Hepatitis B Virus Infection in Pregnant Women

Abstract

The chronic infection HBV is a worldwide public health trouble with high morbidity and mortality. The vertical transmission (pregnancy) has consequences for mother and baby. During pregnancy, cell-mediated immunity is suppressed, possibly because of an increase in adrenal corticosteroids, estrogens, and progesterone, thereby allowing the woman to tolerate the semiallogenic fetus. The characteristics and predictors of postpartum hepatitis flares in women with chronic hepatitis B are Serum Alanine Aminotransferase and Hepatitis B DNA Flares in Pregnant and Postpartum Women. HBV DNA and ALT monitoring every 4-6 weeks during first and second trimesters, as well as every 4 weeks during third trimester, and at postpartum months 3 and 6 should be considered in women with CHB (chronic hepatitis B). Initial assessment requires a determination of the need for treatment of chronic HBV, independent of pregnancy. This will determine the need for treatment during pregnancy and after delivery. For women without active or advanced chronic HBV infection, antiviral therapy can be deferred until post-partum. However, all women need to be assessed in the second trimester for consideration of antiviral therapy for prevention of mother-to-child transmission. Women with HBV DNA above 200,000 IU/mL warrant antiviral therapy with tenofovir, telbivudine or lamivudine in the third trimester. Tenofovir is the preferred drug during pregnancy. The management of this population with HBV is important in order to decrease the vertical transmission.