[HBV and pregnancy]

The clinical course of HBV infection in pregnant women does not usually differ from the course in non-pregnant women. Hepatitis flare rarely occurs during pregnancy, but it is frequent after delivery. HBV carrier status is associated with a higher incidence of gestational diabetes mellitus, pre-term labour and miscarriage. In the case of HBV-infected women wishing to become pregnant, the therapy could be delayed after delivery if the liver disease is mild, while if the woman has a moderate/severe liver disease, or becomes pregnant while on treatment, the potential risks of the antivirals have to be compared with the risks of hepatitis flares with progression to hepatic decompensation without treatment. The availability of highly effective passive-active immunoprophylaxis of the neonate using hepatitis B immune globulin and hepatitis B vaccine has considerably reduced the incidence of the vertical transmission of HBV infection, but a residual risk exists in cases of high maternal HBV-DNA levels: in such cases, the administration of anti-viral therapy during the third trimester of pregnancy may further reduce the risk of neonatal infection.