

Advertisement

SpringerLink
Log in

Management of the pregnant hepatitis B patient

  • Published:
Current Hepatitis Reports Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. World Health Organization: Hepatitis B. World Health Organization fact sheet 204 (revised Oct. 2000). Available at: http://who.int/inf-fs/en/fact204.html.

  2. Coleman PJ, McQuillan GM, Moyer LA, et al.: Incidence of hepatitis B virus infection in the United States—implications for vaccination strategies. J Infect Dis 1988, 178:1579–1584.

    Google Scholar 

  3. Margolis HS, Alter MJ, Hadler SC: Hepatitis B: evolving epidemiology and implications for control. Semin Liver Dis 1991, 11:84–92.

    PubMed  CAS  Google Scholar 

  4. Connolly JH, McClelland WM, O’Neill HJ, et al.: Hepatitis B virus infection in Northern Ireland 1970–1987. Ulster Med J 1989, 58:72–82.

    PubMed  CAS  Google Scholar 

  5. Stevens CE, Beasley RP, Tsui J, et al.: Vertical transmission of hepatitis B antigen in Taiwan. N Engl J Med 1975, 292:771–774.

    PubMed  CAS  Google Scholar 

  6. Xu ZY, Duan SC, Margolis HS, et al.: Long-term efficacy of active postexposure immunization of infants for prevention of hepatitis B virus infection. United States-People’s Republic of China Study Group on Hepatitis B. J Infect Dis 1995, 171:54–60.

    PubMed  CAS  Google Scholar 

  7. Ngui SL, O’Connell S, Eglin RP, et al.: Low detection rate and maternal provenance of hepatitis B virus S gene mutants in cases of failed postnatal immunoprophylaxis in England and Wales. J Infect Dis 1997, 176:1360–1365.

    Article  PubMed  CAS  Google Scholar 

  8. Lee SD, Lo KJ, Tsai YT, et al.: Maternal hepatitis B virus DNA in mother-infant transmission. Lancet 1989, 1:719.

    Article  PubMed  CAS  Google Scholar 

  9. Karthigesu VD, Allison LM, Ferguson M, et al.: A hepatitis B virus variant found in the sera of immunised children induces a conformational change in the HBsAg “a” determinant. J Med Virol 1999, 58:346–352.

    Article  PubMed  CAS  Google Scholar 

  10. Lin HH, Lee TY, Chen DS, et al.: Transplacental leakage of HBeAg-positive maternal blood as the most likely route in causing intrauterine infection with hepatitis B virus. J Pediatr 1987, 111:877–881.

    Article  PubMed  CAS  Google Scholar 

  11. Lazizi Y, Badur S, Perk Y: Selective unresponsiveness to HBsAg vaccine in newborns related with an in utero passage of hepatitis B virus DNA. Vaccine 1997, 15:1095–1100.

    Article  PubMed  CAS  Google Scholar 

  12. Gerety RJ: Maternal transmission of hepatitis B [letter]. N Engl J Med 1976, 295:170–171.

    PubMed  CAS  Google Scholar 

  13. Chircu LV, Mattiaccu M, Schiano G, et al.: HBs and anti-HBs survey in mother/infant pairs [letter]. Lancet 1975, 2:706.

    Article  PubMed  CAS  Google Scholar 

  14. Xu DZ, Yan YP, Choi BC, et al.: Risk factors and mechanism of transplacental transmission of hepatitis B virus: a case-control study. J Med Virol 2002, 67:20–26.

    Article  PubMed  Google Scholar 

  15. Lin HH, Lee TY, Chen DS, et al.: Transplacental leakage of HBeAg-positive maternal blood as the most likely route in causing intrauterine infection with hepatitis B virus. J Pediatr 1987, 111:877–881.

    Article  PubMed  CAS  Google Scholar 

  16. Towers CV, Asrat T, Rumney P: The presence of hepatitis B surface antigen and deoxyribonucleic acid in amniotic fluid and cord blood. Am J Obstet Gynecol 2001, 184:1514–1518.

    Article  PubMed  CAS  Google Scholar 

  17. Burk RD, Hwang LY, Ho GY, et al.: Outcome of perinatal hepatitis B virus exposure is dependent on maternal virus load. J Infect Dis 1994, 170:1418–1423.

    PubMed  CAS  Google Scholar 

  18. Lee SD, Lo KJ, Tsai YT, et al.: Role of caesarean section in prevention of mother-infant transmission of hepatitis B. Lancet 1988, 2;833–834.

    Article  PubMed  CAS  Google Scholar 

  19. Pao CC, Yao DS, Lin MY, et al.: Hepatitis B virus DNA in cervicovaginal cells. Arch Pathol Lab Med 1991, 115:607–609.

    PubMed  CAS  Google Scholar 

  20. Zhang SL, Yue YF, Bai GQ, et al.: Mechanism of intrauterine infection of hepatitis B virus. World J Gastroenterol 2004, 10:437–438.

    PubMed  CAS  Google Scholar 

  21. Wang J, Zhu Q, Zhang X: Effect of delivery mode on maternal-infant transmission of hepatitis B virus by immunoprophylaxis. Chinese Med J 2002, 115:1510–1512.

    Google Scholar 

  22. Marion SA, Pastore MT, Pi DW, et al.: Long-term follow-up of hepatitis B vaccine in infants of carrier mothers. Am J Epidemiol 1994, 140:734–736.

    PubMed  CAS  Google Scholar 

  23. Andre FE, Zuckerman AJ: Review: protective efficacy of hepatitis B vaccines in neonates. J Med Virol 1994, 44:144–151.

    Article  PubMed  CAS  Google Scholar 

  24. Hill JB, Sheffield JS, Kim MJ, et al.: Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers. Obstet Gynecol 2002, 99:1049–1052.

    Article  PubMed  Google Scholar 

  25. CDC: A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States. MMWR Recomm Rep 2005, 54:1–23.

    Google Scholar 

  26. Mast E, Mahoney F, Kane M, et al.: Hepatitis B vaccine. In Vaccines. Edited by Plotkin SA, Orenstein WA. Philadelphia: Saunders; 2004:299–337.

    Google Scholar 

  27. Connor EM, Sperling RS, Gelber R, et al.: Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med 1994, 331:1173–1180.

    Article  PubMed  CAS  Google Scholar 

  28. van Zonneveld M, van Nunen AB, Niesters HG, et al.: Lamivudine treatment during pregnancy to prevent perinatal transmission of hepatitis B virus infection. J Viral Hepat 2003, 10:294–297.

    Article  PubMed  Google Scholar 

  29. Xu WM, Cui YT, Wang L, et al.: Efficacy and safety of lamivudine in late pregnancy for the prevention of mother-child transmission of hepatitis B: a multicentre, randomized, double-blind, placebo-controlled study [abstract]. Hepatology 2004, 40:272A.

    Google Scholar 

  30. Watts DH, Covington DL, Beckerman K, et al.: Assessing the risk of birth defects associated with antiretroviral exposure during pregnancy. Am J Obstet Gynecol 2004, 191:985–992.

    Article  PubMed  CAS  Google Scholar 

  31. Moodley J, Moodley D, Pillay K, et al.: Pharmacokinetics and antiretroviral activity of lamivudine alone or when coadministered with zidovudine in human immunodeficiency virus type 1-infected pregnant women and their offspring. J Infect Dis 1998, 178:1327–1333.

    Article  PubMed  CAS  Google Scholar 

  32. Tyzeka [ackage insert]. East Hanover, NJ: Novartis Pharmaceuticals Corp.; 2006.

  33. Lok ASF, McMahon BJ: Chronic hepatitis B. Hepatology 2007, 45:507–539.

    Article  PubMed  CAS  Google Scholar 

  34. Keeffe EB, Dieterich DT, Han SB, et al.: A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: an update. Clin Gastroenterol Hepatol 2006, 4:936–962.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Comprehensive Transplant Center, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 590 W, Los Angeles, CA, 90048, USA

    Tram T. Tran

Authors
  1. Tram T. Tran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emmet B. Keeffe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tram T. Tran.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tran, T.T., Keeffe, E.B. Management of the pregnant hepatitis B patient. Curr hepatitis rep 7, 12–17 (2008). https://doi.org/10.1007/s11901-008-0016-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11901-008-0016-0

Search

Navigation