Hepatitis B in pregnancy and breastfeeding: current approaches to prophylaxis and treatment

Chronic hepatitis B infection affects an estimated 258 million people globally. Mother-to-child transmission (MTCT) accounts for over one-third of new cases in endemic regions and almost invariably results in lifelong infection if acquired at birth. Over the past four decades, universal vaccination, hepatitis B immunoglobulin (HBIG), and maternal antiviral prophylaxis have substantially reduced MTCT. However, limited access to antiviral therapy and HBIG in resource-constrained settings continues to hinder elimination efforts.

This review focuses on HBV in pregnancy and breastfeeding, with emphasis on maternal antiviral prophylaxis. It outlines epidemiology, maternal risk factors, and the limitations of vaccination and HBIG. Evidence supporting tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) is evaluated, alongside HBIG-free strategies and novel vaccine delivery platforms. Postpartum management, including hepatitis flares and the safety of breastfeeding during antiviral therapy, is also addressed.

Maternal antiviral prophylaxis with TDF, and increasingly TAF, is central to preventing mother-to-child transmission of hepatitis B. HBIG-free strategies, earlier treatment initiation, and improved vaccines may further reduce transmission, particularly in resource-limited settings. Achieving WHO 2030 elimination goals will require policy commitment, affordable access, and integration of HBV prevention into routine maternal-child health care.