Abstract
Chronic hepatitis B affects over 350 million people worldwide. Vertical transmission is known to be the leading cause of infection and perinatal infection is associated with a very high rate of chronicity (up to 90%). Up to 40% of chronically infected individuals will die prematurely from complications such as acute liver failure, cirrhosis and hepatocellular cancer. Addressing perinatal transmission through the use of immunoprophylaxis can help contain the spread of HBV. Pregnant mothers with chronic hepatitis B have unique challenges and require specialised management during and after pregnancy. This review will look at the screening of pregnant women for hepatitis B, passive and active immunoprophylaxis, mechanisms of perinatal viral transmission and therapeutic considerations in pregnancy including possible teratogenicity and efficacy of medication. Other issues such as the mode of delivery and breastfeeding will be covered.
Highlights
Chronic hepatitis B infection affects over 350 million people worldwide
Screening In Australia, pregnant women are universally screened for chronic infection with hepatitis B virus (HBV), which is defined as testing positive for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), or both, on routine antenatal serological screening, performed during an early antenatal visit, as recommended by the American Congress of Obstetricians and Gynecologists [3]
Telbivudine has been studied in highly viraemic HBeAg-positive women (HBV DNA viral load >107 IU/mL) in late pregnancy in a recent trial that demonstrated a significant reduction in perinatal transmission [74]
Summary
Chronic hepatitis B infection affects over 350 million people worldwide. Vertical transmission is known to be the leading cause of infection, and perinatal infection is associated with an extremely high rate of chronicity (up to 90%) [1]. This review will examine: the antenatal screening of pregnant women for hepatitis B infection; passive and active immunoprophylaxis; mechanisms of perinatal viral transmission; and therapeutic considerations in pregnancy, including possible teratogenicity of medication and efficacy of treatment. Other issues such as breastfeeding and the mode of delivery will be covered. In Australia, pregnant women are universally screened for chronic infection with hepatitis B virus (HBV), which is defined as testing positive for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), or both, on routine antenatal serological screening, performed during an early antenatal visit, as recommended by the American Congress of Obstetricians and Gynecologists [3] This practice ensures that women with hepatitis B receive optimal medical care, both during and after pregnancy, and that infants born to these women receive appropriate post-exposure prophylaxis. Affordability, access and nationwide delivery and implementation of HBV immunoprophylaxis are just some of the major public health challenges faced by health organisations
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