Hepatitis B (HBV) remains endemic in Asia. In Singapore, the prevalence of hepatitis B surface antigen (HBsAg) amongst adults is between 3% to 4%. Mother to Child (Perinatal) transmission is the most common mode of HBV transmission.
Transmission of hepatitis B to the infant happens at the time of birth when the mother’s blood comes into contact with the infant. However, maternal screening programs and universal vaccination in newborns with active and passive immunoprophylaxis have dramatically reduced HBV transmission rates to infants worldwide.
Screening For Hepatitis B In Pregnancy
Maternal screening for hepatitis B is essential, because of the risk of perinatal transmission of the hepatitis B virus to her baby at birth. A routine blood test (Hepatitis B surface antigen or HBsAg) is performed for pregnant women during their first prenatal visit to detect if the mother is a hepatitis B (HBV) carrier.
Assessment Of Liver Disease In Pregnancy
If the mother is proven to be a hepatitis B carrier, the next step is assessing the severity of liver disease in the mother due to chronic hepatitis B. This involves further blood tests including HBV viral load, an ultrasound scan and fibroscan liver stiffness measurement. These tests are safe in pregnancy and are necessary to assess whether the mother requires treatment for hepatitis B.
Treatment For Pregnant Mothers With Hepatitis B
Treatment of hepatitis B in pregnancy may be necessary for one of several reasons. Mothers with abnormal liver blood tests may be diagnosed with chronic active hepatitis or inflammation of the liver. Mothers may also be diagnosed to have advanced scarring or fibrosis/cirrhosis of the liver. Fibroscan liver stiffness measurement is a non-invasive scan that can help to determine this and is safe in pregnancy. Treatment of the mother in these scenarios is indicated to reduce the progression of liver disease in the mother and for the reduction of the incidence of liver cancer or hepatocellular carcinoma. Treatment of the mother in these scenarios increases the chances of a successful pregnancy.
Prevention Of Transmission of Hepatitis B To The Infant
If the mother is proven to be a hepatitis B carrier, the healthcare practitioner will be able to provide the necessary medical care to treat the newborn immediately after delivery. This includes delivery of Hepatitis B immune globulin or antibodies to the infant at the time of birth plus three doses of the recombinant hepatitis B vaccine over the first 6 months of life of the infant. This strategy has proven to be effective in preventing perinatal transmission in more than 95% of cases.
However, mothers with high HBV viral loads may still be at risk of increased risk of perinatal transmission to the infant. Mothers who are screened at 28 weeks of pregnancy and found to have high HBV viral loads may benefit from short term treatment with anti-viral medication to reduce the risk of transmission to the infant. Tenofovir has recently been approved for the treatment of hepatitis B in pregnancy.
How To Get Advice And Treatment?
If your antenatal blood test reflects that you are a hepatitis B carrier or you already know you have hepatitis B and are trying for a baby, it is a good idea to talk to your doctor first.
gutCARE is a gastroenterology clinic in Singapore that provides a full spectrum of sub-specialized care services for digestive and liver disorders. Our trained team of specialists also have subspecialty interests in hepatitis B to provide the quality of care you need.
At gutCARE, your gastroenterologist will help to assess your condition and discuss the options available to you for treatment of Hepatitis B in pregnancy as well as the precautions needed to reduce transmission to your baby taking into account the risks and benefits to the mother and baby during and after pregnancy.
Book an appointment with gutCARE and talk to one of our specialists about Hepatitis B in pregnancy today.