Hep B Blog

Expert Calls for Viral Load Testing in All Pregnant Women with Hepatitis B

Dr. Ravi Jhaveri, an infectious disease specialist at the University of North Carolina at Chapel Hill School of Medicine, talks to parents.
Dr. Ravi Jhaveri, an infectious disease specialist at the University of North Carolina at Chapel Hill School of Medicine, talks to parents.

Today, all pregnant women are routinely screened for hepatitis B, but a growing number of doctors say this single test doesn’t go far enough to protect the health of women and children.

In a commentary published in the medical journal Pediatrics,  infectious disease specialist Dr. Ravi Jhaveri calls for a mandatory second test in pregnant women infected with hepatitis B. This test would measure the amount of hepatitis B virus (HBV) in her body (called viral load).

When women have high viral loads, their newborns can become infected even if they are immunized at birth and treated with HBIG (hepatitis B antibodies) to prevent infection.

Dr. Jhaveri, a pediatric infectious disease specialist and associate professor at the University of North Carolina at Chapel Hill School of Medicine, knows this first-hand. He has patients who became infected despite vaccination and HBIG treatment because of their mothers’ high viral loads. Infection occurs when newborns are exposed to these mothers’ highly infectious blood during delivery.

In the past, when anguished parents asked Dr. Jhaveri why their children became infected, he could offer no explanation or treatment to lower the risk. “But now we can,” he told the Hepatitis B Foundation.

Doctors now have potent, antiviral drugs that safely lower viral load in pregnant women and reduce the risk of mother-to-child infection to nearly zero.

Before immunizations, nearly all infants born to infected women developed chronic hepatitis B. Today, immunization within 12 hours of birth and use of HBIG reduces mother-to-child infection by 95 percent.

But despite those prevention efforts, infection still occurs in 3-5 percent of infants born to women who:

  • Test positive for the hepatitis B “e” antigen (HBeAg), which is present when viral load is high,
  • And have viral loads (HBV DNA) that exceed 20,000 international units per milliliter (IU/mL) or about 1 million copies per milliliter.

Recent studies have confirmed that antiviral drugs, which stop the virus from reproducing, are safe for both mother and child. These drugs, administered in a daily pill, were used for decades in HIV-infected women to lower their viral load and prevent mother-to-child infection.

But here’s the problem: Current guidelines don’t require doctors to take that next step and measure viral load if a pregnant woman tests positive for hepatitis B. As a result, doctors may know a pregnant patient has hepatitis B, but they don’t know if she has a high viral load that requires antiviral treatment.

“We should put in place a system where any pregnant woman who tests positive for the hepatitis B surface antigen (HBsAg) is then tested for the hepatitis B “e” antigen, which is another marker of very high levels of hepatitis B replication, and viral load,” he said. “This could be done on the same blood sample.”

Treating pregnant women with antivirals is not yet approved by the U.S. Food and Drug Administration, however many doctors are prescribing them “off-label” because of the growing number of studies that confirm their safety.

There is another reason that viral load testing early in a woman’s pregnancy is important. Recent studies show that the earlier a woman starts on antivirals during her pregnancy, the lower her risk of infecting her newborn.

“It is clear that we have come a long way in preventing (mother-to-child transmission of HBV). It is also clear that it is time to take the next step,” Dr. Jhaveri wrote in his Pediatrics commentary. “We have the tools available, we just need to have the will.”

Doctors currently recommend one of the newer antivirals, such as tenofovir (brand name Viread) or entecavir (Baraclude), for use in pregnant women. Tenofovir has proven to be safe in pregnant women who have developed resistance to other antivirals, such as lamivudine (Epivir-HBV).

All women with hepatitis B should also be monitored carefully after delivery and women who stop taking antivirals after delivery should also be carefully followed as a sudden increase in her viral load may occur.

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8 thoughts on “Expert Calls for Viral Load Testing in All Pregnant Women with Hepatitis B”

  1. I am now 7 months pregnant,i am a chronic hbsag carrier,hbeag negative,hbv dna viral load is 23 iu/ml with normal lft levels(alt 16).I am aware of HBIG and hepatitis b vaccine for the new born with in 12 hrs of birth.
    Doctor said i dont need any treatment now.Is that true,what else precautionary steps do i need to take to not to transmit to my baby.

    1. Hello: Based on medical guidelines, your doctor is correct. Antivirals, to lower a pregnant woman’s viral load, are recommended only if her viral load is in the millions or close to 1 billion. Your HBV DNA level of 23 iU/mL does not pose a risk to your baby, as long as the newborn is immunized within 12 hours of birth. Good luck!!!

  2. Iam chronically infected hbsag +ve with undetectable limits.my kid was immunized with HBIG after 15 hrs of birth.but normally we shud give it in 12 hrs.does he is at risk of getting infected.

    1. Hello: I am not sure if a three-hour delay is significant. The fact that your viral load is undetectable is a good sign — your blood and body fluids have few virus to potentially infect your child. Your doctor will test your baby for the hepatitis B surface antigen and antibody in about 12 months. In the meantime, continue with your child’s vaccination schedule, the second hepatitis B vaccine dose should be administered 30 days after the first, and the third dose administered six months after the first. Good luck.

  3. Iam chronically infected hep b carrier.iam going to deliver a child in few days.India bcg and polio,hep b vaccine are commonly given after birth to infant.i heard about HBIG.Can it be given along with the above vaccines or only HBIG and hep b should be given.

    1. Hello: When your child is born, the hepatitis B vaccine is far more important than HBIG. When the hepatitis B vaccine is administered within 12 hours of birth, it reduces the baby’s risk of hepatitis B by about 90%. HBIG has been found to add a few percentage points to that protection. If you can afford it, ask for HBIG, but otherwise the hepatitis B vaccine is critical. Good luck!

  4. Thank u so much for the prompt response.

    Does mother having hepatitis b (low viral load dna) cause jaundice in new born??
    Can i breast feed the baby.

    1. Hello: There are a number of things that can cause jaundice in a newborn, but your low viral load is probably not one of them. Please have a doctor examine the baby and figure out what is causing the jaundice. Hopefully the baby was immunized against hepatitis B at birth.
      Yes, you can safely breastfeed your baby. All research shows the hepatitis B virus IS NOT transmitted through breast milk. Good luck.

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