Viral hepatitis B in pregnancy: A review of its burden, vertical transmission and neonatal prophylaxis

Abstract

Chronic hepatitis B infection represents a high society burden due to its high morbidity and mortality rate, especially infections acquired by vertical transmission. This review’s purpose is to update information regarding acute and chronic evolution and management of hepatitis B during pregnancy, vertical transmission, and prophylaxis of HBV infection. The database of PubMed was searched for literature reviews, guidelines, and research articles in English, regarding pregnancy and HBV infection from 2015 to October 2021. Pregnancy may have a serious impact on the natural evolution of chronic HBV in cases of advanced disease or liver fibrosis. Management of these patients include periodical monitoring and antiviral therapy during pregnancy. Alanine amino transferase (ALT) flares can occur during pregnancy or more often after birth, being related to the specific immune changes in pregnant women. The most important impact of HBV infection on pregnancy outcomes is represented by vertical transmission. Almost 90% of the infants infected at birth will develop chronic HBV infection out of which 25-40% will develop specific complications. Almost 9% of the newborns of positive HBsAg mothers acquire HBV infection despite standard immunoprophylaxis with hepatitis B vaccine and hepatitis B immune globulin. Failure of immunoprophylaxis can have a higher rate due to elevated levels of HBV DNA during pregnancy, that can be lowered by prophylactic antiviral administration from 28-32 weeks, during pregnancy. Screening every pregnant woman for HBsAg is a good practice measure, which should be standard, among the universal hepatitis B vaccination, in order to achieve a reduction of HBV infection prevalence.