Hepatitis B in Pregnancy — Updated Guideline 2024 / 2025 

1️⃣ Screening (According to ACOG & CDC)

• Every pregnant woman should be screened for HBsAg at the first antenatal visit, regardless of vaccination history.  
• If HBsAg positive → check:  
•  HBV DNA(viral load)  
•   HBeAg
•  Liver function tests: ALT, AST, bilirubin, ALP, albumin, INR  
•   Renal function:urea, creatinine, eGFR (Tenofovir is renally excreted).  
•  If HBsAg negative but at risk → vaccinate during pregnancy (safe in all trimesters).  

2️⃣ Assessing Severity & Baseline Work-up

•  Normal LFTs + low viral load (< 200,000 IU/mL) → usually no antiviral ; follow up every trimester.  
•  Elevated LFTs or high viral load (≥ 200,000 IU/mL) → initiate antiviral prophylaxis.  
•  Screen for co-infections(Hepatitis C, HIV).  
•  Assess fibrosis if chronic infection (Fibroscan / FIB-4 if available).  

3️⃣ Antiviral Therapy (AASLD 2023 / WHO 2024)

- Drug of choice:Tenofovir Disoproxil Fumarate (TDF) 300 mg daily

  - Start at 28–32 weeks gestation if:  

    - HBV DNA > 200,000 IU/mL, or  

    - HBeAg positive with high transmission risk.  

  - Continue until delivery or up to 12 weeks postpartum(to prevent flare).  

- Do NOT start antivirals if viral load < 200,000 IU/mL with normal LFTs.  

- Monitor  renal & hepatic function every 4–6 weeks while on Tenofovir.  

4️⃣ Delivery & Intrapartum Management

•  Cesarean section not recommended solely for HBV prevention.  
•  Avoid: prolonged rupture of membranes & invasive procedures (e.g., fetal scalp sampling).  
•  Inform the delivery team of maternal HBV status and newborn prophylaxis plan.  

 5️⃣ Neonatal Prophylaxis (CDC / WHO)

- Within 12 hours after birth, each infant born to an HBsAg-positive mother must receive:  

  1. Hepatitis B vaccine (birth dose) 

  2. Hepatitis B immune globulin (HBIG) — in a separate site.  

- Complete 3-dose vaccine series at 0 – 1 – 6 months.  

- Follow-up serology at 9–12 months:  

  - anti-HBs > 10 mIU/mL + HBsAg negative → protected.

  - HBsAg positive → refer for specialist care.  

6️⃣ Postpartum & Breastfeeding

- Breastfeeding is safe if the baby received vaccine + HBIG.  

- Continue Tenofovir if indicated for maternal liver disease.  

- Re-check maternal LFTs 6–12 weeks postpartum for possible flare.  

 7️⃣ Patient Education Points

💬 Hepatitis B doesn’t mean you can’t have a healthy baby

- Early testing = early protection.  

- Antivirals are safe in pregnancy.  

- Baby’s birth-dose + HBIG = life-saving combo.  

- HBV vaccine is safe during pregnancy for women at risk.  

#DrRababCares 

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