Hepatitis B in pregnancy: screening, treatment, and prevention of vertical transmission
- The diagnosis of the chronic carrier state is confirmed with persistence of HBsAg and the absence of hepatitis B surface antibody (HBsAb).
- HBsAg and HBsAb do not coexist.
- Start with maternal HBsAg.
- HBV core ab is produced secondary to infection (never from immunization).
In the United States, vertical transmission is responsible for up to 50% of HBV infection worldwide.o In pregnancy, prevalence 0.7-0.9% for chronic HBV
- HBV viral load in the third trimester (28-32 weeks)
- If> 6-8 log 10 copies /mL – antiretroviral Rx to decrease risk of intrauterine transmission
- To convert viral load from IU/mL to copies /mL multiply x5.6
- Tenofovir (first line) 300 mg/day till delivery
- Lamivudine (high rate of resistance) if used as a single agent
- Indications for antiretroviral: Copies > 106-8; Pos HBeAg
- The use of lamivudine and tenofovir in the postpartum period is not currently recommended solely for HBV prevention until additional data are available.