Hepatitis Vaccination in Pregnancy
Direct Recommendation
Pregnant women at high risk for hepatitis B infection should receive the hepatitis B vaccine during pregnancy, as it is safe and does not increase adverse pregnancy outcomes. 1, 2 Hepatitis A vaccine can also be safely administered to pregnant women at risk of exposure. 1
Hepatitis B Vaccination in Pregnancy
Who Should Be Vaccinated
Pregnant women meeting any of the following high-risk criteria should receive hepatitis B vaccination 1, 2:
- More than one sex partner during the previous 6 months 1
- Evaluation or treatment for a sexually transmitted infection 1
- Recent or current injection-drug use 1
- HBsAg-positive sex partner 1
- Any pregnant patient who requests the vaccine can be offered vaccination 2
The CDC and ACOG are clear that acknowledgment of specific risk factors should not be a requirement—any pregnant woman at risk or requesting protection should be vaccinated. 1, 2
Vaccination Schedule and Timing
- Standard 3-dose series (0,1, and 6 months) should be initiated during pregnancy for those who test negative but have risk factors 2
- An accelerated schedule (0,1, and 4 months) has been shown effective and can be completed during pregnancy, with 90% seroconversion rates after three doses 3
- Do not delay vaccination while assessing risk factors 2
Safety Profile
The hepatitis B vaccine has an excellent safety record in pregnancy 2, 4:
- No increased risk of gestational hypertension, gestational diabetes, pre-eclampsia, cesarean delivery, preterm delivery, low birthweight, or small for gestational age infants 4
- No congenital abnormalities observed even with first-trimester exposure 5
- Most common side effect is injection site discomfort (10.5% of recipients) 3
- Seroconversion rates are high (90-100%), though body mass index is inversely associated with response 3
Critical Distinction: Maternal vs. Neonatal Protection
Important caveat: The vaccine does NOT prevent infant infection from maternal transmission if the mother is already HBsAg-positive. 2 The vaccine's purpose is to protect the mother from acquiring HBV infection during pregnancy. 2 Infants born to HBsAg-positive mothers require both HBIG and vaccine within 12 hours of birth for protection. 1, 2
Hepatitis A Vaccination in Pregnancy
Indications
Vaccination of pregnant women identified to be at risk for hepatitis A infection during pregnancy is recommended. 1
Safety and Options
- Both hepatitis A vaccine and immunoglobulin for postexposure prophylaxis can be used in pregnancy 1
- The EASL guidelines (2023) provide 100% consensus support for this recommendation 1
Universal Screening Requirements
Regardless of vaccination status, all pregnant women should be tested for HBsAg during the first trimester of each pregnancy, even if previously vaccinated or tested. 1, 2 This is critical because:
- Testing identifies chronically infected women who need antiviral therapy consideration 1
- Ensures infants of HBsAg-positive mothers receive timely prophylaxis 1
- Women not tested prenatally or with high-risk behaviors should be tested at hospital admission for delivery 1
Counseling Beyond Vaccination
Pregnant women at risk should be counseled on additional prevention methods beyond vaccination, including avoidance of high-risk behaviors and exposure reduction strategies. 1, 2
Implementation in Clinical Practice
Healthcare providers should implement standing orders to identify and vaccinate pregnant women at risk as part of routine prenatal services. 1 The low uptake observed in real-world data (2.1 per 1000 pregnancies) suggests significant underutilization despite clear safety and efficacy data. 4