Screening for and managing hepatitis B around pregnancy and postnatally is important to ensure the health of the birthing parent and newborn and reduce the risk of transmission.
“I knew I could prevent my child from getting hepatitis B at birth when they get vaccinated, but I wasn’t told there was still a small risk of transmission if my viral load was too high. I never had my viral load checked during pregnancy. My pregnancy was pretty straightforward, and I trusted the doctors knew what they were doing. I didn’t realise I could be physically ok but my viral load could still be high. I later found out there was medication that I could’ve taken to reduce the viral load to further reduce the risk of transmission to my baby. How do I ever forgive myself for now burdening my child with a chronic lifelong condition with no cure? As a mother I can never forgive myself for what happened. What did I do wrong to deserve this?” – Community member with lived experience of hepatitis B
Universal testing at the first antenatal appointment or before pregnancy allows for management to significantly reduce the risk of transmission to the newborn and is an opportunity to enrol people in ongoing care.
Summary of pre-pregnancy and pregnancy planning steps
Before and during pregnancy
Delivery and postnatal care
People who are diagnosed when pregnant are vulnerable and may require extra psychosocial support and counselling.
Pregnancy care guidelines: Hepatitis B (see section 9 Routine maternal health tests) | Website | Australian Living Evidence Collaboration
Hepatitis B Testing Policy: Antenatal and perinatal testing | Website | ASHM
Clinician’s quick guide – Hepatitis B testing and management in pregnancy and beyond | PDF| St Vincent’s Hospital Melbourne
Management of Hepatitis B in pregnancy | PDF | RANZCOG
B Positive: Managing hepatitis B virus in pregnancy and children | Website | ASHM
“My wife has Hep B but I have tested negative twice after being vaccinated. My doctor tells us we can safely have children but what are the chances – the risk still seems too great. Even if there was 90% chance of no transmission it means there is still 10% chance and that scares me”. – Community member with lived experience of hepatitis B
It is important to reassure that hepatitis B is managed well during pregnancy and that the risk of transmission to the newborn is also managed. If maternal antivirals and immunoglobulin are given (see information here), the risk can be less than 2%.
Check the birthing parent’s understanding of their diagnosis and provide information on transmission, availability of effective care and treatment, and the need for ongoing monitoring.
Allow time for questions. And consider arranging an extended or further consultation in future. Offer written and online resources that are linguistically appropriate. Consider the patient’s preferred language and use a professional interpreter if required.
Further support can be found here.
Hep B Help: New diagnosis – what now? | Website | Cancer Council, Doherty Institute & VIDRL
Management of hepatitis B in pregnancy | PDF | RANZCOG
A person who has been diagnosed with hepatitis B via antenatal screening should be tested for HBeAg and hepatitis B virus DNA to determine risk of transmission to the infant and the degree of infectivity.
Complete additional testing, including for co-infection (HIV and hepatitis C).
Education about ongoing management, care and testing of family and close contacts is important.
Clinician’s quick guide – Hepatitis B testing and management in pregnancy and beyond | PDF| St Vincent’s Hospital Melbourne
B Positive: Managing hepatitis B virus in pregnancy and children | Website | ASHM
Management of hepatitis B in pregnancy | PDF | RANZCOG
For HBsAg-positive pregnant people with high viral loads (> 200,000 IU/mL or 5.3 log IU/ml), referral should be made to a tertiary specialist to discuss starting tenofovir at 28–32 weeks gestation to further reduce the risk of perinatal transmission.
The Therapeutic Goods Administration pregnancy categories for hepatitis B therapies reflect the limited human safety data but absence of toxicity for humans; thus, all therapies are classified in category B. For more information see here. Prospective registries have provided significant and reassuring data about tenofovir in pregnancy so its use can be recommended with confidence.
Amniocentesis should be avoided if alternatives are possible.
Pregnant people with a high viral load may start on medication and continue up to 12 weeks postpartum.
There is no evidence that elective caesarean delivery reduces the risk of hepatitis B transmission, and this is not recommended in any obstetrics guidelines.
B Positive: Managing hepatitis B virus in pregnancy and children | Website | ASHM
Clinician’s quick guide – Hepatitis B testing and management in pregnancy and beyond | PDF| St Vincent’s Hospital Melbourne
Australian consensus recommendations for the management of hepatitis B infection | PDF | Gastroenterological Society of Australia
Management of hepatitis B in pregnancy | PDF | RANZCOG
See information on the hepatitis B vaccine schedule here.
All children of HBsAg-positive birthing parents should be tested for HBsAg and anti-HBs at 9–12 months of age (at least 3 months after the final dose of hepatitis B vaccine) to avoid detecting anti-HBs from the HBIG given at birth.
Clinician’s quick guide – Hepatitis B testing and management in pregnancy and beyond | PDF| St Vincent’s Hospital Melbourne
Hepatitis B Testing Policy: Antenatal and perinatal testing | Website | ASHM
B Positive: Managing hepatitis B virus in pregnancy and children | Website | ASHM
Management of hepatitis B in pregnancy | PDF | RANZCOG
A hepatitis flare is common in the postpartum period. It is usually asymptomatic and settles spontaneously. If medication was started during the third trimester, it is usually discontinued from 4–12 weeks postpartum. Duration of treatment is determined by monitoring, which is usually undertaken by a non-GP specialist.
All people living with chronic hepatitis B should be engaged in ongoing care with a plan for the management of hepatitis B, family testing and support.
B Positive: Managing hepatitis B virus in pregnancy and children | Website | ASHM
Clinician’s quick guide – Hepatitis B testing and management in pregnancy and beyond | PDF| St Vincent’s Hospital Melbourne
Australian consensus recommendations for the management of hepatitis B infection (see section 9, page 64) | PDF | Gastroenterological Society of Australia
Breastfeeding/chestfeeding in a person living with hepatitis B is safe and should be supported as long as the baby is having the recommended course of vaccinations. Breastfeeding/chestfeeding is not safe if there is blood present (from cracks in nipples or sores in the baby’s mouth). In this case, breastfeeding/chestfeeding should be paused and only resumed once healed.
Breastfeeding/chestfeeding is safe for patients taking antiviral therapy for hepatitis B.
Pregnancy and breastfeeding with hepatitis B | Website | Pregnancy, birth & baby, Australian Government Department of Health and Aged Care
Bloodborne viruses and sexually transmissible infections in antenatal care | PDF | ASHM
Management of hepatitis B in pregnancy | PDF | RANZCOG
See below for a list of relevant community resources.
This resource is for clinicians to use alongside their patients: Me, my baby and hepatitis B | PDF | St Vincent’s Hospital Melbourne
ASHM Head Office - Sydney
Level 3, 160 Clarence Street Sydney, NSW 2000
Tel: (+61) 02 8204 0700
ASHM acknowledges the Traditional Owners of Country across the various lands on which we live and work. We recognise Aboriginal and Torres Strait Islander peoples’ continuing connection to land, water, and community and we pay our respects to Elders past and present. ASHM acknowledges Sovereignty in this country has never been ceded. It always was, and always will be, Aboriginal land.
The information provided on this website and its related websites and guidelines, and the resources made available by ASHM in any format or medium, are for general information purposes only and are not intended as medical advice or as a substitute for consultation with a qualified healthcare professional. While ASHM Health strives to provide accurate and current resources and information, the resources, information and guidelines made available by ASHM Health do not provide personalised medical advice, diagnosis, or treatment. Healthcare professionals should apply their clinical judgment and consider individual circumstances when using this information. To the extent permitted by law, ASHM Health disclaims all liability for any outcomes resulting from reliance on the information provided. For specific medical concerns, please consult a licensed healthcare provider.
ASHM Health | ABN 48 264 545 457 | CFN 17788 | Copyright © 2024 ASHM