From the Guidelines
Hepatitis B treatment in pregnancy is recommended for women with high viral loads (typically HBV DNA >200,000 IU/mL) starting at 24-28 weeks of gestation to reduce the risk of mother-to-child transmission, as stated in the most recent guidelines 1. The preferred medication is tenofovir disoproxil fumarate (TDF) 300 mg orally once daily, which should be continued until delivery or up to 12 weeks postpartum if the mother has active hepatitis. Some key points to consider in the management of hepatitis B in pregnancy include:
- Treatment is also indicated regardless of viral load for pregnant women with active liver disease (elevated ALT levels) or cirrhosis.
- All infants born to HBsAg-positive mothers should receive hepatitis B immune globulin (HBIG) and the first dose of hepatitis B vaccine within 12 hours of birth, followed by completion of the vaccine series.
- Tenofovir is preferred during pregnancy because it has a good safety profile, high resistance barrier, and effectively reduces viral load, as supported by studies such as 1 and 1.
- Regular monitoring of liver function tests and viral load is important during pregnancy.
- Women with hepatitis B should be screened for hepatitis D co-infection and other liver diseases that may require additional management during pregnancy.
- Breastfeeding is not contraindicated in mothers taking TDF, but the safety of NA therapy during lactation is uncertain, as noted in 1 and 1.
From the FDA Drug Label
In published data from three controlled clinical trials, a total of 327 pregnant women with chronic HBV infection were administered tenofovir disoproxil fumarate from 28 to 32 weeks gestation through 1 to 2 months postpartum and followed for up to 12 months after delivery The treatment of hepatitis B in pregnancy with tenofovir disoproxil fumarate can start from 28 to 32 weeks gestation.
- Key points:
- Tenofovir disoproxil fumarate can be administered during the third trimester of pregnancy.
- The decision to treat hepatitis B in pregnancy should be based on the mother's clinical need and the potential benefits and risks to the infant 2.
From the Research
Treatment of Hepatitis B in Pregnancy
- Hepatitis B treatment in pregnancy is recommended for women with significant viremia, typically defined as HBV DNA levels greater than 2 × 10^5 IU/mL or 6 log copies/mL 3, 4.
- The goal of treatment is to reduce the risk of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) 3, 4.
- Antiviral therapy, such as tenofovir disoproxil fumarate (TDF), lamivudine, and telbivudine, can be used to treat HBV in pregnancy 3, 4.
- TDF is considered a first-line treatment option due to its favorable resistance profile and safety data 3, 4.
Timing of Treatment
- Treatment is typically started around 28-32 weeks of gestation 4.
- The exact timing of treatment may vary depending on the individual patient's circumstances and the level of viremia 4.
Safety and Efficacy
- Antiviral therapy during pregnancy has been shown to significantly reduce maternal HBV DNA levels and subsequent reductions in infant HBV infections 3.
- TDF has been associated with mild gastrointestinal distress and potential decreased fetal bone growth, but the clinical significance of this finding is still being evaluated 3.
- Lamivudine and telbivudine have been shown to be inferior to TDF in terms of resistance profiles 3.
Additional Recommendations
- All pregnant women should be screened for hepatitis B surface antigen (HBsAg) and antibody to HBsAg 4, 5.
- HBsAg-positive pregnant women should undergo further workup for liver status and indicative factors for immunoprophylaxis failure 4.
- Breastfeeding is not contraindicated in women with HBV infection, as long as the infant receives immunoprophylaxis at birth (HBV vaccination and hepatitis B immunoglobulin) 4, 5.