Hepatitis B virus (HBV) during pregnancy presents unique management challenges. Varying aspects of care must be considered, including the effects of HBV on maternal and fetal health, effects of pregnancy on the course of HBV infection, treatment of HBV during and after pregnancy, and prevention of perinatal infection. Antiretroviral therapy has not been associated with increased risk of birth defects or toxicity, but despite studies designed to elucidate the drug efficacy and safety in affected individuals and the developing fetus, recommendations are inconclusive. Clinicians and patients must make individualized decisions after carefully evaluating the risks and benefits summarized in this article.
Disease burden
An estimated 350 million people, 5% of the world’s population, are chronically infected with the hepatitis B virus (HBV); of those, 70% live in the western Pacific area. Despite global adoption of hepatitis B immunization programs over the past 2 decades, chronic HBV infection and its complications, cirrhosis and hepatocellular carcinoma, remain significant medical and financial burdens to the health care system. The prevalence of HBV infection varies greatly among countries. In high endemic areas such as China, most of Africa, and South America, more than 10% of the population is infected.
In the United States, an estimated 1.4 million individuals are infected with HBV. Between 2000 and 2003, HBV infection was responsible for 2000 to 4000 deaths. Chronic HBV prevalence is the highest among immigrants from high endemic countries, people who have human immunodeficiency virus (HIV), injecting drug users, men who have sex with men, and household contacts of people with chronic HBV infection.
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