Managing hepatitis B virus in pregnancy and children

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  • All pregnant women should be tested for hepatitis B surface antigen (HBsAg). A woman identified as HBsAg positive should be tested for hepatitis B e antigen (HBeAg) and hepatitis B virus (HBV) DNA, to determine risk of transmission to the infant and the degree of infectivity.
  • If a pregnant woman has HBV, health professionals should take the opportunity to provide education about disease management, plan ongoing care, and test family and close contacts.
  • The risk of mother-to-child transmission of HBV can be significantly reduced. The baby should be given a combination of hepatitis B immunoglobulin (HBIG) and the first dose of hepatitis B vaccine as soon as possible after birth and ideally within 4 hours, followed by a full course of hepatitis B vaccine.
  • For HBsAg-positive women with high viral loads (> 200,000 IU/mL or 5.3 log IU/ml), referral should be made to a specialist to discuss consideration of tenofovir between 28-32 weeks gestation, to further reduce the risk of perinatal transmission.
  • There is no evidence of HBV transmission as a result of breastfeeding.
  • All children of HBsAg-positive mothers should be tested for HBsAg and anti-HBs at 9–12 months of age (at least 3 months after final dose of HBV vaccine). Most children with HBV infection develop chronic infection. They are asymptomatic and have little liver damage, but have high viral loads.
  • Children with chronic hepatitis B (CHB) should be monitored annually, with liver function tests and HBV serology and viral load.
  • Ensure adolescents with chronic hepatitis B infection are appropriately transferred from paediatric to adult care.

Click to open GESA recommendations

GESA Consensus Recommendation 21

GESA Consensus Recommendation 22

GESA Consensus Recommendation 23

GESA Consensus Recommendation 24

  1. Leung N. Chronic hepatitis B in Asian women of childbearing age. Hepatol Int 2009;3 Suppl 1:24-31.
  2. Chu CM, Liaw YF. Natural history of chronic hepatitis B virus infection: an immunopathological study. J Gastroenterol Hepatol 1997;12:S218–22.
  3. Australian Government. Australian Technical Advisory Group on Immunisation (ATAGI). The Australian Immunisation Handbook. Chapter 4.5. Hepatitis B. 10th ed. (updated 22 June 2015) [internet]. Available at: accessed 24 June 2018).
  4. European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol 2017;67:370-98.
  5. Terrault N, Bzowej N, Chang K, Hwang JP, Jonas MM, Murad MH; American Association for the Study of Liver Diseases. AASLD guidelines for treatment of chronic hepatitis B. Hepatology 2016;63:261-83.
  6. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology 2009;50:661–2.
  7. Wen W-H, Chang M-H, Zhao L-L, Ni Y-H, Hsu H-Y, Wu J-F, et al. Mother-to-infant transmission of hepatitis B virus infection: Significance of maternal viral load and strategies for intervention. Journal of Hepatology 2013;59:24–30.
  8. Wiseman E, Fraser MA, Holden S, Glass A, Kidson BL, Heron LG, et al. Mother to child transmission of hepatitis B virus: an Australian experience. Med J Aust 2009;190:489–92.
  9. Guo Z, Shi XH, Feng YL, Wang B, Feng LP, Wang SP, et al. Risk factors of HBV intrauterine transmission among HBsAg-positive pregnant women. J Viral Hepat 2013;20:317–21.
  10. Pan CQ, Zou HB, Chen Y, Zhang X, Zhang H, Li J, et al. Cesarean section reduces mother to child transmission of hepatitis B virus infection from hepatitis B surface antigen-positive women to their infants. Clin Gastroenterol Hepatol 2013;11:1349–55.
  11. Yang J, Zeng X-m, Men Y-l, Zhao L-S. Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus – a systematic review. Virol J 2008;5:100.
  12. Liaw YF, Omata M. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2012 update. Hepatol Int. 2012;Hepatol Int(6):531–61.
  13. Levy M. Preventing mother to child transmission of HBV: an Australian perspective. Curr Hepat Rep 2012;11:206–12.
  14. Giles M, Visvanathan K, Sasadeusz J. Antiviral therapy for hepatitis B infection during pregnancy and breastfeeding. Antiviral Therapy 2011;16:621–8.
  15. Pan CQ, Duan Z, Dai E, Zhang S, Han G, Wang Y, et al. Tenofovir to prevent hepatitis B transmission in mothers with high viral load. N Engl J Med 2016;374:2324-34.
  16. Visvanathan K, Dusheiko G, Giles M, Wong ML, Phung N, Walker S, et al. Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow-up. Position paper produced by Australian, UK and New Zealand key opinion leaders. Gut 2016;65:340-50.
  17. van Zonneveld M, van Nunen AB, Niesters HGM, de Man RA, Schalm SW, Janssen HLA. Lamivudine treatment during pregnancy to prevent mother to child transmission of hepatitis B virus infection. J Viral Hepat 2003;10:294–7.
  18. Xu WM, Cui YT, Wang L, Yang H, Liang ZQ, Li XM, et al. Lamivudine in late pregnancy to prevent Mother to Child Transmissionof hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study. J Viral Hepat 2009;16:94–103.
  19. Shi Z, Yang Y, Ma L, Li X, Schreiber A. Lamivudine in late pregnancy to interrupt in utero transmission of hepatitis B virus: a systematic review and meta-analysis. Obstet Gynecol 2010;116:147–59.
  20. Ayres A, Yuen L, Manoharan S, Glass A, Maley M, Levy M, et al. Ultradeep pyrosequencing identifies multidrug resistant HBV in pregnancy women undergoing lamivudine therapy. Hepatology. 2011;October 1074A.
  21. Galluzzo C, Liotta G, Andreotti M, Luhanga R, Jere H, Mancinelli S, et al. Emergence of lamivudine resistance hepatitis B virus mutations in pregnant women infected with HBV and HIV receiving antiretroviral prophylaxis for the prevention of mother-to-infant transmission in Malawi. J Med Virol 2012;84:1553–7.
  22. Kitrinos KM, Corsa A, Liu Y, Flaherty J, Snow-Lampart A, Marcellin P, et al. No detectable resistance to tenofovir disoproxil fumarate after 6 years of therapy in patients with chronic hepatitis B. Hepatology 2014;59:434-42.
  23. Greenup A-J, Tan PK, Nguyen V, Glass A, Davison S, Chatterjee U, et al. Efficacy and safety of tenofovir disoproxil fumarate in pregnancy to prevent mother to child transmission of hepatitis B virus. J Hepatol 2014;61:502-7
  24. Pan CQ, Mi LJ, Bunchorntavakul C, Karsdon J, Huang WM, Singhvi G, et al. Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women: a case series. Dig Dis Sci 2012;57:2423–9.
  25. van Rompay KKA, Brignolo LL, Meyer DJ, Jerome C, Tarara R, Spinner A, et al. Biological effects of short-term or prolonged administration of 9-[2-(phosphonomethoxy)propyl]adenine (tenofovir) to newborn and infant rhesus macaques. (Erratum appears in Antimicrob Agents Chemother 2994 Jan;48:2346). Antimicrob Agents Chemother 2004;48:1469–87.
  26. Brown RS, Jr., Verna EC, Pereira MR, Tilson HH, Aguilar C, Leu C-S, et al. Hepatitis B virus and human immunodeficiency virus drugs in pregnancy: findings from the Antiretroviral Pregnancy Registry. J Hepatology 2012;57:953–9.
  27. Wang L, Kourtis AP, Ellington S, Legardy-Williams J, Bulterys M. Safety of tenofovir during pregnancy for the mother and fetus: a systematic review. Clin Infecti Dis 2013;57:1773-81.
  28. Van Rompay KKA, Hamilton M, Kearney B, Bischofberger N. Pharmacokinetics of tenofovir in breast milk of lactating rhesus macaques. Antimicrob Agents Chemother 2005;49:2093–4.
  29. Vigano A, Bedogni G, Manfredini V, Giacomet V, Cerini C, di Nello F, et al. Long-term renal safety of tenofovir disoproxil fumarate in vertically HIV-infected children, adolescents and young adults: a 60-month follow-up study. Clin Drug Investig 2011;31:407–15.
  30. Nguyen V, Tan PK, Greenup AJ, Glass A, Davison S, Samarasinghe D, et al. Anti-viral therapy for prevention of perinatal HBV transmission: extending therapy beyond birth does not protect against post-partum flare. Aliment Pharmacol Ther 2014;39:1225–34.
  31. ter Borg MJ, Leemans WF, de Man RA, Janssen HLA. Exacerbation of chronic hepatitis B infection after delivery. J Viral Hepat 2008;15:37–41.
  32. Pan C, Guo-Rong H, Jiang H-X, Zhao W, Cao M-K, Want C-M, et al. Telbivudine prevents vertical transmission from HBeAg postive women with chronic hepatitis B. Clin Gastroenterol Hepatol. 2012;10:520–6.
  33. Bortolotti F, Guido M, Bartolacci S, Cadrobbi P, Crivellaro C, Noventa F, et al. Chronic hepatitis B in children after e antigen seroclearance: final report of a 29-year longitudinal study. Hepatology 2006;43:556–62.
  34. Roushan MR, Bijani A, Ramzaninejad S, Roushan MH, Amiri MJ, Baiani M. HBeAg seroconversion in children infected during early childhood with hepatitis B virus. J Clin Virol 2012;55:30–3.
  35. Sokal EM, Paganelli M, Wirth S, Socha P, Vajro P, Lacaille F, et al. Management of chronic hepatitis B in childhood: ESPGHAN clinical practice guidelines: consensus of an expert panel on behalf of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Hepatol 2013;59:814–29.
  36. Jonas MM, Chang MH, Sokal E, Schwarz KB, Kelly D, Kim KM, et al. Randomized, controlled trial of entecavir versus placebo in children with hepatitis B envelope antigen-positive chronic hepatitis B. Hepatology 2016;63:377-87.
  37. Rosenthal P, Ling SC, Belle SH, Murray KF, Rodriguez-Baez N, Schwarzenberg SJ, et al. The combination of entecavir and peginter-feron alfa-2a in HBeAg-positive immune-tol-erant (IT) children and adolescents with chronic hepatitis B virus (HBV) Infection: results of the HBRN pediatric IT trial. AASLD abstract 133. Hepatology 2017;66 Suppl 1:77A.
  38. Hepatitis B Consensus Statement Working Group. Australian consensus recommendations for the management of hepatitis B infection. Melbourne. Gastroenterological Society of Australia, 2022. Available at: