HBV managment and pregnancy

Question 1

General findings

Answer 1

Whereas maternal hepatitis B infections rarely cause fetal complications during pregnancy, the risk of perinatal transmission is high, especially if the maternal viral load is increased. If an infant becomes infected, the risk of developing chronic hepatitis is 90%.

• Maternal screening for HBsAg should be performed on all women at the first prenatal visit.
• Management for HBsAg-positive mothers:

1. In mild disease and/or low HBV DNA levels, therapy may be delayed until after birth
2. In severe disease (e.g., cirrhosis) and/or high HBV DNA, therapy with nucleoside/nucleotide analogs (especially tenofovir) is commonly recommended
3. Delivery: spontaneous vaginal delivery possible!

Newborn immunization: within 12 hours of birth (first dose of hepatitis B vaccine series plus 1 dose of HBIG)
Breastfeeding: allowed as long as passive‑active postexposure prophylaxis was given, se la madre ha carica virale alta con lamattia cronica attiva no breast feeding

Infected newborns:
Usually asymptomatic, but up to 90% risk developing chronic infection and significant risk of cirrhosis and progression to hepatocellular carcinoma if left untreated
Serum studies:
Normal or only slightly elevated transaminases
High viral replication rate

💥Interferon therapy is contraindicated during pregnancy!