Hepatitis B in pregnancy: information for healthcare professionals.
In early pregnancy, all mothers should be tested for HEPATITIS B.
This can be done through:
Point-of-care HBsAg rapid test: finger stick with rapid results
or
HBsAg blood test: requires blood draw which must be sent to a lab – the results can take several days.
If the patient is HBsAg-
If the patient is HBsAg+
HBV DNA <200,000 IU/mL or HBeAg negative: Treatment is not required to the reduce the risk of transmission to the infant.
HBV DNA <200,000 IU/mL or HBeAg positive: Treatment is required to the reduce the risk of transmission to the infant. It should be taken from the second trimester until delivery or completion of the infant vaccination series.
Where HBV DNA or HBeAg testing is not available, pregnant women should be offered antiviral medication from the second trimester until at least delivery or completion of the infant vaccination series.
Immediate family and sexual partners should also be tested.
Their infant should receive the hepatitis B vaccination series.
Hepatitis B infant vaccination series
At birth: Infant should receive a hepatitis B birth dose within 24 hours of birth. The birth dose should be a vaccine that only has hepatitis B in it (not a pentavalent vaccine).
1-2 Months: Infant receives the second dose of hepatitis B vaccine. This may be part of a combined vaccine (ex: pentavalent vaccine) but should be in addition to the routine infant series that starts at 1-2 months.
6 Months: Infant receives the third dose of hepatitis B vaccine. This may be part of a combined vaccine (ex: pentavalent vaccine) but should be in addition to the routine infant series that starts at 1-2 months.
When the infant is nine to 12 months old, a blood test should be considered to check if they are protected against hepatitis B. The tests are hepatitis B surface antigen and hepatitis B surface antibody. If they are not immune, a second round of vaccines is indicated.
BREASTFEEDING
The World Health Organization (WHO) recommendation is that women who have hepatitis B can safely breastfeed.
Hepatitis B is not transmitted through breastmilk. Breastfeeding mothers with cracked nipples should be given support to practice proper nipple care.
FUTURE PREGNANCIES
Speak to your patient about if they are planning additional pregnancies, as women can choose to continue to take antiviral medication after delivery and during subsequent pregnancies.
THINGS TO REMEMBER
Please refer to the WHO Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection for further information.
To link patients to peer support please contact a World Hepatitis Alliance member near you.
Infants born to HBsAg-positive mothers may be recommended to receive hepatitis B immune globulin (HBIg) if available.
The hepatitis B vaccine series is safe to give during pregnancy or can be given after.
For more information, please visit www.who.int, www.nohep.org/news-resources/nohepmums/ and www.worldhepatitisalliance.org
