What do I need to know about hepatitis B before, during and after pregnancy?
Key takeaways:
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.
On this page
What screening should be done for hepatitis B during pregnancy?
“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
All people who are pregnant or planning pregnancy should be tested for hepatitis B after giving informed consent. See information on testing here.
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
- Ideally, provide counselling of people with hepatitis B before getting pregnant, including education about minimising risk of transmission and enrolment in care.
- Conduct universal testing of all pregnant people.
- Do initial work-up for pregnant people with hepatitis B (see here) to see if treatment is indicated.
- Consider testing and vaccination for the sexual partner of the pregnant person.
- Test for hepatitis B DNA in the second trimester.
- Give antiviral treatment for people with a viral load of > 200,000 IU/mL with tenofovir to reduce risks of transmission from 28 weeks until post delivery.
Delivery and postnatal care
- Take care during delivery to reduce transmission eg avoid scalp clips and any other procedures that cause trauma to skin.
- Vaccinate the infant born to person with hepatitis B with immunoglobulin < 12 hours after birth and hepatitis B birth vaccine < 24 hours after birth.
- Administer 3 infant vaccines in line with the National Immunisation Program schedule.
- Encourage breast feeding.
- Test the infant 3 months after the fourth dose of hepatitis B vaccine at 6 months.
- Provide ongoing care of the person and their family for hepatitis B (see here)
People who are diagnosed when pregnant are vulnerable and may require extra psychosocial support and counselling.
Quick Links
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
Detailed Information
Management of Hepatitis B in pregnancy | PDF | RANZCOG
B Positive: Managing hepatitis B virus in pregnancy and children | Website | ASHM
What pre-pregnancy counselling should be done for people who are hepatitis B positive?
“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.
Quick Links
Hep B Help: New diagnosis – what now? | Website | Cancer Council, Doherty Institute & VIDRL
Detailed Information
Management of hepatitis B in pregnancy | PDF | RANZCOG
What are the next steps when a pregnant person has hepatitis B?
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.
Quick Links
Clinician’s quick guide – Hepatitis B testing and management in pregnancy and beyond | PDF| St Vincent’s Hospital Melbourne
Detailed Information
B Positive: Managing hepatitis B virus in pregnancy and children | Website | ASHM
Management of hepatitis B in pregnancy | PDF | RANZCOG
What care is required for hepatitis B during pregnancy and birth?
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.
Quick Links
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
Detailed Information
Australian consensus recommendations for the management of hepatitis B infection | PDF | Gastroenterological Society of Australia
Management of hepatitis B in pregnancy | PDF | RANZCOG
What care is required for an infant when the birthing parent has hepatitis B?
An infant born to a birthing parent with hepatitis B should be given:
- hepatitis B immunoglobulin (HBIG) in the first 12 hours
- the first dose of hepatitis B vaccine within 24 hours
- the full course of hepatitis B vaccine at birth, 2, 4 and 6 months
- testing at 9–12 months
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.
Quick Links
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
Detailed Information
B Positive: Managing hepatitis B virus in pregnancy and children | Website | ASHM
Management of hepatitis B in pregnancy | PDF | RANZCOG
What care is required for a person with hepatitis B after giving birth?
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.
Quick Links
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
Detailed Information
Australian consensus recommendations for the management of hepatitis B infection (see section 9, page 64) | PDF | Gastroenterological Society of Australia
What information should I provide my patient about breastfeeding/chestfeeding and hepatitis B?
There is no evidence of hepatitis B transmission as a result of breastfeeding/chestfeeding.
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.
Quick Links
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
How do I support my patients with information on pregnancy and birth and hepatitis B?
See below for a list of relevant community resources.
Further Information
This resource is for clinicians to use alongside their patients: Me, my baby and hepatitis B | PDF | St Vincent’s Hospital Melbourne
