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©The Author(s) 2021.
World J Gastroenterol. Jun 21, 2021; 27(23): 3279-3289
Published online Jun 21, 2021. doi: 10.3748/wjg.v27.i23.3279
Published online Jun 21, 2021. doi: 10.3748/wjg.v27.i23.3279
Table 1 Examination of pregnant women
APASL 2016[8] | EASL 2017[9] | AASLD 2018[10] | |
All pregnant women | Pregnant female (preferably during the first trimester to vaccinate unprotected mothers) should be tested for HBV infection | Screening for HBsAg in the first trimester of pregnancy is strongly recommended | All pregnant women should be screened for HBV infection |
Examination of HBsAg-positive women during pregnancy | Maternal HBeAg, HBV DNA status, and ALT level should be checked during pregnancy | ALT, HBV DNA level, and HBsAg level | ALT level, HBV DNA or imaging for HCC surveillance if indicated |
Table 2 Prevalence of hepatitis B surface antigen among pregnant women
Ref. | Country | Years | Number | HBsAg-positive (%) |
Kirbak et al[17], 2017 | Republic of South Sudan | 2013-2014 | 280 | 11 |
Fouelifack et al[18], 2018 | Cameroon | 2016 | 360 | 9.4 |
Bittaye et al[19], 2019 | Gambia | 2015 | 426 | 9.2 |
Tanga et al[20], 2019 | South Western Ethiopia | 2017 | 253 | 7.9 |
Kishk et al[21], 2020 | Egypt | 2018-2019 | 600 | 5 |
Fessehaye et al[22], 2018 | Eritrea | 2016 | 5009 | 3.2 |
Sheng et al[23], 2018 | China | 2016 | 14314 | 3.1 |
Cetin et al[24], 2018 | Turkey | 2016 | 475 | 2.1 |
Mishra et al[25], 2017 | India | 2016 | 3567 | 1.09 |
Biondi et al[26], 2020 | Canada | 2012-2016 | 651745 | 0.63 |
Lembo et al[27], 2017 | Italy | 2010-2015 | 7558 | 0.5 |
Ruiz-Extremera et al[28], 2020 | Spain | 2015 | 21870 | 0.42 |
Harris et al[29], 2018 | United States | 2011-2014 | 870888 | 0.14 |
Table 3 Clinical features and vertical transmission risk in different phases of chronic hepatitis B
Phase of CHB | ALT | Fibrosis (Metavir score) | HBV DNA level | Markers of HBV-infection | Vertical transmission risk |
Phase of immune tolerance | Normal | F0 | Very high (108-109 IU/mL) | HBsAg+; HBeAg+; HBeAb-; HBcorAb+ | Very high |
Immunoreactive phase | Elevated | F1-F4 | High (106-107 IU/mL) | HBsAg+; HBeAg+/-; HBeAb-/+; HBcorAb+ | High |
Inactive carriage of HBsAg | Normal | F0 | Less than 2000 IU/mL | HBsAg+; HBeAg-; HBeAb+; HBcorAb+ | Low |
Phase of HBeAg-negative CHB | Elevated | F1-F4 | Middle (10³-107 IU/mL) | HBsAg+; HBeAg-; HBeAb+; HBcorAb+ | Depends on HBV viral load |
Occult CHB | Normal | F1-F4 | +/-, HBV DNA in liver+ | HBsAg-; HBeAg-; HBeAb-; HBcorAb+/- | Low |
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 |
Table 5 Cessation of nucleoside analogues treatment after delivery
APASL 2016[8] | EASL 2017[9] | AASLD 2018[10] |
Cessation of NA therapy (at delivery or 4-12 wk after delivery) is recommended in females without ALT flares and without pre-existing advanced liver fibrosis/cirrhosis. Continuation of NA treatment after delivery may be necessary according to maternal liver disease status | If NA therapy is given as prophylaxis, i.e., only for the prevention of perinatal transmission, its duration is not well defined (stopping at delivery or within the first 3 mo after delivery) | HBV-infected pregnant women who are not on antiviral therapy as well as those who stop antiviral at or early after delivery should be monitored closely for up to 6 mo after delivery for hepatitis flares and seroconversion. Long-term follow-up should be continued to assess need for future therapy |
Table 6 Hepatitis B virus prophylaxis in newborns
APASL 2016[8] | EASL 2017[9] | AASLD 2018[10] |
HBIG and hepatitis B vaccine can be given to newborns from HBsAg-positive mothers immediately after delivery | The combination of HBIG and vaccination is administered within 12 h of birth | HBIG and HBV vaccine should be administered to the newborn < 12 h after delivery |
Table 7 Breastfeeding of newborns
APASL 2016[8] | EASL 2017[9] | AASLD 2018[10] |
Breastfeeding is not recommended while the woman is receiving antiviral therapy | Breastfeeding is not contraindicated in women not receiving antiviral therapy and during treatment with tenofovir | Breastfeeding is not prohibited for women with or without antiviral therapy |
- Citation: Belopolskaya M, Avrutin V, Kalinina O, Dmitriev A, Gusev D. Chronic hepatitis B in pregnant women: Current trends and approaches. World J Gastroenterol 2021; 27(23): 3279-3289
- URL: https://www.wjgnet.com/1007-9327/full/v27/i23/3279.htm
- DOI: https://dx.doi.org/10.3748/wjg.v27.i23.3279