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Hepatitis B Virus Screening in Pregnant Women

The prevalence of maternal HBV infection in the United States is estimated to be 85.8 cases per 100,000 deliveries. Rates of maternal HBV have increased annually by 5.5% since 1998. CDC estimates that 800 to 100 cases of perinatal transmission occur annually. Persons infected with HBV during infancy or childhood are more likely to progress to chronic infection. Chronic HBV infection increases long-term morbidity and mortality by predisposing infected persons to cirrhosis of the liver and liver cancer.

Screening for HBV infection during pregnancy identifies women whose infants are at risk of perinatal transmission. Universal prenatal screening for HBV infection substantially reduces perinatal transmission of HBV and the subsequent development of chronic HBV infection. Vaccination of all infants against HBV infection and provision of post exposure prophylaxis with hepatitis B immune globulin (HBIG) at birth to infants of mothers infected with HBV substantially reduce the risk for acquisition of HBV infection in infants.

The principal screening test for detecting maternal HBV infection is the serologic identification of HBsAg. A test for HBsAg should be ordered at the first prenatal visit. Testing should also be performed on women admitted to a hospital or other delivery setting with unknown HBsAg status or with new or continuing risk factors for HBV infection such as injection drug use or sexually transmitted infection. Screening should be performed in each pregnancy, regardless of previous HBV vaccination or previous negative HBsAg test results

Perinatal transmission of HBV infection is prevented by screening all pregnant women for HBV, vaccinating infants born to HBV-negative mothers within 24 hours of birth and completing the infant HBV vaccination series by age 18 months.

HBV-positive mothers should have HBV DNA viral load testing and be referred to specialty care for counseling and medical management of HBV infection. Infants born to mothers who are positive for HBsAg should receive HBV vaccination and HBIG within 12 hours of birth. They should complete the vaccine series and have serologic testing for HBV infection and immunity by age 9 to 12 months. For infants born to mothers with unknown HBsAg status, current guidelines for case management include HBV vaccination within 12 hours of birth followed by HBIG.


Henderson JT, Webber EM, Bean SI. Screening for Hepatitis B Virus Infection in Pregnant Women: An Updated Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 179. AHRQ Publication No. 19-05248-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2019.

U.S. Preventive Services Task Force. Screening for hepatitis B virus infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009;150(12):869-73, W154.

Chen HL, Zha ML, Cai JY, Qin G. Maternal viral load and hepatitis B virus mother-to-child transmission risk: a systematic review and meta-analysis. Hepatol Res. 2018;48(10):788-801.

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