Overview
Chronic hepatitis B virus (HBV) infection is a significant global health concern. In pregnant individuals, there is a risk of mother-to-child transmission (MTCT) of HBV, particularly in those with high viral loads 123.Diagnosis
Management
Standard care for preventing MTCT in highly viremic mothers includes maternal antiviral prophylaxis starting at 28 weeks of gestation, combined with infant HBV vaccine series and hepatitis B immune globulin (HBIG) at birth 1.
Tenofovir disoproxil fumarate (TDF) is an antiviral used for prophylaxis 13.
Lamivudine is another antiviral that has been studied for use during pregnancy 23.Special Populations
Pregnancy: Antiviral prophylaxis may be considered for pregnant individuals with chronic HBV infection and a high risk of MTCT, especially when infant immunoprophylaxis alone may not be sufficient 3.
* Initiating TDF at 16 weeks of gestation combined with infant vaccinations was evaluated against starting TDF at 28 weeks with infant vaccinations and HBIG 1.
* Concerns exist regarding potential suppression of the fetal immune response to HBV with antiretroviral therapy (ART) 2.
* Lamivudine has been shown to decrease neonatal HBsAb seronegativity within 24 hours of birth compared to controls 2.Key Recommendations
Maternal antiviral prophylaxis during pregnancy may be required for pregnant individuals with chronic HBV and a high risk of MTCT, in addition to infant immunoprophylaxis 3. (Evidence: Moderate)
Initiating tenofovir disoproxil fumarate (TDF) at 16 weeks of gestation combined with infant HBV vaccinations is being investigated as an alternative to the standard of care (TDF at 28 weeks with infant vaccinations and HBIG) for preventing MTCT in highly viremic mothers 1. (Evidence: Moderate)
Lamivudine treatment in late pregnancy may reduce HBsAb seronegativity in newborns within 24 hours of birth 2. (Evidence: Moderate)References
1 Pan CQ, Dai E, Mo Z, Zhang H, Zheng TQ, Wang Y et al.. Tenofovir and Hepatitis B Virus Transmission During Pregnancy: A Randomized Clinical Trial. JAMA 2025. link
2 Zhao P, Zhao Y, Du M, Chen X, Lu Y. Impact of lamivudine treatment in late pregnancy on the development of the foetal immune response to hepatitis B virus: a meta-analysis in R with the metafor package. Transactions of the Royal Society of Tropical Medicine and Hygiene 2024. link
3 Funk AL, Lu Y, Yoshida K, Zhao T, Boucheron P, van Holten J et al.. Efficacy and safety of antiviral prophylaxis during pregnancy to prevent mother-to-child transmission of hepatitis B virus: a systematic review and meta-analysis. The Lancet. Infectious diseases 2021. link30586-7)