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Tag Archives: HBV perinatal transmission

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Why Postpartum Women Struggle with HBV Treatment Adherence and What We Can Do About It

 

 

 

 

 

 

 

 

 

Hepatitis B remains a global health challenge.. There are strategies to prevent perinatal (mother to child) transmission of hepatitis B. Prevention includes testing all pregnant persons for the marker of hepatitis B infection (HBsAg), if the pregnant person is positive, then assessment is needed throughout pregnancy. If the pregnant person’s viral load becomes high, antiviral treatment (TDF) might be recommended during the second trimester taken throughout pregnancy. Data shows this is safe and effective, and reducing the viral load can reduce the risk of transmission.  

Additionally, making sure that all infants get hepatitis B birth dose as soon as possible after delivery, ideally within the first 24 hours of birth followed by at least two subsequent doses of hepatitis B vaccine (usually part of global childhood immunization series ex: the pentavalent vaccination). However, for many individuals, adhering to these guidelines in many parts of the world can be a challenge. Recent research sheds light on the barriers and opportunities to improve treatment adherence during this important period. Treatment adherence means taking your medicine the right way, at the right time, in the right amount, and for as long as your doctor tells you. It’s about sticking to your treatment plan to maintain your health.  

The postpartum drop-off: a hidden risk 

A study published in the Journal of the Pediatric Infectious Diseases Society explored adherence to tenofovir disoproxil fumarate (TDF), a medication used to treat HBV, among pregnant individuals. While adherence during pregnancy was relatively high, many women discontinued treatment postpartum. A mix of factors contributed to the drop in HBV treatment adherence following delivery including:  

  • Lack of follow-up care after delivery 
  • Low awareness about health risks that may come from stopping medication 
  • Limited knowledge about the long-term benefits of continued treatment 
  • Healthcare system gaps, especially in low-resource settings, making access to care and medication difficult 

What the numbers say?

In a broader context, a study from Israel found that only about 67% of chronic HBV patients maintained high adherence (defined as taking at least 80% of the prescribed medication). Many women stopped taking their medication after giving birth or were not consistent with their medication routines (Mor et al., 2022). A 2025 pilot study published in Virology Journal looked at what happens when women with chronic hepatitis B stop taking antiviral medication after giving birth. Among 88 women who discontinued treatment postpartum, nearly 29% experienced liver inflammation (ALT flares)—a sign that the virus was becoming elevated (Tang et al., 2025).  

What can be done? 

Improving postpartum adherence to HBV treatment requires a holistic approach and strategies can include: 

  • Integrated care models that link obstetric and hepatology services, making it easier for women to stay on track with their hepatitis B care and medication 
  • Patient education that emphasizes the importance of continued treatment beyond pregnancy 
  • Support from community health workers to provide follow-up and encouragement to stay connected with hepatitis B care 
  • Mobile health tools (like SMS reminders) to help new mothers stay on track after delivery 

The postpartum period is a time of immense change—and often, medical follow-up takes a backseat. But for women living with HBV, taking efforts to prevent perinatal transmission is crucial not just for their own health, but for preventing the future generation from hepatitis B. With better systems, education, and support, we can close the adherence gap and protect more lives. 

To learn more about prevention of perinatal transmission of hepatitis B, you can also visit the Hepatitis B Foundation’s Informed Training Hub, which includes modules on perinatal prevention. 

References: 

Greenup, A. J., Tan, J., Nguyen, V., & Visvanathan, K. (2020). Adherence to antiviral therapy for chronic hepatitis B during pregnancy and postpartum: A prospective cohort study. Journal of the Pediatric Infectious Diseases Society, 9(3), 289–295. https://doi.org/10.1093/jpids/piz064 

Mor, Z., Grotto, I., & Anis, E. (2022). Adherence to antiviral therapy among patients with chronic hepatitis B in Israel. Israel Journal of Health Policy Research, 11(1), 1–9. https://doi.org/10.1186/s13584-022-00527-2 

Tang, Q., Wang, C., Li, H., Chen, Z., Zhang, L., Zhang, J., Liu, X., Xue, Y., Qiu, Y., Peng, M., Zeng, Y., & Hu, P. (2025). Unexpected HBsAg decrease after nucleoside analogues retreatment among HBeAg positive postpartum women: A pilot study. Virology Journal, 22, Article 36. https://doi.org/10.1186/s12985-025-02632-x 

World Health Organization. (2024). Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection (WHO Guidelines). https://www.who.int/publications/i/item/9789240090903 

Hepatitis B Prevention, Living with Hepatitis B, Uncategorized

What to do about hepatitis B when you’re pregnant?

Around the world, the most common mode of hepatitis B transmission is from mother to child. Unfortunately, pregnant mothers who have hepatitis B can transmit the virus to their newborn during the delivery process. 90% of these HBV infected babies will progress to chronic infection  putting them at increased risk of serious liver disease or liver cancer later in life.

It is important that ALL pregnant women get tested for hepatitis B to prevent the transmission of the virus to newborns at birth.

The U.S. Centers for Disease Control and Prevention (CDC) recommends that all newborns born to hepatitis B positive women be given two shots in the delivery room – the first dose of hepatitis B vaccine (5 mcg dose) and one dose of hepatitis B immune globulin (HBIG, 0.5 mL dose). If a woman knows that she is infected, it is important that she tell her doctor to have these two drugs available when she is ready to deliver. These two shots must be given at separate injection sites, i.e. different limbs. When administered correctly within the first 12 hours of life, a newborn has a 95% chance of being protected against a lifelong hepatitis B infection. The infant will need to complete the hepatitis B vaccine according to schedule as part of a 3 or 4 dose series. CDC recommends follow up testing to confirm immunity or protection against HBV at 9 months or at the baby’s 1 year checkup.

The World Health Organization (WHO) recommends the birth dose of the hepatitis B vaccine for ALL babies, though it is especially important for a baby born to a woman with hepatitis B to receive the first dose of the vaccine as soon as possible, within 24 hours. HBIG may not be available in all countries or may be cost prohibitive. The hepatitis B vaccine series may be completed with the remaining monovalent  (single) injections of the HBV vaccine, or may be completed as part of a combination vaccine series.

In developing countries combination vaccines such as the pentavalent vaccine are often given to babies. The first dose of the pentavalent vaccine (which includes hepatitis B vaccine) is given at 6 weeks of age, and the 2nd and 3rd doses are given at 10 and 14 weeks of age. Waiting for the first dose at 6 weeks is too late for babies born to mothers living with chronic hepatitis, though the pentavalent vaccine should never be used as the birth dose or before 6 weeks. Women who know they have hepatitis B should talk to their doctor about ensuring that a birth dose of the hepatitis B vaccine is available for their baby at birth.

There is no second chance!  It is vitally important that we protect all newborns from hepatitis B!

Also, all infected pregnant women need to learn more about their hepatitis B infection from a liver specialist or a doctor with experience treating patients with chronic hepatitis B. It is recommended that pregnant women have their hepatitis B monitored throughout their pregnancy, to check the health of their liver and to see if they need treatment. For HBeAg positive women with high hepatitis B viral loads, taking FDA-approved antivirals during the last trimester can reduce the amount of virus in the blood and help prevent the chance of transmission to the newborn. Once an infected woman gives birth, it is important that she routinely see her doctor to keep monitoring her hepatitis B infection. Keeping mothers healthy allows them to better take care of their families!

For more information, or if you live in the U.S. and need help with hepatitis B infection during pregnancy, please visit the Perinatal Hepatitis B Prevention Program to find a coordinator near you. If you are outside of the U.S., you may consider visiting the World Hepatitis Alliance to find if there are organizations in your country that can ensure your baby starts with a birth dose of the hepatitis B vaccine.

Visit our website for additional information!

Baruch S. Blumberg Institute