SMFM Consult: Preventing vertical transmission of hepatitis B
SMFM answers questions on preventing vertical transmission of hepatitis B during pregnancy.
Society for Maternal-Fetal Medicine (SMFM); Jodie Dionne-Odom, MD Alan TN Tita, MD, PhD; and Neil S Silverman, MD
This Maternal-Fetal Medicine (MFM) consult provides information regarding the risks, diagnosis, and management of hepatitis B in pregnancy and the prevention of vertical transmission. The purpose of this document is to aid clinicians in counseling their patients regarding the risk and management options available after a positive test for hepatitis B surface antigen (HBsAg).
Q. What risks and potential impact does hepatitis B infection present during pregnancy?
Between 800,000 and 1.4 million people in the United States and more than 240 million people worldwide are infected with hepatitis B virus (HBV). Specific to pregnancy, an estimated prevalence of 0.7% to 0.9% for chronic hepatitis B infection among pregnant women in the United States has been reported, with more than 25,000 infants at risk for chronic infection born annually to these women.
While transmission through sexual intercourse and intravenous drug abuse are the major risk factors for acquisition of hepatitis B among adults in the United States, perinatal transmission is responsible for up to 50% of HBV infections worldwide (Table 1). Universal screening for hepatitis B infection during pregnancy is recommended by both the American College of Obstetricians and Gynecologists and the US Preventative Services Task Force at the first prenatal visit.
In contrast to HBV acquisition in adulthood, which more commonly leads to acute resolved infection and immunity, perinatal/neonatal HBV is more likely to lead to chronic infection and its long-term disease risks.
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