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Chronic hepatitis B in pregnant women: Current trends and approaches
Maria Belopolskaya1, Viktor Avrutin2, Olga Kalinina3
1Polyclinical Department, Botkin's Infectious Disease Hospital, St-Petersburg 195067, Russia.
Insights
Pregnant women with chronic hepatitis B (CHB) require screening and management based on infection phase. Tenofovir is recommended during pregnancy to treat CHB and prevent vertical transmission.
Area of Science:
- Hepatology
- Virology
- Obstetrics
Background:
- Chronic hepatitis B (CHB) poses a global health challenge.
- Hepatitis B virus (HBV) prevalence in pregnant women mirrors the general population.
- Screening all pregnant women for hepatitis B surface antigen (HBsAg) is crucial.
Purpose of the Study:
- To review current management strategies for CHB in pregnant women.
- To outline diagnostic and therapeutic approaches for HBV in pregnancy.
- To address the prevention of vertical HBV transmission.
Main Methods:
- Review of current literature on CHB management in pregnancy.
- Discussion of screening protocols including HBsAg, HBeAg, HBV viral load, ALT, and HBsAg levels.
- Analysis of antiviral therapy options and their goals.
Main Results:
- Pregnancy management hinges on the HBV infection phase determined pre-conception.
- Tenofovir is the preferred antiviral agent during pregnancy for CHB treatment and transmission prevention.
- Infants require immediate hepatitis B immunoglobulin and vaccine administration.
Conclusions:
- Comprehensive screening and individualized management are essential for pregnant women with CHB.
- Antiviral therapy, particularly tenofovir, plays a key role in managing CHB during pregnancy.
- Post-exposure prophylaxis for newborns is critical to prevent HBV infection.
- Breastfeeding is safe for infants born to mothers with CHB.
Abstract:
Chronic hepatitis B (CHB) is a significant public health problem worldwide. The aim of the present review is to summarize the actual trends in the management of CHB in pregnant women. The prevalence of hepatitis B virus (HBV) infection in pregnant women is usually comparable to that in the general population in the corresponding geographic area. All women have to be screened for hepatitis B surface antigen (HBsAg) during pregnancy. Additional examinations of pregnant women with CHB may include maternal hepatitis B e antigen, HBV viral load, alanine aminotransferase level, and HBsAg level. The management of pregnancy depends on the phase of the HBV infection, which has to be determined before pregnancy. In women of childbearing age with CHB, antiviral therapy can pursue two main goals: Treatment of active CHB, and vertical transmission prevention. During pregnancy, tenofovir is the drug of choice in both cases. A combination of hepatitis B immunoglobulin and vaccine against hepatitis B should be administered within the first 12 h to all infants born to mothers with CHB. In such cases, there are no contraindications to breastfeeding.
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