Can a mother with hepatitis B give birth to a healthy baby?

This is the 4228th article of Da Yi Xiao Hu

The department where Dr. Fang works has a pediatric chronic hepatitis B clinic, and parents often bring their children infected with the hepatitis B virus for examination. When Dr. Fang asked further, he found that in most cases the mothers had hepatitis B, but did not go to a specialist for examination and evaluation before and during pregnancy, and did not take effective measures in time to prevent vertical transmission of hepatitis B from mother to child.

Dr. Fang once again reminded mothers and fathers with hepatitis B of childbearing age that the hepatitis B virus can be blocked through effective methods to prevent it from being transmitted to the child. It is hoped that mothers with hepatitis B can visit a specialist in time before and during pregnancy for examination, evaluation and intervention to block the mother-to-child transmission of the hepatitis B virus.

Below, Dr. Fang uses some of the most confusing questions for clinical patients to explain how mothers with hepatitis B can give birth to a healthy baby in a question-and-answer format.

1. Can women with hepatitis B get married and have children?

A: Yes. If a woman has hepatitis B, she can ask her partner to go to the hospital for a check-up in time. If there is no antibody, she should get the hepatitis B vaccine as soon as possible. After the antibody is produced, it will be protective and can avoid transmitting hepatitis B to the other party. In addition, you must consult a professional hepatitis doctor before pregnancy to see what the current condition is and whether you can get pregnant. If it is in the chronic hepatitis stage, but the condition is stable, you can prepare for pregnancy. If chronic hepatitis is in the active stage, you should receive timely treatment and wait until the condition is stable before getting pregnant. If it has developed to the stage of cirrhosis, but it is in the early stage of cirrhosis with normal liver function and no complications, you can also get pregnant and have children. If it has developed to the decompensated stage of cirrhosis, accompanied by serious complications such as ascites, gastrointestinal bleeding, etc., the risk of pregnancy and childbirth is relatively high and needs to be treated with caution.

2. What hepatitis B-related items do women of childbearing age need to screen for before pregnancy?

A: Women who are planning to get pregnant should undergo six tests for hepatitis B. Once the hepatitis B surface antigen is positive, further tests for hepatitis B virus DNA, liver function, alpha-fetoprotein, and liver ultrasound should be performed to determine whether the hepatitis B is active, assess the severity of the disease, and decide whether treatment is needed.

3. Under what circumstances is it easy for mothers with hepatitis B to have vertical transmission of hepatitis B from mother to child?

Answer: When the level of viral DNA replication in the blood of a mother with hepatitis B is high, generally greater than 2×105, and if there is no effective mother-to-child transmission prevention, vertical transmission of hepatitis B from mother to child is likely to occur.

4. What are the dangers of hepatitis B activity during pregnancy?

Answer: Hepatitis B activity during pregnancy may cause liver damage or even liver failure in pregnant women, especially when there are pregnancy complications, such as intrahepatic cholestasis of pregnancy, fatty liver of pregnancy, or hypertension, diabetes, etc., which may endanger the life of the pregnant woman in severe cases; at the same time, the incidence of postpartum hemorrhage and puerperal infection is also significantly increased; it may also have adverse effects on fetal development, such as fetal distress, premature birth, stillbirth, low birth weight or neonatal asphyxia.

5. At which stage of pregnancy is it easier for a mother with hepatitis B to transmit the hepatitis B virus to her baby?

A: The virus is most easily transmitted during the third trimester and delivery. Because the placental barrier function is severely degraded in the third trimester, the virus can easily pass through the placenta and enter the fetus. During delivery, the virus in the mother's blood, vaginal secretions, amniotic fluid and other body fluids can easily enter the fetus through tiny wounds and cause infection.

6. What should mothers with hepatitis B pay attention to after becoming pregnant?

(1) Go to the hospital every month to test your liver function to detect abnormalities and receive timely treatment.

(2) Maintain a stable mentality, a happy mood, a regular lifestyle, and a healthy diet.

(3) At 24 weeks of pregnancy, the baby should undergo a comprehensive evaluation at a liver disease specialist and, if appropriate, initiate anti-HBV treatment to prevent vertical transmission from mother to child.

7. What safe antiviral drugs can be used during pregnancy?

Answer: The first-line antiviral drugs that are safe during pregnancy include tenofovir fumarate, tenofovir alafenamide fumarate, and telbivudine; the second-line antiviral drugs include lamivudine.

8. What should a mother with hepatitis B do if she becomes pregnant while taking oral antiviral medication?

Answer: If you are taking tenofovir, telbivudine or lamivudine for treatment, you can become pregnant normally during the treatment; if you are taking entecavir or adefovir dipivoxil for antiviral treatment, you should switch to tenofovir or telbivudine after an unexpected pregnancy, and you can continue the pregnancy.

9. Do different delivery methods have an impact on the transmission of hepatitis B?

A: Delivery methods include natural birth and cesarean section. Currently, there is no evidence to prove that cesarean section can reduce the incidence of mother-to-child vertical transmission of hepatitis B more than natural birth. Therefore, it is recommended that mothers with hepatitis B choose a delivery method based on the indications for delivery.

10. What should mothers with hepatitis B pay attention to after giving birth?

Answer: After a mother with hepatitis B gives birth, if she was using anti-hepatitis B virus drugs before pregnancy, she cannot stop taking the drugs after giving birth, and can go to the hospital for a check-up every 3-6 months. If the mother with hepatitis B was taking drugs to block vertical transmission from mother to child in the late pregnancy, she can stop taking the drugs after giving birth, and can breastfeed after stopping the drugs. It is recommended to go to the hospital for a check-up one month after giving birth, and then change to a check-up every 3-6 months as appropriate.

11. Can mothers with hepatitis B breastfeed normally after giving birth? Which antiviral drugs are safe during breastfeeding?

A: If the newborn is vaccinated with high-titer hepatitis B immunoglobulin and hepatitis B vaccine on time after delivery, breastfeeding is safe. The content of tenofovir fumarate in breast milk is extremely low, and the prototype drug is generally not absorbed through the digestive tract, so it can be used safely during breastfeeding.

12. Can combined immunization with hepatitis B vaccine and high-titer hepatitis B immunoglobulin completely block the vertical transmission of hepatitis B from mother to child?

A: No. If pregnant women with active HBV replication do not receive blocking antiviral drug treatment during pregnancy, there is still a 10% chance of infection in their newborns even if they receive combined HBV vaccine and HBV high-titer immunoglobulin after birth.

13. How to determine whether a newborn is infected with hepatitis B after birth?

A: For infants who have timely mother-to-child transmission prevention, the positive peripheral blood HBsAg at birth cannot be used as an indicator of HBV infection in the newborn; the hepatitis B virus serological markers should be checked one month after the third dose of hepatitis B vaccine to evaluate whether the prevention is successful. Only after 7 months of age can the hepatitis B surface antigen be positive to confirm hepatitis B infection.

14. What are the differences in hepatitis B vaccination for low birth weight and premature babies?

A: Low birth weight and premature birth do not affect the vaccination of hepatitis B high-titer immunoglobulin and hepatitis B vaccine, but the hepatitis B vaccine needs to be administered in 4 injections. Newborns should be vaccinated with hepatitis B vaccine and hepatitis B high-titer immunoglobulin at different sites within 12 hours of birth, and injected with 1 injection of hepatitis B vaccine at 1, 2 and 7 months of age.

To sum up

To avoid transmitting hepatitis B to the baby, mothers with hepatitis B need to pay attention to the following points: go to the hospital for examination and evaluation before pregnancy to determine whether they can become pregnant and whether they need treatment; regular check-ups during pregnancy, and if hepatitis B attacks during pregnancy, start safe antiviral treatment in time; if the hepatitis B virus is actively replicating but liver function has been normal, blocking anti-hepatitis B virus treatment should be started at 24 weeks of pregnancy; the newborn should be given an injection of hepatitis B-specific high-titer immunoglobulin as soon as possible after birth, and the hepatitis B vaccine at the same time, according to the 0, 1, 6 plan; one month after the third hepatitis B vaccine injection, check to evaluate whether the blocking was successful.

Through reasonable and scientific blocking, mothers with hepatitis B can completely avoid transmitting the hepatitis B virus to their babies.

Author: Shenzhen Third People's Hospital

Wang Fang, Department of Hepatology II