All decisions about initiating, continuing, or stopping therapy of the hepatitis B virus (HBV) during pregnancy must include an analysis of the risks and benefits for mother and fetus. The trimester of the pregnancy and the stage of the mother’s liver disease are important factors. Treatment in the third trimester may be initiated to aid in preventing perinatal transmission, which appears to be most pronounced in mothers with high viral loads. Consideration of initiating treatment in the third trimester should occur after a high viral load is documented in the latter part of the second trimester, to allow adequate time for initiation of antiviral therapy with significant viral suppression before delivery. This discussion should include the topic of breastfeeding, because it is generally not recommended while receiving antiviral therapy. Currently, lamivudine and tenofovir appear to be the therapeutic options with the most reasonable safety data in pregnancy.
World Health Organization: Hepatitis B: World Health Organization fact sheet 204 (revised August 2008). Available at http://www.who.int/mediacentre/factsheets/fs204/en. Accessed August 2010.
Lok AS, McMahon BJ: Chronic hepatitis B: update 2009. Hepatology 2009, 50:1–36.
McMahon BJ, Alward WL, Hall DB, et al.: Acute hepatitis B virus infection: relation to the clinical expression of disease and subsequent development of the carrier state. J Infect Dis 1985, 151:599–603. PubMed
Tassopoulos NC, Papavangelou GJ, Sjogren MH, et al.: Natural history of acute hepatitis B surface antigen-positive hepatitis in Greek adults. Gastroenterology 1987, 92:1844–1850. PubMed
Marcellin P, Heathcote EJ, Buti, M, et al.: Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B. 2008, 359:2442–2455.
Antiretroviral Pregnancy Registry: Available at http://www.apregistry.com. Accessed August 2010.
Munderi P, Wilkes H, Tumukunde D, et al.: Pregnancy and outcomes among women on triple-drug antiretroviral therapy (ART) in the DART trial [poster WEPEB261]. Presented at the Fifth IAS Conference on HIV Pathogenesis, Treatment and Prevention. Cape Town, South Africa; July 19–22, 2009.
FDA Pregnancy class definitions: Available at http://en.wikipedia.org/wiki/Pregnancy_category. Accessed August 2010.
Berg T, Marcellin P, Zoulim F, et al.: Tenofovir is effective a monotherapy or in combination with emtricitabine in adefovir treated patients with chronic hepatitis B infection. Gastroenterology 2010 (Epub ahead of print).
Beasley RP, Hwang LY, Lin CC, et al.: Hepatitis B immune globulin (HBIG) efficacy in the interruption of perinatal transmission of hepatitis B virus carrier state. Initial report of a randomised double-blind placebo-controlled trial. Lancet 1981, 2:388–393. PubMed
• Wiseman E, Fraser MA, Holden S, et al.: Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust 2009, 190:489–492. This study reported the perinatal transmission rate in 313 HBsAg-positive women from Australia. To date, most data have come from Asian countries. This study confirmed that immunoprophylaxis failure occurs in those with very high viral loads. PubMed
• Xu WM, Cui YT, Wang L, et al.: Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study. J Viral Hepat 2009, 16:94–103. This study is one that is unlikely to ever be performed again, because double-blind, placebo-controlled studies are difficult to do in pregnant women. CrossRefPubMed
• Shi Z, Yang Y, Ma L, et al.: Lamivudine in late pregnancy to interrupt in utero transmission of hepatitis B virus: a systematic review and meta-analysis. Obstet Gynecol 2010, 116:147–159. This meta-analysis helps to clarify whether antiviral therapy is beneficial in preventing perinatal transmission. CrossRefPubMed
Li XM, Yang YB, Hou HY, et al.: Interruption of HBV intrauterine transmission: a clinical study. World J Gastroenterol 2003, 9:1501–1503. PubMed
Shi M, Li X, He J, et al.: Lamivudine in interruption of HBV intrauterine infection. Clin Med Chin 2005, 21:77–78.
Han ZH, Chen YH, Li LW, et al.: Effect and safety of preventing HBV vertical transmission by lamivudine treatment. Clin J Intern Med 2005, 44:378.
Li WF, Jiang R, Wie Z, Li Y: Clinical effect and safety of lamivudine in interruption of chronic HBV maternal to infant transmission. Chin Hepatol 2006, 11:106–107.
Feng HF, Zhang SF: Effect on interruption of hepatitis B virus vertical transmission by lamivudine. J Appl Clin Pediatr 2007, 22:1019–1020.
Xiang GJ, Sun JW, Jiang SQ, et al.: Evaluation of therapeutic effect in HBV vertical transmission by lamivudine treatment combined with active-passive immunization for pregnant women. Clin Prac Med 2007, 2:14–16.
Yang JH: The clinical observation of effect of lamivudine on blocking mother to infant transmission of chronic HBV. Int Med Health Guid News 2008, 14:76–78.
Yang S, Liu M, Wang L: Effect of high viral hepatitis B virus DANN loads on vertical transmission of hepatitis B virus in late-pregnant women. Zhonghua Fu Chan Za Zhi 2008, 43:329–331.
Shi Z, Li X, Yang Y, Ma L: Clinical research on the interruption of mother to child transmission of HBV—a randomized, double-blind, placebo-controlled study. Presented at Unite for Sight 6th Annual Global Health Conference. New Haven, CT: Yale University; April 18–19, 2009.
Zhang LJ, Wang L: Blocking intrauterine infection by telbivudine in pregnant chronic hepatitis B patients [in Chinese]. Zhonghua Gan Zang Bing Za Zhi 2009, 17:561–563. PubMed
ter Borg MJ, Leemans WF, de Man RA, Janssen HL: Exacerbation of chronic hepatitis B infection after delivery. J Viral Hepat 2008, 15:37–41. PubMed
Lamivudine [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2009. Available at http://us.gsk.com/products/assets/us_epivir.pdf. Accessed August 2010.
Tenofovir DF [package insert]. Foster City, CA: Gilead Sciences; 2010. Available at http://www.gilead.com/pdf/viread_pi.pdf. Accessed August 2010.
- Hepatitis B Therapy in Pregnancy
Natalie H. Bzowej
- Current Science Inc.
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