Hepatitis B in pregnancy: a concise review of neonatal vertical transmission and antiviral prophylaxis

AbstractHepatitis B is a chronic viral infection of the liver leading to complications including cirrhosis and hepatocellular carcinoma. The leading cause of acquisition is vertical transmission from an infected mother to the newborn. Despite newborn immunoprophylaxis, vertical transmission may stil...

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Bibliographic Details
Published in:Annals of hepatology 2014-03, Vol.13 (2), p.187-195
Main Authors: Wong, Frank, Pai, Rohit, Schalkwyk, Julie Van, Yoshida, Eric M., MD, MHSc, FRCPC
Format: Article
Language:English
Subjects:
Antiviral Agents - pharmacology
Antiviral Agents - therapeutic use
Female
Gastroenterology and Hepatology
HBIG
Hepatitis B - blood
Hepatitis B - prevention & control
Hepatitis B - transmission
Hepatitis B e Antigens - blood
Hepatitis B virus - drug effects
Humans
Infectious Disease Transmission, Vertical - prevention & control
Lamivudine
Pregnancy
Pregnancy Complications, Infectious - blood
Pregnancy Complications, Infectious - virology
Risk Factors
Telbivudine
Tenofovir
Vaccine
Viral Load - drug effects
Viral Vaccines - therapeutic use
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Summary:AbstractHepatitis B is a chronic viral infection of the liver leading to complications including cirrhosis and hepatocellular carcinoma. The leading cause of acquisition is vertical transmission from an infected mother to the newborn. Despite newborn immunoprophylaxis, vertical transmission may still occur in 1-14%. The aim of this article is to provide a concise review of the mechanisms and risk factors involved in vertical transmission, as well as prophylactic strategies using immunoprophylaxis and antiviral medications. Mechanisms of vertical transmission include intrauterine and perinatal transfer of virus. High HBV viral load and presence of HBeAg increases risk of transmission. Combination vaccine and hepatitis B immunoglobulin given at birth reduces risk of transmission, as does HBIG given to mothers in the third trimester. Three antivirals have been studied in pregnancy: lamivudine, telbivudine, and tenovofir. All have shown significant reduction in viral loads and vertical transmission and have favorable safety profiles. In conclusion, HBV vertical transmission is preventable through use of immunoprophylaxis and antiviral medications. Recommendation for antiviral use in third trimester in mothers whose HBV VL is greater than 1 × 10 6 copies/mL.
ISSN:1665-2681
DOI:10.1016/S1665-2681(19)30881-6