Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Hepatitis B and pregnancy

Hannah Lee, MD
Anna SF Lok, MD
Section Editors
Rafael Esteban, MD
Louise Wilkins-Haug, MD, PhD
Deputy Editor
Jennifer Mitty, MD, MPH


Hepatitis B virus (HBV) infection during pregnancy presents with unique management issues for both the mother and the fetus. These include the effects of HBV on maternal and fetal health, the effects of pregnancy on the course of HBV infection, treatment of HBV during pregnancy, and prevention of mother-to-child transmission.

Prevention of mother-to-child transmission is an important component of global efforts to reduce the burden of chronic HBV since vertical transmission is responsible for approximately one-half of chronic infections worldwide. The risk of developing chronic HBV infection is inversely proportional to the age at time of exposure. The risk is as high as 90 percent in those exposed at birth without vaccination, while the risk is much lower (about 20 to 30 percent) in those exposed during childhood. Maternal screening programs and universal vaccination of infants have significantly reduced transmission rates.

This topic will review special considerations for the management of patients with acute and chronic HBV infection during pregnancy and the post-partum period, as well as prevention of mother-to-child transmission. Additional topic reviews that address prevention and management of HBV infection in children, and liver disease in pregnancy, are found elsewhere:

(See "Hepatitis B virus immunization in infants, children, and adolescents".)

(See "Hepatitis viruses and the newborn: Clinical manifestations and treatment".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Feb 04, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Sookoian S. Liver disease during pregnancy: acute viral hepatitis. Ann Hepatol 2006; 5:231.
  2. Hieber JP, Dalton D, Shorey J, Combes B. Hepatitis and pregnancy. J Pediatr 1977; 91:545.
  3. Jonas MM. Hepatitis B and pregnancy: an underestimated issue. Liver Int 2009; 29 Suppl 1:133.
  4. Degertekin B, Lok AS. Indications for therapy in hepatitis B. Hepatology 2009; 49:S129.
  5. Potthoff A, Rifai K, Wedemeyer H, et al. Successful treatment of fulminant hepatitis B during pregnancy. Z Gastroenterol 2009; 47:667.
  6. Rawal BK, Parida S, Watkins RP, et al. Symptomatic reactivation of hepatitis B in pregnancy. Lancet 1991; 337:364.
  7. Giles M, Visvanathan K, Lewin S, et al. Clinical and virological predictors of hepatic flares in pregnant women with chronic hepatitis B. Gut 2015; 64:1810.
  8. Lin HH, Wu WY, Kao JH, Chen DS. Hepatitis B post-partum e antigen clearance in hepatitis B carrier mothers: Correlation with viral characteristics. J Gastroenterol Hepatol 2006; 21:605.
  9. ter Borg MJ, Leemans WF, de Man RA, Janssen HL. Exacerbation of chronic hepatitis B infection after delivery. J Viral Hepat 2008; 15:37.
  10. Yang YB, Li XM, Shi ZJ, Ma L. Pregnant woman with fulminant hepatic failure caused by hepatitis B virus infection: a case report. World J Gastroenterol 2004; 10:2305.
  11. Nguyen G, Garcia RT, Nguyen N, et al. Clinical course of hepatitis B virus infection during pregnancy. Aliment Pharmacol Ther 2009; 29:755.
  12. Tan HH, Lui HF, Chow WC. Chronic hepatitis B virus (HBV) infection in pregnancy. Hepatol Int 2008; 2:370.
  13. Söderström A, Norkrans G, Lindh M. Hepatitis B virus DNA during pregnancy and post partum: aspects on vertical transmission. Scand J Infect Dis 2003; 35:814.
  14. Lao TT, Chan BC, Leung WC, et al. Maternal hepatitis B infection and gestational diabetes mellitus. J Hepatol 2007; 47:46.
  15. Lao TT, Tse KY, Chan LY, et al. HBsAg carrier status and the association between gestational diabetes with increased serum ferritin concentration in Chinese women. Diabetes Care 2003; 26:3011.
  16. Lobstein S, Faber R, Tillmann HL. Prevalence of hepatitis B among pregnant women and its impact on pregnancy and newborn complications at a tertiary hospital in the eastern part of Germany. Digestion 2011; 83:76.
  17. Connell LE, Salihu HM, Salemi JL, et al. Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes. Liver Int 2011; 31:1163.
  18. Wong S, Chan LY, Yu V, Ho L. Hepatitis B carrier and perinatal outcome in singleton pregnancy. Am J Perinatol 1999; 16:485.
  19. Tse KY, Ho LF, Lao T. The impact of maternal HBsAg carrier status on pregnancy outcomes: a case-control study. J Hepatol 2005; 43:771.
  20. Reddick KL, Jhaveri R, Gandhi M, et al. Pregnancy outcomes associated with viral hepatitis. J Viral Hepat 2011; 18:e394.
  21. Safir A, Levy A, Sikuler E, Sheiner E. Maternal hepatitis B virus or hepatitis C virus carrier status as an independent risk factor for adverse perinatal outcome. Liver Int 2010; 30:765.
  22. Shaheen AA, Myers RP. The outcomes of pregnancy in patients with cirrhosis: a population-based study. Liver Int 2010; 30:275.
  23. Terrault NA, Bzowej NH, Chang KM, et al. AASLD guidelines for treatment of chronic hepatitis B. Hepatology 2016; 63:261.
  24. Society for Maternal-Fetal Medicine (SMFM), Dionne-Odom J, Tita AT, Silverman NS. #38: Hepatitis B in pregnancy screening, treatment, and prevention of vertical transmission. Am J Obstet Gynecol 2016; 214:6.
  25. American Academy of Pediatrics. Hepatitis B. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.400.
  26. Cundy KC, Sueoka C, Lynch GR, et al. Pharmacokinetics and bioavailability of the anti-human immunodeficiency virus nucleotide analog 9-[(R)-2-(phosphonomethoxy)propyl]adenine (PMPA) in dogs. Antimicrob Agents Chemother 1998; 42:687.
  27. Van Rompay KK, Hamilton M, Kearney B, Bischofberger N. Pharmacokinetics of tenofovir in breast milk of lactating rhesus macaques. Antimicrob Agents Chemother 2005; 49:2093.
  28. Benaboud S, Pruvost A, Coffie PA, et al. Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan, Cote d'Ivoire, in the ANRS 12109 TEmAA Study, Step 2. Antimicrob Agents Chemother 2011; 55:1315.
  29. Ehrhardt S, Xie C, Guo N, et al. Breastfeeding while taking lamivudine or tenofovir disoproxil fumarate: a review of the evidence. Clin Infect Dis 2015; 60:275.
  30. Gouraud A, Millaret A, Bernard N, et al. Tenofovir exposure through breast feeding: Serum concentrations in neonates and clinical follow-up. Fundam Clin Pharmacol. 2012;26 (Suppl 1):9
  31. Pan CQ, Mi LJ, Bunchorntavakul C, 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.
  32. Ganne-Carrie N, Causse X, Zarski JP et al. Efficacy and safety results of tenofovir DF (TDF) treatment from the first trimester in HBV pregnant women in real-life clinical practice. Hepatology. 2013;58 (Suppl 1):664A-5A
  33. Lactmed. Tenofovir. http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~SOkg2H:1.
  34. Stevens CE, Beasley RP, Tsui J, Lee WC. Vertical transmission of hepatitis B antigen in Taiwan. N Engl J Med 1975; 292:771.
  35. Schillie S, Walker T, Veselsky S, et al. Outcomes of infants born to women infected with hepatitis B. Pediatrics 2015; 135:e1141.
  36. Xu DZ, Yan YP, Choi BC, et al. Risk factors and mechanism of transplacental transmission of hepatitis B virus: a case-control study. J Med Virol 2002; 67:20.
  37. Stevens CE, Toy PT, Tong MJ, et al. Perinatal hepatitis B virus transmission in the United States. Prevention by passive-active immunization. JAMA 1985; 253:1740.
  38. Chen HL, Lin LH, Hu FC, et al. Effects of maternal screening and universal immunization to prevent mother-to-infant transmission of HBV. Gastroenterology 2012; 142:773.
  39. Thompson ND, Perz JF, Moorman AC, Holmberg SD. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008. Ann Intern Med 2009; 150:33.
  40. Guidelines for Perinatal Care. In: American Academy of Pediatrics and American College of Obstetricians and Gynecologists, 4th ed, Washington, DC 1997. p.286.
  41. Soldan K, Ramsay M, Collins M. Acute hepatitis B infection associated with blood transfusion in England and Wales, 1991-7: review of database. BMJ 1999; 318:95.
  42. Zou H, Chen Y, Duan Z, et al. Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg-positive mothers. J Viral Hepat 2012; 19:e18.
  43. Burk RD, Hwang LY, Ho GY, et al. Outcome of perinatal hepatitis B virus exposure is dependent on maternal virus load. J Infect Dis 1994; 170:1418.
  44. Li XM, Shi MF, Yang YB, et al. Effect of hepatitis B immunoglobulin on interruption of HBV intrauterine infection. World J Gastroenterol 2004; 10:3215.
  45. Wiseman E, Fraser MA, Holden S, et al. Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust 2009; 190:489.
  46. Wen WH, Chang MH, Zhao LL, et al. Mother-to-infant transmission of hepatitis B virus infection: significance of maternal viral load and strategies for intervention. J Hepatol 2013; 59:24.
  47. Kubo A, Shlager L, Marks AR, et al. Prevention of vertical transmission of hepatitis B: an observational study. Ann Intern Med 2014; 160:828.
  48. Lin HH, Lee TY, Chen DS, et al. Transplacental leakage of HBeAg-positive maternal blood as the most likely route in causing intrauterine infection with hepatitis B virus. J Pediatr 1987; 111:877.
  49. Ohto H, Lin HH, Kawana T, et al. Intrauterine transmission of hepatitis B virus is closely related to placental leakage. J Med Virol 1987; 21:1.
  50. Bai H, Zhang L, Ma L, et al. Relationship of hepatitis B virus infection of placental barrier and hepatitis B virus intra-uterine transmission mechanism. World J Gastroenterol 2007; 13:3625.
  51. Zhang SL, Yue YF, Bai GQ, et al. Mechanism of intrauterine infection of hepatitis B virus. World J Gastroenterol 2004; 10:437.
  52. López M, Coll O. Chronic viral infections and invasive procedures: risk of vertical transmission and current recommendations. Fetal Diagn Ther 2010; 28:1.
  53. Towers CV, Asrat T, Rumney P. The presence of hepatitis B surface antigen and deoxyribonucleic acid in amniotic fluid and cord blood. Am J Obstet Gynecol 2001; 184:1514.
  54. Yi W, Pan CQ, Hao J, et al. Risk of vertical transmission of hepatitis B after amniocentesis in HBs antigen-positive mothers. J Hepatol 2014; 60:523.
  55. Ko TM, Tseng LH, Chang MH, et al. Amniocentesis in mothers who are hepatitis B virus carriers does not expose the infant to an increased risk of hepatitis B virus infection. Arch Gynecol Obstet 1994; 255:25.
  56. Chen LZ, Zhou WQ, Zhao SS, et al. A nested case-control study of maternal-neonatal transmission of hepatitis B virus in a Chinese population. World J Gastroenterol 2011; 17:3640.
  57. Song YM, Sung J, Yang S, et al. Factors associated with immunoprophylaxis failure against vertical transmission of hepatitis B virus. Eur J Pediatr 2007; 166:813.
  58. Wang J, Zhu Q, Zhang X. Effect of delivery mode on maternal-infant transmission of hepatitis B virus by immunoprophylaxis. Chin Med J (Engl) 2002; 115:1510.
  59. Yang J, Zeng XM, Men YL, Zhao LS. Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus--a systematic review. Virol J 2008; 5:100.
  60. Chang MS, Gavini S, Andrade PC, McNabb-Baltar J. Caesarean section to prevent transmission of hepatitis B: a meta-analysis. Can J Gastroenterol Hepatol 2014; 28:439.
  61. Tran TT. Hepatitis B in Pregnancy. Clin Infect Dis 2016; 62 Suppl 4:S314.
  62. Beasley RP, Stevens CE, Shiao IS, Meng HC. Evidence against breast-feeding as a mechanism for vertical transmission of hepatitis B. Lancet 1975; 2:740.
  63. Hill JB, Sheffield JS, Kim MJ, et al. Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers. Obstet Gynecol 2002; 99:1049.
  64. Chen HL, Lee CN, Chang CH, et al. Efficacy of maternal tenofovir disoproxil fumarate in interrupting mother-to-infant transmission of hepatitis B virus. Hepatology 2015; 62:375.
  65. Brown RS Jr, McMahon BJ, Lok AS, et al. Antiviral therapy in chronic hepatitis B viral infection during pregnancy: A systematic review and meta-analysis. Hepatology 2016; 63:319.
  66. Pan CQ, Duan ZP, Dai E, et al. Tenofovir disoproxil fumarate (TDF) reduces perinatal transmission of hepatitis B virus in highly viremic mothers: A multi-center, prospective, randomized and controlled study. Presented at the AASLD Liver Meeting 2015. San Francisco, 2015.
  67. Han GR, Cao MK, Zhao W, et al. A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection. J Hepatol 2011; 55:1215.
  68. Pan CQ, Han GR, Jiang HX, et al. Telbivudine prevents vertical transmission from HBeAg-positive women with chronic hepatitis B. Clin Gastroenterol Hepatol 2012; 10:520.
  69. Shi Z, Yang Y, Ma L, et al. Lamivudine in late pregnancy to interrupt in utero transmission of hepatitis B virus: a systematic review and meta-analysis. Obstet Gynecol 2010; 116:147.
  70. Xu WM, Cui YT, Wang L, et al. Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study. J Viral Hepat 2009; 16:94.
  71. Visvanathan K, Dusheiko G, Giles M, 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.
  72. Nguyen V, Tan PK, Greenup AJ, 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.
  73. Pan CQ, Duan Z, Dai E, et al. Tenofovir to Prevent Hepatitis B Transmission in Mothers with High Viral Load. N Engl J Med 2016; 374:2324.
  74. Intron-A [package insert]. Kenilworth, NJ. Schering Corporation; 1994.
  75. Hoyert DL, Mathews TJ, Menacker F, et al. Annual summary of vital statistics: 2004. Pediatrics 2006; 117:168.
  76. The antiretroviral pregnancy registry. http://www.apregistry.com/forms/interim_report.pdf (Accessed on January 18, 2017).
  77. Van Rompay KK, Durand-Gasselin L, Brignolo LL, et al. Chronic administration of tenofovir to rhesus macaques from infancy through adulthood and pregnancy: summary of pharmacokinetics and biological and virological effects. Antimicrob Agents Chemother 2008; 52:3144.
  78. Gill US, et al. Factors determining bone mineral density loss in chronic hepatitis B patients: is tenofovir disoproxil fumarate the main culprit? Gut 2011; 60:A230.
  79. Gibb DM, Kizito H, Russell EC, et al. Pregnancy and infant outcomes among HIV-infected women taking long-term ART with and without tenofovir in the DART trial. PLoS Med 2012; 9:e1001217.
  80. Wang L, Kourtis AP, Ellington S, et al. Safety of tenofovir during pregnancy for the mother and fetus: a systematic review. Clin Infect Dis 2013; 57:1773.
  81. Siberry GK, Jacobson DL, Kalkwarf HJ, et al. Lower Newborn Bone Mineral Content Associated With Maternal Use of Tenofovir Disoproxil Fumarate During Pregnancy. Clin Infect Dis 2015; 61:996.
  82. Viganò A, Mora S, Giacomet V, et al. In utero exposure to tenofovir disoproxil fumarate does not impair growth and bone health in HIV-uninfected children born to HIV-infected mothers. Antivir Ther 2011; 16:1259.
  83. Siberry GK, Williams PL, Mendez H, et al. Safety of tenofovir use during pregnancy: early growth outcomes in HIV-exposed uninfected infants. AIDS 2012; 26:1151.
  84. Jao J, Abrams EJ, Phillips T, et al. In Utero Tenofovir Exposure Is not Associated With Fetal Long Bone Growth. Clin Infect Dis 2016; 62:1604.
  85. Trotter JF, Zygmunt AJ. Conception and pregnancy during interferon-alpha therapy for chronic hepatitis C. J Clin Gastroenterol 2001; 32:76.