title: Management of hepatitis B during pregnancy.
abstract: Chronic HBV infection is estimated to affect >350 million people worldwide and represents a substantial source of morbidity and mortality related to cirrhosis and hepatocellular carcinoma. Mother-to-child transmission (MTCT) remains an important source of incident cases of hepatitis B. Immunoprophylaxis of infants born to mothers who are positive for hepatitis B surface antigen is used to prevent MTCT; however, under-utilization of this intervention in certain regions endemic for HBV infection and failure of immunoprophylaxis in 5-10% of cases are barriers to preventing HBV transmission via this route. Data suggest that a high level of HBV viraemia in pregnant women is a substantial risk factor for immunoprophylaxis failure. Potential means of reducing viral load include antiviral therapy in the third trimester to reduce exposure of the neonate to the virus. Determining the optimal time to treat active HBV-related liver disease in women who wish to become pregnant, as well as managing antiviral therapy in patients who become pregnant, remains challenging. Owing to the vulnerable population affected by these issues, clinical trials are difficult and, thus, evidence-based recommendations are limited. Emerging data are addressing management of HBV during pregnancy that health-care providers should be made aware of. Here, we provide an overview of issues pertinent to HBV infection during pregnancy and present a management algorithm.
authors.affiliation: UC San Diego Health System, 200 West Arbor Drive, San Diego, CA 92103, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Patton
authors.affiliation: Cedars Sinai Medical Center, 8635 West 3rd Street, Suite 590W, Los Angeles, CA 90048, USA.
authors.forename: Tram T
authors.initials: TT
authors.lastname: Tran
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D019694:Hepatitis B, Chronic / Q000628:therapy* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control* / Q000628:therapy*; D011256:Pregnancy Outcome
chemical_list: D000998:Antiviral Agents