Testing and Treatment During Pregnancy
A hepatitis B virus infection should not cause any problems for you or your unborn baby during your pregnancy if you take the correct precautions. It is important for your doctor to be aware of your hepatitis B infection so that he or she can run appropriate tests and evaluate and monitor the health of your liver, and so your baby can be protected from infection with hepatitis B when it is born. The U.S. CDC and WHO recommend that ALL pregnant people are tested for hepatitis B. Please ask your doctor to test you for hepatitis B early in your pregnancy!
The birth dose of the hepatitis B vaccine and hepatitis B immune globulin (HBIG, if recommended and available) can sometimes fail to prevent transmission to newborns. This typically occurs in pregnant people who are HBeAg positive and have a very high viral load, allowing for the transmission of hepatitis B to your baby. Fortunately, there is a way to prevent transmission even if you are a person with a high viral load.
All people 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 HBV DNA level (viral load), and should be checked to see if there is evidence of cirrhosis (extensive liver damage). (click here for a detailed description of these tests).
An HBV DNA level greater than 200,000 IU/mL or 1 million cp/ml indicates a level where the combination of the birth dose of the hepatitis B vaccine (and HBIG) will fail. First-line, antiviral therapy with tenofovir (TDF/viread) is recommended starting from week 28 of pregnancy until delivery but may continue 3 months postpartum. Please talk to your doctor about your own test results.
If the HBV DNA (viral load) blood test is not available or is cost prohibitive, then pregnant people should be tested for HBeAg (a blood test). A “positive” HBeAg test result can indicate a high virus level. Antiviral treatment with tenofovir (TDF) during the last trimester would be recommended for women who test HBeAg positive. TDF Treatment may be discontinued after delivery or 3-months postpartum.
All babies born to people with hepatitis B should receive a birth dose of the hepatitis B vaccine within 24 hours of delivery whether they receive treatment with an antiviral or not.
All people who are diagnosed with hepatitis B should be referred to care with a knowledgeable doctor. Some may require continued treatment with an antiviral, many will not. All people need regular monitoring throughout their life since hepatitis B infection and the health of the liver can change over time.
Additional Resource Links:
U.S.:
Centers for Disease Control and Prevention: Viral Hepatitis, Perinatal Transmission (2018)
EU/EEA:
Antenatal Screening for HIV, Hepatitis B, Syphilis and Rubella Susceptibility in the EU/EEA (2016)
Globally:
WHO Prevention of Mother-To-Child Transmission of Hepatitis B Virus: Guidelines on Antiviral Prophylaxis in Pregnancy (2020)
Page updated September 2020