HEPATITIS B INFECTION DURING PREGNANCY EXPERIENCE AT TERTIARY
CARE CENTRE OF NORTH INDIA
Dr Vani Malhotra MD MICOGProfessorDepartment of Obstetrics and
GynecologyPGIMS, Rohtak, India
Hepatitis B Virus (HBV) infection is a global problem with
nearly 350 million carriers at risk for cirrhosis and
hepatocellular carcinoma50% carriers have acquired their infection
vertically from mothers (MTCT)90% of vertically acquired infection
become chronic
AASLDAll pregnant women be screened for HBsAg during the first
trimester, even if previously vaccinated or tested
Lok ASF, McMahon BJ. Chronic Hepatitis B: update 2009.
Hepatology 2009; 50: 661-2AASLD & ACOG POSITIVE MOTHERSMedical
evaluation immediately-duration of disease-extent of liver
disease-risk factors for MTCT(HBeAg status & viral
load)VERTICAL TRANSMISSION (MTCT)Transmission of pathogen from
mother to child during pregnancy or childbirth or by
breastfeedingROUTE OF TRANSMISSIONIN UTERO-TRANSMISSIONMain risk
factors Maternal HbeAg positivity High maternal viral load History
of threatened abortion or preterm labor NATAL
TRANSMISSIONTransfusion of mothers blood to fetus during labor
contractions(microtransfusions)Infection after rupture of
membranesDirect contact of the infants mucosal membranes POSTNATAL
TRANSMISSIONIngestion of virus or by contact with skin lesions on
mothers breastRISK FACTORS FOR MTCTHigh maternal viral loadPositive
HBeAg statusANTIVIRAL DRUGSPotent antiviral suppressionSafe &
well toleratedReduces perinatal HBV transmissionproblemsViral drug
resistanceContraindication to breast feedingHepatitis flares upon
discontinuationDrugFDA
CategoryRemarksLamivudineCRecommendedTelbivudineBRecommended
TenofovirBMay be recommendedEntecavirCNot Recommended
AdefovirCNot Recommended
IMMUNOPROPHYLAXISInfants born to HBsAg positive mothers should
receive both HBIG and HBV within 12 hours of birthNext two doses
should be given within six months of birth90-95% protection
Follow up of infantsHBsAg and anti HBs at 9 months of ageHBsAg
negative + anti-HBs>10mIU/ml are disease freeAnti-HBs
