Mother‐to‐Child Transmission Risk in Pregnant Women With Chronic HBV

Infant in Utero with infection
Infant in Utero with infection
Front-line providers minimally could check HBV DNA and ALT during pregnancy to assess mother‐to‐child transmission risk but HBeAg is recommended to be included in the initial HBV evaluation to get a more comprehensive understanding of the patient’s HBV disease state.

Full assessment of pregnant women who have chronic hepatitis B virus (HBV) and early coordinated care is needed to deliver interventions to prevent mother-to-child transmission (MTCT) during critical windows of time, according to study results published in the Journal of Viral Hepatitis.1

MTCT is responsible for the majority of chronic HBV infections worldwide, with infection in infancy associated with a 90% chance of developing chronic HBV infection.2,3 Timely HBV immunoprophylaxis of neonates has reduced MTCT worldwide and clinical guidelines recommend screening for HBV infection in all pregnant women at their first prenatal visit.4,5 However, despite timely HBV immunoprophylaxis of neonates, MTCT can occur in infants born to mothers with high levels of HBV viremia.1

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Thus, researchers at 2 community health sites in New York City performed a retrospective cross-sectional analysis of Asian American women with chronic HBV from 2007 to 2017 to assess the demographic and clinical characteristics and MTCT risk by HBV DNA level. They identified a total of 1298 pregnancies in 1012 mostly women who were born in China (97.6%) with chronic HBV. Of the 1241 pregnancies in women not on antiviral treatment, 22.4% were considered high-risk for MTCT and of these, 255 (91.7%) were HBV e antigen (HBeAg)-positive and 19 (6.8%) were HBeAg-negative. In addition to HBeAg status, alanine aminotransferase levels between 26 to 50 U/mL was associated with a higher likelihood of being high-risk for MTCT.

“Our findings can be used to inform front-line providers, including obstetricians and [primary care providers], on the relative frequency of encountering HBsAg-positive women in high-risk groups who meet treatment criteria for antiviral treatment during pregnancy to reduce perinatal transmission, and those with immune active disease to reduce risk of developing cirrhosis and/or [hepatocellular carcinoma],” concluded the investigators.1

Disclosure: Calvin Pan, MD, and Su Wang, MD, MPH, have served as consultants and received research grants from Gilead Sciences.


1. Lyu J, Wang S, He Q, Pan C, Tang AS. Hep B moms: a cross‐sectional study of mother‐to‐child transmission risk among pregnant Asian American women with chronic hepatitis B in New York City, 2007‐2017 [published online October 22, 2019]. J Viral Hepat. doi:10.1111/jvh.13221

2. Beasley RP, Trepo C, Stevens CE, Szmuness W. The e antigen and vertical transmission of hepatitis B surface antigen. Am J Epidemiol. 1977;105(2):94-98.

3. Edmunds WJ, Medley GF, Nokes DJ, Hall AJ, Whittle HC. The influence of age on the development of the hepatitis B carrier state. Proc R Soc London Ser B Biol Sci. 1993;253(1337):197-201.

4. Mast EE, Margolis HS, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents. MMWR Recomm Rep. 2005;54(RR-16):1-31.

5. U.S. Preventive Services Task Force. Screening for hepatitis B virus infection in pregnancy: U.S. preventive services task force reaffirmation recommendation statement. Ann Intern Med. 2009;150(12):869-873.