Update in the Management of Chronic Hepatitis B in Pregnancy

Abstract

Purpose of Review

Vertical transmission accounts for almost half of the chronic hepatitis B infections worldwide. Therefore, management of HBV in pregnancy presents a unique opportunity for intervention, so that vertical transmission and overall HBV could be reduced. There is limited data on outcomes of acute HBV. There were several observational and prospective studies on effects of chronic HBV during pregnancy, modes of mother to child transmission (MTCT), role of obstetric interventions, indications for antiviral therapy during pregnancy which demonstrated variable findings. Our purpose is to summarize and update the data published in the recent years on the topic.

Recent Findings

Pregnant women with acute HBV had fewer symptoms but were prone to become chronic HBV carriers compared to non-pregnant women with acute HBV infection. HBV transmission could occur at any time during pregnancy via germ cell, intra-uterine, or peri-natal transmission. Avoidance of invasive procedures during pregnancy and elective Cesarean section have shown evidence in minimizing the risk of MTCT. Antiviral therapy during third trimester at 30–32 weeks of gestation in pregnant mothers with high viremia > 200,000 IU/mL was associated with significantly lowered risk of MTCT. Among lamivudine, telbivudine, and tenofovir that are considered safe during pregnancy, tenofovir is the preferred drug of choice due to higher resistance barrier and efficacy. Immuno-prophylaxis with HBIG and HBV vaccine is recommended within 12 hours after birth to all neonates born to HBV infected mothers.

Summary

The large global burden of chronic HBV could be reduced with judicious implementation of various steps and strategies during pregnancy. The review provides an update in the management of HBV infection during pregnancy that have demonstrated improved maternal and fetal outcomes. The endemicity rates are variable across various geographic regions, the highest seen in China and South East Asia where the HBV prevalence rate is 10–20% in women of child-bearing age in contrast to 0.4% in USA. Global elimination of HBV by 2030 has been taken up a target goal by several countries in the world and the crucial step is to reduce MTCT by implementing screening and treatment strategies in pregnant mothers. Current research is focused to eliminate cccDNA to achieve true viral cure of HBV.

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Correspondence to Kalyan Ram Bhamidimarri.

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Kalyan Ram Bhamidimarri reports advisor from Merck, other from Gilead, other from AbbVie, speaker from Alexion, other from Intercept, outside the submitted work. Calvin Pan received grants from Gilead, Bristol Myers Squibb, and Merck. Calvin Pan also serves as a consultant or advisor for Gilead, and speaker for Gilead, Abbvie, and Intercept.

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Bhamidimarri, K.R., Pan, C.Q. Update in the Management of Chronic Hepatitis B in Pregnancy. Curr Hepatology Rep 17, 475–484 (2018). https://doi.org/10.1007/s11901-018-0437-3

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Keywords

  • Chronic hepatitis B
  • Vertical transmission
  • Mother to child transmission
  • Anti-viral therapy
  • Pregnancy outcomes
  • Immuno-prophylaxis
  • Management strategies
  • Global eradication