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Review
. 2020 Jan 2;4(2):157-171.
doi: 10.1002/hep4.1460. eCollection 2020 Feb.

Hepatitis B and Pregnancy: Virologic and Immunologic Characteristics

Shivali S Joshi  1   2 , Carla S Coffin  1   2
Affiliations
Review

Hepatitis B and Pregnancy: Virologic and Immunologic Characteristics

Shivali S Joshi et al. Hepatol Commun. .

Abstract

The hepatitis B virus (HBV) is an important human pathogen. Unvaccinated infants infected through mother-to-child transmission (MTCT) are at >95% risk of developing serum hepatitis B surface antigen-positive chronic hepatitis B (CHB). Despite complete passive-active HBV immunoprophylaxis, approximately 10% of infants born to mothers who are highly viremic develop CHB, and thus maternal treatment with nucleos(t)ide analogs (tenofovir disoproxil fumarate, lamivudine, or telbivudine) is recommended in the third trimester of pregnancy to reduce MTCT risk. Viral rebound usually occurs after stopping treatment and, in the context of maternal immunologic reconstitution postpartum, can also precipitate host immune-mediated hepatic (biochemical) flares. In this article, we review the epidemiology of HBV MTCT, discuss management and potential mechanisms of HBV vertical transmission, and highlight recent studies on virologic and immunologic aspects of hepatitis B in pregnancy and postpartum.

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Figures

Figure 1
Figure 1
Summary of proposed modes of HBV MTCT and underlying mechanisms. Abbreviation: ASGPR, asialoglycoprotein receptor.
Figure 2
Figure 2
Schematic representation of immunologic changes in the peripartum period in mothers with CHB and their infants.
See this image and copyright information in PMC

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