(Reaffirmed October 2019)
This Practice Advisory was developed by the American College of Obstetricians and Gynecologists’ Immunization and Emerging Infections Expert Work Group in collaboration with Brenna L. Hughes, MD.
The Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) have released updated guidance on preventing the transmission of hepatitis B virus (HBV) infection 1. A critical element of the strategy to eliminate HBV in the United States is the prevention of perinatal transmission. The CDC and ACIP’s updated guidance reflects the best currently available evidence and select new or updated recommendations include the following:
- Pregnant women positive for hepatitis B surface antigen (HBsAg) should be tested for hepatitis B virus deoxyribonucleic acid (HBV DNA) to guide the use of antiviral medication to prevent perinatal transmission
- Persons with chronic liver disease* should be vaccinated against HBV
- The American Association for the Study of Liver Diseases suggests antiviral therapy for pregnant women with HBV DNA >200,000 IU/mL (7.6 log10 IU/mL). Published evidence indicates that maternal antiviral therapy during pregnancy further reduces perinatal HBV transmission 2 3 4 5
- The American Association for the Study of Liver Diseases suggests all HBsAg-positive pregnant women should be referred to their jurisdiction’s Perinatal Hepatitis B Prevention Program (PHBPP) for case management to ensure that their infants receive timely prophylaxis and follow-up
In addition to those highlighted above, there are also new recommendations regarding postvaccination serologic testing of infants born to HBsAg-positive mothers and revaccination for those not responding to initial vaccination (see CDC’s MMWR for details).
The CDC now recommends universal hepatitis B vaccination within 24 hours of birth for medically stable infants >2000 grams, removing permissive language that allowed the vaccine to be delayed until after hospital discharge, and continues to recommend hepatitis B vaccination and hepatitis immune globulin regardless of birth weight within 12 hours of birth for infants born to hepatitis b-infected mothers. Both of these recommendations are consistent with ACOG and AAP’s Guidelines for Perinatal Care, 8th edition.
ACOG agrees with the recommendations outlined in this MMWR and encourages members to adopt these strategies into practice. Recommendations related to hepatitis B and pregnancy will be addressed in a future revision of Practice Bulletin 86: Viral Hepatitis in Pregnancy.
*Persons with chronic liver disease include, but are not limited to, those with hepatitis C virus infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase or aspartate aminotransferase level greater than twice the upper limit of normal.