Hepatitis B and Pregnancy

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31 July 2019 ,

Contributed by Dr. Vidyasagar Ramappa, Consultant –Gastroenterology, Columbia Asia

Referral Hospital Yeshwanthpur

Hepatitis B is an infection caused by a virus that has the potential to cause severe damage to the
liver. Babies born to a mother with hepatitis B have a greater than 90% chance of developing chronic
hepatitis B if they are not properly treated at birth. Pregnant women with Hepatitis B infection can
transmit the infection to child (vertical transmission) during delivery. There is greater than 90%
chance of developing of chronic Hepatitis B infection in infants born to such women.
If your doctor is aware that you have Hepatitis B, he or she can make arrangements to have proper
medications in the delivery room to prevent your baby from being infected.  Therefore, it is
imperative to know the hepatitis B status of all pregnant women.


Pregnant women should be screened for Hepatitis B infection in their first trimester, especially for
the women who fall under the high- risk category like health care workers, living with an infected
spouse or also women who come from ethnic communities where the infection is very common.
Screening early in pregnancy would allow the doctor to assess the risk to the mother and infant and
provides time for appropriate measures to be taken during pregnancy to reduce the risk of
transmission of virus to the infant. This involves starting the pregnant women on medications to
reduce the viral load and also vaccinate the newborn infant in the delivery room with Hepatitis B
vaccine and Hepatitis B Immune Globulin (HBIG).

Treatment during Pregnancy

Hepatitis B infection should not cause any problems for you or your unborn baby during your
pregnancy. It is important for your doctor to be aware of your hepatitis B infection so that he or she
can monitor your health and so your baby can be protected from an infection after it is born.
All women who are diagnosed with hepatitis B in pregnancy should be referred for follow up care
with a physician skilled at managing hepatitis B infection.
A virus level greater than 2,00,000 IU/mL indicates a level where the combination of the birth dose
of the vaccine and HBIG may fail. In such instances antiviral therapy with tenofovir may be
recommended. Antiviral treatment begins at 28-32 weeks of gestation and continues 3 months post-

Treatment after Pregnancy

If you are prescribed antiviral treatment during pregnancy, you should have your ALT (SGPT)
monitored every 3 months for 6 months, following the discontinuation of antiviral treatment. This
will help determine if you should continue antiviral treatment.
For most women whose follow up testing shows no signs of active disease, your physician will
recommend regular monitoring with a liver specialist.


All women with hepatitis B should be encouraged to breastfeed their newborns. The benefits of
breastfeeding outweigh any potential risk of infection. Since it is recommended that all infants be
vaccinated against hepatitis B at birth, any potential risk is further reduced.

For women taking antiviral treatment, there is sufficient data to support the safety of antiviral therapy with Tenofovir during breastfeeding.

Protecting your baby through vaccination

Infants born to hepatitis B-positive women must receive the accurate doses of HBV vaccine and
HBIG to ensure complete protection. In order to protect these infants, both medications should be
given immediately after birth in the delivery room or within the first 12 hours of life.  Subsequent
HBV vaccine doses are administered at ages of 1-2 months and 6 months. All doses must be
completed in order for your infant to be fully protected against hepatitis B. It is also important that a
baby born to an HBV-positive mother receive post-vaccination testing at age 9-12 months to confirm
the baby is protected against HBV and is not infected. Tests include the HBsAg and anti-HBs titer

How is Hepatitis B spread?

The hepatitis B virus is transmitted through blood and body fluids. This can most commonly occur in
the following ways:
Direct contact with infected blood
Unprotected sex with an infected partner
Use of illegal or “street” drugs
Needles that are contaminated or not sterile
From an infected woman to her newborn during pregnancy and childbirth
Body piercing, tattooing, acupuncture are other potential routes of infection unless sterile needles
and equipment are used.
In addition, sharing personal items with an infected person such as razors, toothbrushes, nail
clippers, earrings and body jewelry can be a source of infection.
Hepatitis B is NOT transmitted casually. It cannot be spread through toilet seats, doorknobs,
sneezing, coughing, hugging or eating meals with someone who is infected with hepatitis B.
Measures to prevent from Hepatitis B
Hepatitis B is a vaccine-preventable disease. HBV vaccine is considered to be very safe and effective
vaccine to protect infants, children and adults from hepatitis B
All sexual partners, family and close household members living with a chronically infected person
should be tested and vaccinated. It is important to remember that hepatitis B is not spread by
coughing, sneezing, hugging, cooking and sharing food. It is spread through direct contact with
infected blood and bodily fluids.
In addition to vaccination, there are other simple ways to help stop the spread of hepatitis B:
• Washing exposed area thoroughly with soap and water after any potential exposure to
infected blood and body fluids
• Use condoms with infected sexual partners
• Avoid direct contact with blood and body fluids
• Cover all cuts carefully
• Avoid sharing sharp items such as razors, nail clippers, toothbrushes, and earrings or body
• Avoid illegal street drugs (injecting, inhaling, snorting, or popping pills)
• Make sure new, sterile needles are used for ear or body piercing, tattoos, and acupuncture

What are the risks of not getting the vaccine?

An unvaccinated person is at risk of contracting the virus through contact with infected blood or
body fluids. Such individuals who are chronically infected may not have symptoms, but their liver is
still being silently damaged which can develop into serious liver disease such as cirrhosis or liver
cancer. A timely “post exposure prophylaxis” (PEP) can prevent an infection and subsequent
development of a chronic infection or serious liver disease.