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World J Gastroenterol. Jun 21, 2021; 27(23): 3279-3289
Published online Jun 21, 2021. doi: 10.3748/wjg.v27.i23.3279
Chronic hepatitis B in pregnant women: Current trends and approaches
Maria Belopolskaya, Viktor Avrutin, Olga Kalinina, Alexander Dmitriev, Denis Gusev
Maria Belopolskaya, Polyclinical Department, Botkin's Infectious Disease Hospital, St-Petersburg 195067, Russia
Maria Belopolskaya, Chronic Viral Infectious Disease Lab, Institute of Experimental Medicine, St-Petersburg 197376, Russia
Viktor Avrutin, Institute for Systems Theory, University of Stuttgart, Stuttgart 70569, Baden-Wurttemberg, Germany
Olga Kalinina, Faculty of Biomedical Sciences, Almazov National Medical Research Centre, St-Petersburg 197341, Russia
Alexander Dmitriev, Department of Molecular Microbiology, Institute of Experimental Medicine, St-Petersburg 197376, Russia
Denis Gusev, Botkin's Infectious Disease Hospital, St-Petersburg 195067, Russia
Author contributions: Belopolskaya M: Conceptualization, Methodology, Investigation, Formal Analysis, Writing - original draft, Writing - review & editing. Avrutin V: Conceptualization, Formal Analysis, Writing - review & editing, Validation. Kalinina O: Methodology, Writing - review & editing. Dmitriev A and Gusev D: Writing - review & editing, Supervision.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maria Belopolskaya, MD, PhD, Doctor, Senior Scientist, Polyclinical Department, Botkin's Infectious Disease Hospital, Piskarevsky 49, St-Petersburg 195067, Russia. belopolskaya.maria@yahoo.com
Received: January 28, 2021
Peer-review started: January 28, 2021
First decision: March 6, 2021
Revised: March 10, 2021
Accepted: April 21, 2021
Article in press: April 21, 2021
Published online: June 21, 2021
Processing time: 140 Days and 13.1 Hours
Abstract

Chronic hepatitis B (CHB) is a significant public health problem worldwide. The aim of the present review is to summarize the actual trends in the management of CHB in pregnant women. The prevalence of hepatitis B virus (HBV) infection in pregnant women is usually comparable to that in the general population in the corresponding geographic area. All women have to be screened for hepatitis B surface antigen (HBsAg) during pregnancy. Additional examinations of pregnant women with CHB may include maternal hepatitis B e antigen, HBV viral load, alanine aminotransferase level, and HBsAg level. The management of pregnancy depends on the phase of the HBV infection, which has to be determined before pregnancy. In women of childbearing age with CHB, antiviral therapy can pursue two main goals: Treatment of active CHB, and vertical transmission prevention. During pregnancy, tenofovir is the drug of choice in both cases. A combination of hepatitis B immunoglobulin and vaccine against hepatitis B should be administered within the first 12 h to all infants born to mothers with CHB. In such cases, there are no contraindications to breastfeeding.

Keywords: Chronic hepatitis B; Hepatitis B viral load; Pregnancy; Antiviral treatment; Newborns; Mother-to-child transmission

Core Tip: All women have to be screened for hepatitis B surface antigen (HBsAg) during pregnancy. Additional examinations of pregnant women with chronic hepatitis B (CHB) may include maternal hepatitis B e antigen, hepatitis B virus (HBV) viral load, alanine aminotransferase level, and HBsAg level. The management of pregnancy depends on the phase of the HBV infection, which has to be determined before pregnancy. During pregnancy, tenofovir is the drug of choice both for active CHB treatment and vertical transmission prevention. A combination of hepatitis B immunoglobulin and vaccine against hepatitis B should be administered within the first 12 h to all infants born to mothers with CHB.