Management of hepatitis B in pregnancy: Weighing the options

Geffen UCLA School of Medicine, Center for Liver Disease and Transplantation, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Cleveland Clinic Journal of Medicine (Impact Factor: 2.71). 06/2009; 76 Suppl 3(Suppl_3):S25-9. DOI: 10.3949/ccjm.76.s3.06
Source: PubMed


Maternal screening and active and passive immunoprophylaxis have reduced the perinatal, or vertical, transmission of hepatitis B virus (HBV) dramatically. Without immunoprophylaxis, chronic HBV infection occurs in up to 90% of children by age 6 months if the mother is positive for both hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg). Even with immunoprophylaxis, perinatal transmission is possible when the mother is highly viremic and HBeAg positive. Antiviral therapy during the third trimester of pregnancy in high-risk women with chronic HBV infection reduces viral load in the mother and may decrease the risk of perinatal transmission, although data are lacking. Safety data in pregnancy are most robust with lamivudine and tenofovir compared with other therapies. Careful discussion with the patient regarding the risks and benefits of therapy is warranted. Prophylaxis remains the best method of prevention of perinatal transmission.

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    • "Also it could be that the risk factors we assessed are not among the risk factors associated with HBsAg positivity in Buea Health District. Furthermore, because participants could not possibly remember what happened to them at birth and childhood, we could not assess two important risk factors associated with chronic carrier status: being borne of an HBV-positive mother and early contact in childhood with HBV [32,33]. "
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    ABSTRACT: Background Although infection with Hepatitis B Virus (HBV) remains a global public health problem, little is known about its epidemiology in pregnancy in sub-Saharan Africa. This study sought to determine the prevalence of, and identify factors associated with hepatitis B surface antigen (HBsAg) positivity among pregnant women in the Buea Health District (BHD) in rural Cameroon. We also assessed pregnant women’s knowledge about hepatitis B. Methods A cross-sectional, descriptive study was undertaken. Participants were evaluated using a structured questionnaire with clinical examination and were then screened for HBsAg using a commercial rapid diagnostic test. Assessment of knowledge was done using a hepatitis B basic knowledge summary score. Results Of the 176 pregnant women studied, 9.7% (95% CI: 5.7%, 15%) tested positive for HBsAg. None of the risk factors assessed was significantly associated with HBsAg positivity. The hepatitis B knowledge summary score ranged from 0 to 12 with a mean of 1.5 (SD = 3.14, median = 0, IQR = 0 to 0). Only 16% of participants had scores greater than 6/12. The knowledge summary score of the participants was associated with the educational level (p-value = 0.0037). Conclusion The high prevalence of HBsAg (9.7%) among women of child bearing age suggests that vertical transmission of HBV may be a public health problem in Buea Health District. Knowledge of HBV among pregnant women was poor. We recommend that all pregnant women ought to be routinely screened for HBV and that health education on HBV should be provided to pregnant women especially during antenatal visits.
    BMC Research Notes 06/2014; 7(1):394. DOI:10.1186/1756-0500-7-394
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    • "Correspondence: O. O. Enabor, Department of Obstetrics and Gynecology, University College Hospital, PMB 5116, Ibadan, Oyo State, Nigeria. E-mail: of children by the age of 6 months in mothers positive for both HBsAg and Hepatitis B e antigen (Xu et al. 2002; Tran 2009; Poovorawan et al. 2009). "
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    ABSTRACT: The knowledge of pregnant women about Hepatitis B virus infection at three different levels of healthcare and their access to screening and vaccination was evaluated by a questionnaire-based cross-sectional study. There were 643 respondents with a mean age of 30.2 ± 5.2 years and mean gestational age of 26.1 ± 8.4 weeks. The distribution of respondents was 55 (8.6%, primary), 204 (31.7%, secondary) and 383 (59.6%, tertiary) women. The majority of respondents were traders (36%) or civil servants/professionals (28.6%). Overall, 76% of all women had inadequate knowledge about hepatitis B infection; 19.5% had been screened, while 9.7% had been vaccinated. There was an increased likelihood of adequate knowledge, previous screening and vaccination among health workers (p = 0.00). Other positive predictors of knowledge and vaccination were tertiary education (p = 0.04) and tertiary care (p = 0.00). There is inadequate knowledge among pregnant women in Ibadan about Hepatitis B infection, with significant differences at the various levels of care, particularly in non-tertiary settings where screening and vaccination is also sub-optimal. Information dissemination, universal screening and vaccination services for pregnant women in Nigeria require urgent consideration.
    Journal of Obstetrics and Gynaecology 02/2013; 33(2):155-9. DOI:10.3109/01443615.2012.711389 · 0.55 Impact Factor
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    • "In the Asia-Pacific region, vertical transmission of HBV is a key factor in its endemicity. The risk of chronic hepatitis B (CHB) virus infection is inversely proportional to the age at which the infection was acquired [2], and at least 50% of cases acquired the infection during either the perinatal period or in early childhood [3], including through vertical transmission. "
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    ABSTRACT: Chronic hepatitis B virus (HBV) infection poses a serious public health problem in many parts of the world. Presently, even with proper joint immunoprophylaxis, approximately 10-15% of newborns from HBV carrier mothers suffer from HBV infection through intrauterine transmission. One of the risk factors is the level of maternal viraemia. Telbivudine is a synthetic thymidine nucleoside analogue with activity against HBV. A few studies have evaluated the efficacy of telbivudine in preventing intrauterine HBV infection during late pregnancy. So we conducted this meta-analysis to arrive at an evidence-based conclusion. We searched Medline/PubMed, EMBASE, Cochrane Library, Web of Knowledge and China Biological Medicine Database from January 1990 to December 2011. Relative risks (RR) of the seropositivity rates for hepatitis B surface antigen (HBsAg) and HBV DNA in newborns and infants were studied. Mean differences (MD) in maternal HBV DNA levels were reviewed. Finally two randomised controlled trials (RCTs) and four non-randomised controlled trials (NRCTs) were left for analysis which included 576 mothers in total, of whom 306 received telbivudine treatment and 270 did not receive any drug. All newborns received hepatitis B vaccine (HBVac) and hepatitis B immunoglobulin (HBIG) after birth. The seropositivity rate for HBsAg or HBV DNA was significantly lower in the telbivudine group, both at birth and at 6--12 months follow up. Meanwhile, maternal HBV DNA levels prior to delivery were significantly lower in the telbivudine group. In addition, the frequency of serum creatine kinase (CK) elevation was similar in the two groups. Our meta-analysis provides preliminary evidence that telbivudine application in late pregnancy is effective in the interruption of intrauterine HBV infection, with no significant adverse effects or complications. More high quality, well-designed, double-blinded, randomised controlled and large size clinical trials are needed for further investigation and more convincing results in the future.
    Virology Journal 09/2012; 9(1):185. DOI:10.1186/1743-422X-9-185 · 2.18 Impact Factor
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