Hepatitis B During Pregnancy in Endemic Areas: Screening, Treatment, and Prevention of Mother-to-Child Transmission

Abstract

The proper management of pregnant women infected with hepatitis B virus (HBV) is necessary to prevent maternal and fetal morbidity and mortality and to protect the baby from HBV infection. In the majority of cases, vertical transmission can be prevented with a universal screening program, HBV vaccine immunoprophylaxis, and administration of hepatitis B immunoglobulin (HBIg) for babies born to mothers with HBV. However, in mothers with a high viral load (>200,000 or >1,000,000 IU/ml, depending on the guideline), the chance of immunoprophylaxis failure remains high. The standard recommendation is to give an antiviral agent during the third trimester in these patients. US FDA pregnancy category B agents such as tenofovir and telbivudine are allowed through all trimesters of pregnancy. Breastfeeding for patients who receive antiviral agents can be allowed after a risk-benefit discussion with the patient.

Interferon alpha treatment leads to a high rate of hepatitis B surface antigen seroconversion in Chinese children with chronic hepatitis B

“…An estimated, 220‐240 million people are long‐term HBV carriers worldwide, 90 million of whom are in China, leading to a high portion of chronic hepatitis infection (CHB) . Although development of the HBV vaccine significantly reduced the incidence of infection in children, and HBV antiviral treatment and prophylactics have efficiently blocked mother‐to‐child transmission, a small per cent of children are still infected perinatally or in early childhood from their mother with a high viral load or in families with a high HCC incidence . Given the large population of CHB patients in China, approximately 50 000‐100 000 children are infected annually, 90%‐95% of which will progress to CHB, and most of these children will develop HBV‐related diseases in adulthood after experiencing decade(s) of immune tolerance.…”

A case of chronic hepatitis B merged with acute fatty liver of pregnancy with severe coagulopathy

“…Tenofovir, a kind of nucleoside reverse transcriptase inhibitor that works by decreasing the amount of HB virus in the blood, has been confirmed as safe for use with fetuses, as evidenced by its level B status given by the Food and Drug Administration [10]. The latest report recommended the use of antiviral drugs to a pregnant patient with a high viral load (100,000-200,000 IU/mL) during their third trimester [10]. This treatment not only benefits the mother, but also the fetus by preventing mother-tochild transmission.…”

“…This treatment not only benefits the mother, but also the fetus by preventing mother-tochild transmission. In addition, HB virus vaccination and HB immunoglobulin are recommended for neonates as in this case [10]. More in-depth research is expected to determine if the levels of transaminase and HBV-DNA and virus genotype are related to AFLP and if antiviral agents are able to prevent AFLP onset.…”

Gebeli̇k Ve İmmuni̇zasyon

“…Ayrıca gebeliğin ikinci veya üçüncü trimestr dönemlerinde geçirildiği taktirde preterm doğumlara neden olabilmektedir. Fetüste ise polihidramnios, asit, distal ileum perforasyonu, neonatal ikterik hepatit A enfeksiyonu ve mekonyum peritoniti yapabilmektedir [26]. Hepatit A aşısı, inaktif virüs aşısıdır.…”