Chronic hepatitis B in pregnant women: Current trends and approaches

Table 4 Treatment of pregnant women with chronic hepatitis B

	APASL 2016[8]	EASL 2017[9]	AASLD 2018[10]
Therapy	In pregnant females with chronic HBV infection who need antiviral therapy, tenofovir is the drug of choice for mothers indicated for antiviral treatment during the first through third trimester of pregnancy	Tenofovir is recommended for pregnant women with CHB and advanced fibrosis. Therapy with tenofovir should be continued, and if the woman was receiving other drugs, these other drugs should be replaced with tenofovir	Women who meet standard indications for HBV therapy should be treated. HBV-infected pregnant women with cirrhosis should be managed in high-risk obstetrical practices and treated with tenofovir to prevent decompensation
To prevent vertical transmission	For reduction of risk of mother-to-infant transmission that occurs during the perinatal period, short-term maternal NAs starting from 28 wk to 32 wk of gestation is recommended using either tenofovir or telbuvidine for those mothers with HBV DNA above 6-7 log10 IU/mL. Since, the HBV transmission could occur even with lower maternal HBV DNA level, NAs could be administered after discussion with the patient, even in patients with lower DNA level. The NA could be stopped at birth and when breastfeeding starts, if there is no contraindication to stopping NA	In all pregnant women with high HBV DNA level (> 200000 IU/mL) or HBsAg level > 4 log10 IU/mL, antiviral prophylaxis with tenofovir disoproxil fumarate should start at week 24-28 of gestation and continue for up to 12 wk after delivery	Women without standard indications but who have HBV DNA > 200000 IU/mL in the second trimester should consider treatment to prevent mother-to-child transmission

APASL: Asia-Pacific Association Society for the Study of the Liver; EASL: European Association for the Study of the Liver; AASLD: American Association for the Study of Liver Diseases; HBV: Hepatitis B virus; CHB: Chronic hepatitis B; NA: Nucleoside analogues; HBsAg: Hepatitis B surface antigen.