Management of pregnancy in women with chronic hepatitis B - literature review and the experience of “Prof. Dr. Panait Sîrbu” Clinical Hospital of Obstetrics and Gynecology, Bucharest
M. Mitran, O. Velicu, R. Ciobanu, I. Diaconu, E. Brătilă
Rezumat: The management of hepatitis B virus (HBV) during
pregnancy remains a challenge and involves various
aspects of maternal-fetal care. Our objective is
to provide a comprehensive review of the current
knowledge regarding pregnancy and HBV infection,
as well as recent efforts to reduce the rate of motherto-
child transmission (MTCT). We also present the
2016 clinical experience with HBV positive patients.
We analysed data from 43 HBV positive pregnancies,
resulting in 44 live childbirths, in “Panait Sîrbu”
Hospital during 2016. A literature review was also
conducted examining recent studies devoted to the
clinical, therapeutic, and prognostic aspects of HBV
infection during pregnancy in order to extrapolate
and interpret data that can help physicians in the
management of HBV infection in this setting. In
our study group, the mean maternal age was 30 (±
7) and the majority were primiparous. Caesarean
section was the birth method in 39 (93%) of the
cases, with 36 (83.7%) being born at term. In 7 cases
(16.2%) spontaneous membrane rupture occurred.
All the newborns received active immunoprophylaxis
(HBV vaccine) and 38 (88.3%) also received passive
immunoprophylaxis consisting in the administration
of hepatitis B immune globulin (HBIG). Testing
for HBV is recommended in every pregnancy,
regardless of previous testing or vaccination. The
identification of HBV-positive pregnant women
remains the most effective way to prevent HBV
transmission to new-borns, combined with passive
and active prophylaxis at birth. Breastfeeding is
not contraindicated for HBV patients, but it is not
recommended for women taking antiviral drugs.
Finally, there is no clear evidence that elective
caesarean section reduces the risk of mother-tochild
transmission compared to vaginal delivery. Cuvinte cheie: chronic hepatitis B, pregnancy,
immunoprophylaxis, MTCT.