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World J Hepatol. May 28, 2015; 7(9): 1233-1237
Published online May 28, 2015. doi: 10.4254/wjh.v7.i9.1233
Chronic hepatitis B infection in pregnancy
Jennifer R Lamberth, Sheila C Reddy, Jen-Jung Pan, Kevin J Dasher
Jennifer R Lamberth, Sheila C Reddy, Jen-Jung Pan, Kevin J Dasher, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, the University of Texas Health Science Center at Houston, Houston, TX 77030, United States
Author contributions: All authors contributed to this paper.
Conflict-of-interest: All authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Jennifer R Lamberth, MD, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, the University of Texas Health Science Center at Houston, 7000 Fannin Street, Houston, TX 77030, United States. jennifer.r.lamberth@uth.tmc.edu
Telephone: +1-713-5006677 Fax: +1-713-5006699
Received: November 29, 2014
Peer-review started: November 29, 2014
First decision: December 12, 2014
Revised: January 26, 2015
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: May 28, 2015
Processing time: 172 Days and 13.4 Hours
Abstract

There are no standard guidelines to follow when a patient with chronic hepatitis B infection becomes pregnant or desires pregnancy. Topics to consider include which patients to treat, when to start treatment, what treatment to use and when to stop treatment. Without any prophylaxis or antiviral therapy, a hepatitis B surface antigen and E antigen positive mother has up to a 90% likelihood of vertical transmission of hepatitis B virus (HBV) to child. Standard of care in the United States to prevent perinatal transmission consists of administration of hepatitis B immune globulin and HBV vaccination to the infant. The two strongest risk factors of mother to child transmission (MTCT) of HBV infection despite immunoprophylaxis are high maternal HBV viral load and high activity of viral replication. The goal is to prevent transmission of HBV at birth by decreasing viral load and/or decreasing activity of the virus. Although it is still somewhat controversial, most evidence shows that starting antivirals in the third trimester is effective in decreasing MTCT without affecting fetal development. There is a growing body of literature supporting the safety and efficacy of antiviral therapies to reduce MTCT of hepatitis B. There are no formal recommendations regarding which agent to choose. Tenofovir, lamivudine and telbivudine have all been proven efficacious in decreasing viral load at birth without known birth defects, but final decision of which antiviral medication to use will have to be determined by physician and patient. The antivirals may be discontinued immediately if patient is breastfeeding, or within first four weeks if infant is being formula fed.

Keywords: Chronic hepatitis B infection; Pregnancy; Hepatitis B immune globulin; Hepatitis B virus vaccine; Antivirals

Core tip: In pregnant patients chronically infected with hepatitis B, determining which patients require treatment is not well understood. In this concise review, we discuss four important questions to consider when faced with this patient population: who to treat, when to treat, what medication in which to treat and when to stop treatment.