Managing hepatitis B virus in pregnancy and children


  • 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 within 12 hours of birth, followed by a full course of hepatitis B vaccine.
  • For HBsAg-positive women with high viral loads (> 200,000 IU/mL), referral should be made to a specialist for consideration of antiviral therapy started 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.

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