title: Hepatitis B in pregnancy: a concise review of neonatal vertical transmission and antiviral prophylaxis.
abstract: Hepatitis 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 x 10⁶ copies/mL.
authors.affiliation: Division of Department of Obstetrics and Gynecology, the University of British Columbia, Vancouver, BC, Canada.
authors.forename: Frank
authors.initials: F
authors.lastname: Wong
authors.affiliation: Division of Department of Obstetrics and Gynecology, the University of British Columbia, Vancouver, BC, Canada.
authors.forename: Rohit
authors.initials: R
authors.lastname: Pai
authors.affiliation: Gastroenterology and the Department of Obstetrics and Gynecology, the University of British Columbia, Vancouver, BC, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Van Schalkwyk
authors.affiliation: Division of Department of Obstetrics and Gynecology, the University of British Columbia, Vancouver, BC, Canada.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoshida
mesh_terms: D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000517:prevention & control* / Q000635:transmission*; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000187:drug effects; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000821:virology*; D012307:Risk Factors; D019562:Viral Load / Q000187:drug effects; D014765:Viral Vaccines / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D014765:Viral Vaccines