Hepatitis B remains a leading cause of cirrhosis, hepatocellular carcinoma and liver transplantation worldwide. Management of chronic hepatitis B during pregnancy is challenging. Transmission of hepatitis B to infants still occurs perinatally although immunoprophylaxis is widely available for infants born to mothers with chronic hepatitis B infection. The emerging data suggest that initiation of antiviral therapy in the beginning of the third trimester in highly viremic mothers can prevent immunoprophylaxis failure in their infants. The available drug safety data show that lamivudine, telbivudine and tenofovir are generally safe to be used during the pregnancy. In order to minimize the fetal exposure to the antiviral medication, antiviral therapy during the pregnancy should be limited to a selected group of patients with cirrhosis, high hepatitis B viral load, or prior history immunoprophylaxis failure. An elective Caesarean section may reduce the risk of perinatal transmission. For those females planning for pregnancy or in early stage of pregnancy, communication and follow-up among obstetrician, gastroenterologist, and primary care physician are important. In this article, we will review the features of hepatitis B infection before, during and after the pregnancy; the risk factors that increase mother-to-child transmission; safety data on antiviral drug use during pregnancy; and the potential role of Caesarean section in selected cases.
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Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is ?no evidence of risk in later trimesters)
B
Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in ?pregnant women or animal studies, which have shown an adverse effect, but adequate and well-controlled studies in pregnant ?women have failed to demonstrate a risk to the fetus in any trimester
?Telbivudine ?Tenofovir
C
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in ?humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks
?Lamivudine ?Entecavir ?Adefovir ?Interferon
D
There is positive evidence of human fetal risk based on adverse-reaction data from investigational or marketing experience or ?studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks
X
Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on ?adverse-reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant ?women clearly outweigh potential benefits
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