Hepatitis B in the Perinatal Period

  • Rebecca A. M. Pierce-Williams
  • Jeanne S. SheffieldEmail author


Chronic hepatitis B virus (HBV) is a significant threat to public health, with an estimated 240 million people living with the disease worldwide ( HBV and the associated complications, such as cirrhosis and hepatocellular carcinoma, cause >600,000 deaths yearly (GBD 2013 Mortality and Causes of Death Collaborators, Lancet 385:117–71, 2015). Since the development of the HBV vaccine in the 1980s, new cases have decreased, yet the disease remains a global health concern, especially due to high rates of mother-to-child transmission (MTCT) in many countries ( The focus of this chapter is to explore the current management of hepatitis B in pregnancy, with an emphasis on treatment and prevention of transmission to the neonate.


Hepatitis B Immune globulin Infant Prophylaxis Vaccine 


  1. 1.
    World Health Organization. Media Centre. Hepatitis B. Fact sheet. Updated July 2016. Accessed 6 Apr 2017.
  2. 2.
    GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2015;385:117–71.CrossRefGoogle Scholar
  3. 3.
    Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine. 2012;30:2212.CrossRefPubMedGoogle Scholar
  4. 4.
    Tran TT. Hepatitis B in pregnancy. Clin Infect Dis. 2016;62:S314–7.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Goldstein ST, Alter MJ, Williams IT, et al. Incidence and risk factors for acute hepatitis B in the United States, 1982–1998: implications for vaccination programs. J Infect Dis. 2002;185:713–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Hyams KC. Risks of chronicity following acute hepatitis B virus infection: a review. Clin Infect Dis. 1995;20:992–1000.CrossRefPubMedGoogle Scholar
  7. 7.
    Centers for Disease Control and Prevention. Hepatitis B FAQs for health professionals. Updated August 4, 2016. Accessed 6 Apr 2017.
  8. 8.
    World Health Organization. Media Centre. Immunization coverage. Fact sheet. Reviewed March 2017. Accessed 6 Apr 2017.
  9. 9.
    Pontisso P, Poon MC, Tiollais P, Brechot C. Detection of hepatitis B virus DNA in mononuclear blood cells. Br Med J Clin Res. 1984;288:1563–6.CrossRefGoogle Scholar
  10. 10.
    Halpern MS, England JM, Deery DT, et al. Viral nucleic acid synthesis and antigen accumulation in pancreas and kidney of Pekin ducks infected with duck hepatitis B virus. Proc Natl Acad Sci U S A. 1983;80:4865–9.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    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;67:20–6.CrossRefPubMedGoogle Scholar
  12. 12.
    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.CrossRefPubMedGoogle Scholar
  13. 13.
    Pan CQ, Duan ZP, Bhamidimarri KR, et al. An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clin Gastroenterol Hepatol. 2012;10:452–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Pawlowska M, Pniewska A, Pilarczyk M, Kozielewicz D, Domagalski K. Prophylaxis of vertical HBV infection. Expert Opin Drug Saf. 2016;15:1361–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Wiseman E, Fraser MA, Holden S, et al. Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust. 2009;109:489–92.Google Scholar
  16. 16.
    Zou H, Chen Y, Duan Z, Zhang H, Pan C. Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg-positive mothers. J Viral Hepat. 2012;19:e18–25.CrossRefPubMedGoogle Scholar
  17. 17.
    Chang M-H. Hepatitis B virus infection. Semin Fetal Neonatal Med. 2007;12:160–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Jonas MM. Hepatitis B and pregnancy: an underestimated issue. Liver Int. 2009;29:133.CrossRefPubMedGoogle Scholar
  19. 19.
    Yi W, Pan CQ, Hao J, Hu Y, Liu M, Liang D. Risk of vertical transmission of hepatitis B after amniocentesis in HBs antigen-positive mothers. J Hepatol. 2014;60:523–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Dionne-Odom J, Tita A, Silverman N. Society for Maternal-Fetal Medicine (SMFM) consult series: #38: hepatitis B in pregnancy screening, treatment, and prevention of vertical transmission. Am J Obstet Gynecol. 2016;214:6–14.CrossRefPubMedGoogle Scholar
  21. 21.
    American College of Obstetricians and Gynecologists. ACOG practice bulletin no 86. Viral hepatitis in pregnancy. Obstet Gynecol. 2007;110:941–55.CrossRefGoogle Scholar
  22. 22.
    Mast EE, Margolis HS, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the advisory committee on immunization practices (ACIP) part 1: immunization of infants, children, and adolescents. Advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2005;54:1–31.PubMedGoogle Scholar
  23. 23.
    Lin K, Vickery J. Screening for hepatitis B virus injection in pregnancy women: evidence for the US preventive services task force reaffirmation recommendation statement. Ann Intern Med. 2009;150:874–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Centers for Disease Control and Prevention. 2017 nationally notifiable infectious diseases. https://wwwncdcgov/nndss/conditions/notifiable/2017/infectious-diseases/ Accessed 12 Apr 2017.
  25. 25.
    Terrault NA, Bzowej NH, Chang KM, et al. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016;63:261–83.CrossRefPubMedGoogle Scholar
  26. 26.
    Mast EE, Weinbaum CM, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the advisory committee on immunization practices (ACIP) part 2: immunization of adults. MMWR Recomm Rep. 2006;55:1–33.PubMedGoogle Scholar
  27. 27.
    Eke AC, Eleje GU, Eke UA, Xia Y, Liu J. Hepatitis B immunoglobulin during pregnancy for prevention of mother-to-child transmission of hepatitis B virus. Cochrane Database Syst Rev. 2017;(2):CD008545.Google Scholar
  28. 28.
    Andre FE, Zuckerman AJ. Review: protective efficacy of hepatitis B vaccines in neonates. J Med Virol. 1994;44:144–51.CrossRefPubMedGoogle Scholar
  29. 29.
    American Academy of Pediatrics. Transmission of infectious agents via human milk. In: Pickering LK, editor. Red book: 2003 report of the committee on infectious diseases. 26th ed. Elk Grove Village: American Academy of Pediatrics; 2003. p. 118–21.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Rebecca A. M. Pierce-Williams
    • 1
  • Jeanne S. Sheffield
    • 2
    Email author
  1. 1.Department of Obstetrics and GynecologySinai Hospital of BaltimoreBaltimoreUSA
  2. 2.Department of Obstetrics and GynecologyJohns Hopkins UniversityBaltimoreUSA

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