Management of Hepatitis B virus infection during pregnancy

Hepatitis B virus (HBV) infects over 2 billion people worldwide, with approximately 360 million chronically infected. It results in substantial morbidity and mortality, with an estimated 600,000 deaths per year. In endemic areas, mother to child transmission (MTCT) is the most important source of new infections, but even in areas with low endemicity, over 1/3 of infections can still be attributed to this route. Although very effective active-passive immunoprophylaxis with hepatitis B immune globulin (HBIG) and HBV vaccine is available, even with full compliance, failure can be seen in highly viremic mothers who are positive for hepatitis B e antigen. Potential means of reducing the risk of MTCT include nucleotide/nucleoside antiviral agents, interferon in very select cases, and mode of delivery. Determining the optimal therapy and its timing, and preventing both obstetric and liver related complications remains a challenge, but is also an important opportunity to reduce chronic hepatitis B infection. In this review, we provide an overview of issues associated with hepatitis B and its treatment during pregnancy, and suggest an algorithm for management.