懷孕與 B 型肝炎
如果我懷孕了，我應該接受 B 型肝炎檢查嗎？
應該，所有孕婦都應該接受 B 型肝炎的檢查！如果您懷孕了，確保您的醫生在您的寶寶出生之前為您做 B 型肝炎檢查。
為什麼這些檢查對孕婦如此重要？
如果您的 B 型肝炎檢查結果呈陽性並且懷孕，病毒會在您懷孕期間或分娩期間傳給您的新生兒。如果您的醫生知道您患有 B 型肝炎，他或她可以安排在產房裡準備適當的藥物來預防您的寶寶受到感染。如果沒有妥善處理，您的寶寶有 95% 的可能性會患上慢性 B 型肝炎！
B 型肝炎感染會影響我的妊娠嗎？
在您懷孕期間，B 型肝炎應該不會給您或您未出生的寶寶造成任何問題。讓您的醫生知曉您感染 B 型肝炎很重要，這樣他或她便可以監測您的健康狀況，並且保護您的寶寶出生後免受感染。
如果我懷孕了而且患有 B 型肝炎，我可以如何保護我的寶寶？
如果您的 B 型肝炎檢查結果呈陽性，您的醫生也應該檢驗您的 B 型肝炎 e 抗原 (HBeAg)，如果呈陽性，您應該進行 B 型肝炎病毒載量驗血（HBV DNA 定量）。在某些情況下，結果可能顯示病毒載量非常高。在這些情況下，您的醫生可能會建議您在妊娠晚期口服抗病毒藥物，服藥是安全的，可以降低新生兒出生時的感染風險。
如果您的 B 型肝炎檢查結果呈陽性，那麼您的新生兒必須在產房立即接種兩劑疫苗：
• 第 1 劑為B 型肝炎疫苗
• 另一劑為B 型肝炎免疫球蛋白 (HBIG)
如果這兩種藥物在出生後 12 小時內正確給藥，則新生兒有 90% 以上的可能性會終生免於 B 型肝炎感染。
您必須確保您的寶寶按照時間表接受其餘 2-3 劑 B 型肝炎疫苗。為了使您的嬰兒能夠徹底抵抗 B 型肝炎，必須完成所有劑量。同樣重要的是，B 型肝炎病毒檢驗結果呈陽性的母親所生的寶寶在 9-12 個月時需要接受疫苗接種後的血清檢查，以確認寶寶能夠抵抗 B 型肝炎病毒，而且未受感染。檢查包括 HBsAg 和 anti-HBs 滴度檢測。
沒有第二次機會可以保護您的新生兒！
在美國境外地區接種疫苗
在許多國家，可以為年齡 6 週至 1 歲以下的嬰兒接種五價疫苗（一種可預防五種疾病的五合一疫苗組合：白喉、百日咳、破傷風、B 型流感嗜血桿菌 (Hib) 和 B 型肝炎）。第 1 劑在 6 週時注射，第 2 劑和第 3 劑在 10 到 14 週時注射。五價疫苗可在全球疫苗聯盟 (Gavi) 的支援下免費提供接種。檢查 Gavi 的國家中心，以查看可能提供的資源和疫苖接種： http://www.gavi.org/country/.
對於患有 B 型肝炎的母親所生的寶寶，等待第一劑五價疫苗接種太遲了，不會保護寶寶在出生時或出生後 6 週內免受感染。B 型肝炎檢查結果呈陽性的女性很可能將病毒傳給她的寶寶，寶寶之後會慢性感染。
世衛組織建議所有嬰兒在出生 24 小時內接種 B 型肝炎疫苗。提前計劃並詢問可接種的單價（單一）疫苗和費用，疫苗的出生劑次，因為這不是 Gavi 提供的免費接種。這對於 B 型肝炎檢查結果呈陽性的女性特別重要。
如果您不確定您的 B 型肝炎狀況，請確保您的醫生為您做 B 型肝炎檢查！
對於未接受五價疫苗的嬰兒，單價 B 型肝炎病毒疫苗的首劑必須在出生 12 小時內接種，隨後根據計劃表接種剩下的第 2-3 劑 B 型肝炎疫苗。
對於接種五價疫苗的嬰兒，在出生 12 小時內接種第 1 劑單價 B 型肝炎疫苗，而第 2 劑和第 3 劑 B 型肝炎病毒疫苗將包括在五價疫苗的第 1 劑和第 2 劑中。
*註釋：CDC 建議在出生 12 小時以內同時接種 B 型肝炎病毒疫苗和 HBIG 的第 1 劑。可能不是所有國家都能獲得 HBIG。
我懷孕期間需要治療嗎？
在您懷孕期間，B 型肝炎感染應該不會給您或您未出生的寶寶造成任何問題。讓您的醫生知曉您感染 B 型肝炎很重要，這樣他或她便可以監測您的健康狀況，並且保護您的寶寶出生後免受感染。如果您住在美國以外，而且不確定您的 B 型肝炎狀況，請要求您的醫生為您做 B 型肝炎檢查。
出生劑次的 B 型肝炎病毒疫苗和 HBIG 失敗情況可能會發生在 HBeAg 呈陽性且病毒載量很高的女性身上，會將 B 型肝炎傳給嬰兒。
所有在妊娠期間被診斷為 B 型肝炎的女性，都應被轉介到擅於控制 B 型肝炎感染的醫生接受後續照護。您的醫生應該進行額外的實驗室檢測，包括 B 型肝炎 e 抗原、HBV DNA 濃度和肝功能檢驗 (ALT)。
超過 200,000 IU/mL 或 100 萬 cp/ml 的病毒濃度表明在該水準，出生劑次疫苗和 HBIG 的結合可能會失敗。可能推薦使用採用惠立妥/韋立得的一線抗病毒療法，以在出生之前減少病毒載量。據顯示，惠立妥/韋立得在懷孕期間和對母乳餵養的母親來說都是安全的。在惠立妥/韋立得無效的情況下，醫生可能開具干適能或干安能。抗病毒治療開始於 28-32 週，並在產後持續 3 個月。
我懷孕後需要治療嗎？
如果您在懷孕期間醫生向您開了抗病毒藥物，您應該每 3 個月監測一次您的 ALT (SGPT)，持續 6 個月。這將有助於確定是否應該繼續抗病毒治療。請不要中斷您的抗病毒藥物，除非醫生根據檢查結果建議您這樣做。對於大多數後續檢測沒有顯示出活動性疾病跡象的女性，您的醫生會建議到肝臟專家處進行定期監測。
很重要的是您的產科醫生和新生兒的兒科醫生都知道您的 B 型肝炎狀態，以確保您的新生兒在出生時接種適當的疫苗，防止終生 B 型肝炎感染，您也可以得到適當的後續照護。
如果我患有 B 型肝炎，我可以餵母乳嗎？
母乳餵養的好處遠遠大於極低的潛在感染風險。此外，由於建議所有嬰兒在出生時都接種 B 型肝炎疫苗，所以任何潛在的風險會進一步降低。有資料顯示，用於控制 B 型肝炎的處方藥惠立妥/韋立得對於餵母乳的女性是安全的。
Pregnancy and Hepatitis B
Should I be tested for hepatitis B if I am pregnant?
Yes, ALL pregnant women should be tested for hepatitis B! If you are pregnant, be sure your doctor tests you for hepatitis B before your baby is born.
Why are these tests so important for pregnant women?
If you test positive for hepatitis B and are pregnant, the virus can be passed on to your newborn baby during your pregnancy or during delivery. If your doctor is aware that you have hepatitis B, he or she can make arrangements to have the proper medications in the delivery room to prevent your baby from being infected. If the proper procedures are not followed, your baby has a 95% chance of developing chronic hepatitis B!
Will a hepatitis B infection affect my pregnancy?
A 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.
If I am pregnant and have hepatitis B, how can I protect my baby?
If you test positive for hepatitis B, your doctor should also test you for the hepatitis B e-antigen (HBeAg), and if positive, you should have a hepatitis B viral load blood test (HBV DNA quantification). In some cases, the laboratory test results may show a very high viral load. In these cases, your physician may recommend that you take an oral antiviral drug in the third trimester, which is safe to take to reduce the risk of infecting your newborn at birth.
If you test positive for hepatitis B, then your newborn must be given two shots immediately in the delivery room:
- First dose of the hepatitis B vaccine
- One dose of hepatitis B immune globulin (HBIG)
If these two medications are given correctly within the first 12 hours of life, a newborn has more than a 90% chance of being protected against a lifelong hepatitis B infection.
You must make sure your baby receives the remaining 2-3 doses of the hepatitis B vaccine according to schedule. 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 serologic testing at 9-12 months to confirm the baby is protected against HBV and is not infected. Tests include the HBsAg and anti-HBs titer test.
There is no second chance to protect your newborn baby!
Vaccination Outside the United States
In many countries, the pentavalent vaccine, a combination 5-in-one vaccine that protects against five diseases (diphtheria, pertussis, tetanus, Hib and hepatitis B) may be given to babies more than 6 weeks of age, and can be given up to 1 year of age. The first dose is given at 6 weeks, and the second and third doses are given at 10 and 14 weeks of age. The pentavalent vaccine may be made available free of charge with the support of Gavi, the Vaccine Alliance. Check the Gavi country hub to see the resources and immunizations that may be available: http://www.gavi.org/country/.
For babies born to mothers with hepatitis B, waiting for the first dose of the pentavalent vaccine is too late and will NOT protect the baby from becoming infected during birth or within the first six weeks of life. A woman who is hepatitis B positive is likely to pass the virus on to her baby, who will then be chronically infected.
WHO recommends the hepatitis B vaccine within 24 hours of birth for ALL babies. Plan ahead and inquire about the availability and cost of the monovalent (single), birth dose of the vaccine, as it is not a Gavi provided immunization. This is particularly important to women who are positive for hepatitis B.
If you are unsure of your hepatitis B status, please be sure your doctor tests you for hepatitis B!
For babies NOT receiving the pentavalent vaccine, the first dose of the monovalent, HBV vaccine must be given within 12 hours of birth, followed by the remaining 2-3 doses of the hepatitis B vaccine according to schedule.
For babies receiving the pentavalent vaccine, the first, monovalent dose of the hepatitis B vaccine is given within 12 hours of birth, and the second and third doses of the HBV vaccine will be included in dose 1 and dose 2 of the pentavalent vaccine.
*Note: CDC recommends both the first shot of the HBV vaccine and HBIG within 12 hours of birth. HBIG may not be available in all countries.
Do I need treatment during my pregnancy?
A 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. If you live outside of the U.S. and are unsure of your hepatitis B status, please ask your doctor to test you for hepatitis B.
Failure of the birth dose of the HBV vaccine and HBIG may occur in women who are HBeAg positive and have a very high viral load, allowing for the transmission of hepatitis B to your baby.
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. Your physician should perform additional laboratory testing, including hepatitis B e-antigen, HBV DNA level, and liver function tests (ALT).
A virus level greater than 200,000 IU/mL or 1 million cp/ml indicates a level where the combination of the birth dose of the vaccine and HBIG may fail. First-line, antiviral therapy with tenofovir may be recommended to reduce the viral load prior to birth. Tenofovir has been shown to be safe both during pregnancy and for breastfeeding mothers. In cases where tenofovir is not effective, doctors may prescribe telbivudine or lamivudine. Antiviral treatment begins at 28-32 weeks and continues 3 months postpartum.
Do I need treatment after my pregnancy?
If you are prescribed antivirals during pregnancy, you should have your ALT (SGPT) monitored every 3 months for 6 months. This will help determine if you should continue antiviral treatment. Please do not discontinue your antiviral medication unless the doctor advises you to, based upon test results. For most women whose follow up testing shows no signs of active disease, your physician will recommend regular monitoring with a liver specialist.
In all cases, it is very important that your obstetrician and your newborn’s pediatrician, are aware of your hepatitis B status to ensure that your newborn receives the proper vaccines at birth to prevent a lifelong hepatitis B infection, and that you receive appropriate follow up care.
Can I breastfeed my baby if I have hepatitis B?
The benefits of breastfeeding outweigh the potential risk of infection, which is minimal. In addition, since it is recommended that all infants be vaccinated against hepatitis B at birth, any potential risk is further reduced. There is data that shows that tenofovir, which may be prescribed to manage hepatitis B, is safe for breastfeeding women.