Chronic hepatitis B infection in pregnancy

Area of Science:

• Hepatology
• Maternal-Fetal Medicine
• Virology

Background:

• Chronic hepatitis B infection in pregnancy lacks standard management guidelines.
• High maternal viral load significantly increases the risk of mother-to-child transmission (MTCT) of hepatitis B virus (HBV).
• Current standard care involves infant immunoprophylaxis, but MTCT still occurs.

Purpose of the Study:

• To review the evidence for antiviral therapy in pregnant patients with chronic hepatitis B.
• To assess the efficacy and safety of antivirals in preventing HBV perinatal transmission.
• To discuss treatment considerations, including timing, choice of agent, and discontinuation.

Main Methods:

• Literature review of studies on antiviral therapy for HBV in pregnancy.
• Analysis of data on viral load reduction and MTCT rates.
• Evaluation of safety profiles regarding fetal development and postpartum considerations.

Main Results:

• Antiviral therapy, particularly in the third trimester, effectively reduces maternal HBV viral load.
• Evidence supports the safety and efficacy of antivirals in decreasing MTCT without adverse fetal effects.
• Tenofovir, lamivudine, and telbivudine are effective options, with discontinuation advised postpartum.

Conclusions:

• Antiviral therapy is a valuable strategy to prevent HBV perinatal transmission in pregnant patients.
• Third-trimester initiation of antivirals is effective and generally safe for fetal development.
• Physician-patient collaboration is crucial for selecting appropriate antiviral agents and managing postpartum treatment cessation.