How should the pregnant HBeAg-positive woman and newborn be managed before, during, and after delivery?

Response from William F. Balistreri, MD 
Dorothy M. Kersten Professor of Pediatrics

 University of Cincinnati College of Medicine, Cincinnati, Ohio

 Medical Director, Liver Transplantation Program

 Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

The hepatitis B virus (HBV) can be transmitted from an infected mother to her infant. In fact, the risk of developing chronic HBV infection after acute exposure ranges from 90% in newborns of hepatitis B e antigen (HBeAg)-positive mothers to approximately 25% in infants and children under 5 years of age, to less than 5% in adults. According to the recently revised guidelines approved by the American Association for the Study of Liver Diseases and endorsed by the Infectious Diseases Society of America,[5] screening is recommended for all pregnant women. Newborns of HBV-infected mothers should receive both hepatitis B immune globulin (HBIG) and the HBV vaccine at the time of delivery and should complete the recommended vaccination series. The guidelines further state that hepatitis B surface antigen (HBsAg)-positive women who are pregnant should be counseled to make sure that they inform their providers of their hepatitis B status so that HBIG and the HBV vaccine can be administered to their newborns immediately after delivery.This has become an established and highly effective practice. Concurrent administration of HBIG and the HBV vaccine to the newborn is 95% effective in the prevention of perinatal transmission of HBV. However, efficacy is lower for maternal carriers with very high serum HBV DNA levels (> 8 log10 IU/mL). Because infants of HBsAg-positive mothers remain at risk for HBV infection, they should be tested for response to vaccination. Postvaccination testing should be performed at 9-15 months of age in infants of carrier mothers.

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