By Dr. Lepakshi Dasari, MBBS, DNB (Obstetrics and Gynaecology), DGO, FMAS
Consultant Gynaecologist & Laparoscopic Surgeon, Yashoda Hospitals, Malakpet, Hyderabad.
Hepatitis B is a viral infection that affects the liver and can cause both short-term and long-term illness. During pregnancy, one important concern is whether the infection can pass from the mother to her baby, particularly around the time of birth.
The good news is that mother-to-child transmission of hepatitis B can be prevented in most cases when the infection is identified early and the mother and newborn receive appropriate care. Testing during pregnancy, assessing the mother’s viral load and timely vaccination of the newborn are central to prevention.
This is particularly relevant in India, where hepatitis B remains a significant public health concern. WHO estimates that around 40 million people in India are living with chronic hepatitis B infection.
Why is hepatitis B a concern during pregnancy?
Hepatitis B does not always cause noticeable symptoms. A woman may therefore have the infection without knowing it.
The virus can be passed from mother to baby around the time of childbirth. The risk is higher when the mother has a high level of hepatitis B virus (HBV) in her blood.
The age at which infection occurs also matters. Babies and young children who acquire hepatitis B are much more likely to develop chronic infection than adults who become infected. Chronic hepatitis B can remain silent for years but may eventually cause liver damage, cirrhosis or liver cancer.
This makes preventing infection during the newborn period particularly important.
Testing during pregnancy is the starting point
Every pregnant woman should discuss hepatitis B screening with her doctor. The initial test is usually a blood test for hepatitis B surface antigen (HBsAg).
WHO recommends that pregnant women are tested for HBsAg at least once and as early as possible during pregnancy. Early identification gives the healthcare team time to assess the infection and plan care for both mother and baby.
A positive result does not mean that a woman cannot have a healthy pregnancy. It means that further evaluation is needed.
Depending on the individual situation, the doctor may recommend:
- HBV DNA or viral load testing
- Hepatitis B e-antigen (HBeAg) testing
- Liver function tests
- Assessment of liver health
- Other tests based on medical history
These investigations help determine how active the infection is and whether the mother needs treatment for her own health or antiviral prophylaxis to reduce the risk of transmission to the baby.
What happens if the mother tests positive?
If a pregnant woman is found to have hepatitis B, the next step is to assess both her own health and the risk of passing the virus to the baby.
One important factor is the HBV DNA level, which indicates the amount of virus in the blood.
WHO recommends that HBsAg-positive pregnant women with an HBV DNA level of 200,000 IU/mL or higher receive tenofovir prophylaxis from around the 28th week of pregnancy until at least delivery, in addition to the baby’s vaccination, to reduce the risk of mother-to-child transmission.
Tenofovir disoproxil fumarate is the preferred antiviral in WHO guidance because of its effectiveness and high barrier to resistance. Available evidence has also supported its use during pregnancy for prevention of hepatitis B transmission.
However, not every pregnant woman with hepatitis B will need antiviral medication. The decision depends on viral load, liver health, previous treatment and other clinical factors. Some women may require long-term treatment for their own liver health, while others may only need monitoring.
What if HBV DNA testing is not available?
Access to HBV DNA testing can vary between healthcare facilities.
Where HBV DNA testing is not available, WHO recommends that HBeAg testing can be used as an alternative to help identify pregnant women who may benefit from antiviral prophylaxis. HBV DNA remains the preferred reference test when available.
This is particularly relevant in settings where access to specialised testing may be limited. Improving access to screening and appropriate follow-up is an important part of reducing hepatitis B transmission.
The newborn’s first vaccine dose is critical
The baby’s vaccination is a key part of preventing infection.
WHO recommends that all babies receive their first hepatitis B vaccine dose as soon as possible after birth, preferably within 24 hours. Additional doses are then given to complete the primary vaccination series.
The timely birth dose is particularly important because it protects against infection acquired around birth and during early childhood. WHO reports that timely vaccination followed by completion of the recommended series provides very high protection against hepatitis B.
For this reason, parents should discuss the newborn vaccination plan with the paediatrician or delivery team before childbirth, particularly when the mother is known to have hepatitis B.
Does the baby need HBIG?
Hepatitis B immunoglobulin (HBIG) can provide additional short-term protection to a newborn exposed to hepatitis B.
Its use and availability can vary between healthcare settings. WHO identifies the timely birth dose of hepatitis B vaccine as the key intervention and recognises that HBIG may provide additional protection where it is available.
A mother who has tested positive should therefore inform the maternity and newborn care team before delivery so that the appropriate preventive measures can be planned.
Does hepatitis B mean a Caesarean delivery is needed?
Hepatitis B infection alone does not mean that a woman needs a Caesarean delivery.
There is insufficient consistent evidence to recommend Caesarean delivery solely to prevent hepatitis B transmission. The decision about the mode of delivery should be based on the mother’s and baby’s obstetric needs.
The focus should remain on identifying the infection, assessing the mother’s condition and ensuring that the newborn receives timely preventive care.
Can a mother with hepatitis B breastfeed?
Hepatitis B infection does not generally mean that breastfeeding has to be avoided.
Once the newborn receives the recommended hepatitis B preventive measures, breastfeeding can generally continue. Breast milk itself is not considered an important route of hepatitis B transmission.
However, women should discuss breastfeeding with their doctor if they have cracked or bleeding nipples or any other concerns.
The mother needs follow-up after delivery too
Preventing transmission to the baby is only one part of hepatitis B care. The mother also needs appropriate follow-up.
Women who test positive for HBsAg may need periodic assessment of liver health and HBV activity. Some may require long-term treatment, while others may be monitored without immediate treatment.
Women who receive tenofovir during pregnancy should also discuss the plan for continuing or stopping treatment with their doctor. Stopping antiviral therapy without medical advice can sometimes lead to a flare of hepatitis B-related liver inflammation.
Follow-up after delivery should therefore be planned rather than ending once the baby is born.
What about the baby’s follow-up?
The baby should complete the recommended hepatitis B vaccination schedule.
Depending on the mother’s infection status and the preventive measures given at birth, the paediatrician may also recommend blood testing later in infancy to check whether the baby has been infected and whether adequate protective antibodies have developed.
Parents should maintain a record of the baby’s vaccine doses and attend the recommended follow-up appointments.
Other family members may need testing
When hepatitis B is diagnosed during pregnancy, it is also important to consider the health of close family members.
The woman’s spouse or partner and household contacts may be advised to undergo hepatitis B testing. Those who are not infected and are not immune can be vaccinated.
Hepatitis B spreads through infected blood and certain body fluids. It is not spread through ordinary activities such as sharing food, hugging or sitting together.
What pregnant women should remember
A hepatitis B diagnosis during pregnancy can cause concern, but it does not mean that the baby will definitely become infected.
The important steps are:
- Get tested for hepatitis B early in pregnancy.
- If the result is positive, undergo the recommended assessment, including viral load testing where available.
- Discuss antiviral prophylaxis if the HBV DNA level is high.
- Inform the delivery and newborn care team about the diagnosis.
- Make sure the baby receives the hepatitis B vaccine as soon as possible after birth, preferably within 24 hours.
- Complete the baby’s vaccination schedule.
- Follow up for the mother’s liver health after delivery.
- Ask the doctor whether the baby’s follow-up testing is required.
- Encourage susceptible household and sexual contacts to get tested and vaccinated.
Prevention is possible
Mother-to-child transmission of hepatitis B is not inevitable. The greatest opportunity to prevent it comes from identifying the infection during pregnancy and ensuring that the mother and newborn receive appropriate care at the right time.
For India, strengthening antenatal screening, access to HBV testing, appropriate maternal antiviral prophylaxis and timely newborn vaccination can help reduce new childhood infections.
For an expectant mother, the message is simple: know your hepatitis B status, discuss the result with your doctor and make sure the newborn vaccination is planned before delivery. With timely care, the risk of passing hepatitis B from mother to child can be greatly reduced.
Dr. Lepakshi Dasari is a Consultant Gynaecologist and Laparoscopic Surgeon at Yashoda Hospitals, Malakpet, Hyderabad, with over 13 years of clinical experience. Her expertise spans comprehensive women’s health, high-risk pregnancy care and minimally invasive gynaecological surgery.
She has extensive experience in managing women across different stages of life, including menstrual and reproductive health concerns, infertility, preconception counselling, pregnancy-related conditions and perimenopausal and menopausal health. She also provides antenatal care and specialises in the management of high-risk pregnancies and obstetric emergencies.
Dr. Dasari has a particular interest in minimally invasive gynaecological procedures and is experienced in laparoscopic and hysteroscopic surgeries. Her surgical expertise includes laparoscopy, hysteroscopy and colposcopy, along with procedures for various gynaecological conditions. She is also experienced in managing complex obstetric cases, including cervical cerclage and elective and emergency caesarean sections.
With her clinical experience across obstetrics and gynaecology, Dr. Dasari focuses on providing evidence-based, individualised care to women while supporting them through pregnancy, childbirth and different phases of reproductive and menopausal health.