Society for Maternal-Fetal Medicine Consult Series #69: Hepatitis B in pregnancy: updated guidelines

• Published in: American journal of obstetrics and gynecology 2024-04, Vol.230 (4), p.B2-B11
• Main Authors: Badell, Martina L., Prabhu, Malavika, Dionne, Jodie, Tita, Alan T.N., Silverman, Neil S.
• Format: Article
• Language: English
• Subjects: antiviral therapy; breastfeeding; chronic hepatitis B; Female; Hepatitis B - diagnosis; Hepatitis B - drug therapy; Hepatitis B - prevention & control; Hepatitis B Surface Antigens - therapeutic use; Hepatitis B Vaccines - therapeutic use; Hepatitis B virus; Hepatitis B, Chronic - diagnosis; Hepatitis B, Chronic - drug therapy; Hepatitis B, Chronic - prevention & control; Humans; immunoprophylaxis; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical - prevention & control; intrapartum care; neonatal care; perinatal transmission; Perinatology; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - prevention & control; Tenofovir - therapeutic use; viral load
• ISSN: 0002-9378; 1097-6868; 1097-6868
• DOI: 10.1016/j.ajog.2023.12.023

More than 290 million people worldwide, and almost 2 million people in the United States, are infected with hepatitis B virus, which can lead to chronic hepatitis B, a vaccine-preventable communicable disease. The prevalence of chronic hepatitis B infection in pregnancy is estimated to be 0.7% to 0.9% in the United States, with >25,000 infants born annually at risk for chronic infection due to perinatal transmission. Given the burden of disease associated with chronic hepatitis B infection, recent national guidance has expanded both the indications for screening for hepatitis B infection and immunity and the indications for vaccination. The purpose of this document is to aid clinicians caring for pregnant patients in screening for hepatitis B infection and immunity status, discuss the perinatal risks of hepatitis B infection in pregnancy, determine whether treatment is indicated for maternal or perinatal indications, and recommend hepatitis B vaccination among susceptible patients. The following are the Society for Maternal-Fetal Medicine recommendations: (1) we recommend triple-panel testing (hepatitis B surface antigen screening, antibody to hepatitis B surface antigen, and total antibody to hepatitis B core antigen) at the initial prenatal visit if not previously documented or known to have been performed (GRADE 1C); (2) we recommend universal hepatitis B surface antigen screening alone at the initial prenatal care visit for all pregnancies where there has been a previously documented negative triple-panel test (GRADE 1B); (3) we recommend that individuals with unknown hepatitis B surface antigen screening status be tested on any presentation for care in pregnancy; we also recommend that those with clinical hepatitis or those with risk factors for acute hepatitis B infection be tested at the time of admission to a birthing facility when delivery is anticipated (GRADE 1B); (4) we do not recommend altering routine intrapartum care in individuals chronically infected with hepatitis B; administration of neonatal immunoprophylaxis is standard of care in these situations (GRADE 1B); (5) we do not recommend cesarean delivery for the sole indication of reducing perinatal hepatitis B virus transmission (GRADE 1B); (6) we recommend that individuals with HBV infection can breastfeed as long as the infant has received immunoprophylaxis at birth (GRADE 1C); (7) we suggest individuals with hepatitis B infection who desire invasive testing may have the procedure perfo