Special Population: Hepatitis B in Pregnancy

Special Population: Hepatitis B in Pregnancy

Screening

• All pregnant women should be screened for HBsAg during antenatal care.

• HBsAg-positive women should undergo assessment for:

  • ALT and AST

  • HBeAg status

  • HBV DNA viral load (where available)

  • Liver fibrosis assessment if indicated

Prevention of Mother-to-Child Transmission (PMTCT)

Pregnant women with:

• HBV DNA >200,000 IU/mL

OR

• HBeAg positive where HBV DNA testing is unavailable

Should receive:

tenofovir disoproxil fumarate (TDF) (PO) 300 mg once daily

• Start at 28–32 weeks gestation (third trimester)

• Continue until delivery or up to 12 weeks postpartum according to local protocol

Infant Prophylaxis

All newborns should receive hepatitis B vaccination according to the national immunization schedule.

Infants Born to HBsAg-Negative Mothers

B: hepatitis B vaccine (IM) 0.5 mL

• Administer within 24 hours of birth

Preterm infants <2 kg:

• Give vaccine at 1 month of age or at hospital discharge according to national policy.

Infants Born to HBsAg-Positive Mothers

B: hepatitis B vaccine (IM) 0.5 mL within 12 hours of birth

AND

hepatitis B immune globulin (HBIG) (IM) 0.5 mL within 12 hours of birth

• Vaccine and HBIG should be administered at different injection sites.

Maternal HBsAg Status Unknown

hepatitis B vaccine (IM) 0.5 mL within 12 hours of birth

AND

Determine maternal HBsAg status urgently.

If maternal HBsAg becomes positive:

hepatitis B immune globulin (HBIG) (IM) 0.5 mL

• Administer as soon as possible and no later than 7 days after birth.

Breastfeeding

• Breastfeeding is recommended.

• HBV infection is not a contraindication to breastfeeding when appropriate neonatal immunoprophylaxis has been given.

Follow-Up of Exposed Infants

• Complete the routine hepatitis B vaccination schedule.

• Test for HBsAg and anti-HBs at 9–12 months of age or at least 1–2 months after completion of vaccination series to confirm protection and exclude infection.