HEPATITIS B

IN PREGNANCY
By Dr. Marie Rose S. Yabut, MD
Fellow, Philippine Obstetrical &
Gynecological Society
Chairman, Department of Obstetrics &
Gynecology
Amang Rodriguez Medical Center

What is Hepatitis B?

CAUSED BY HEPATITIS B VIRUS (HBV)

CAN LEAD TO LIVER CIRRHOSIS, LIVER FAILURE, LIVER
CANCER (80%)

LIVER CANCER IS THE 4TH LEADING CAUSE OF

CANCER DEATH IN THE WORLD

2ND LEADING CAUSE OF CANCER DEATH IN CHINA

IN CALIFORNIA: 2ND LEADING CAUSE OF CANCER

DEATHS AMONG CAMBODIAN and VIETNAMESE
MEN, 4TH AMONG CHINESE and KOREAN MEN, 5TH
AMONG FILIPINO MEN
SILENT TRANSMISSION, SILENT PROGRESSION
5% SURVIVAL RATE
VACCINE PREVENTABLE CANCER

The FIRST ANTI-CANCER VACCINE = HEPATITIS B VACCINE

(CDC)

GLOBAL INCIDENCE

ONE OF THE MOST COMMON

INFECTIOUS DISEASES WORLDWIDE
RANKS BEHIND HIV AS THE 1OTH
LEADING CAUSE OF DEATH WORLDWIDE
ONE THIRD OF THE WORLDS
POPULATION BEEN INFECTED
340-400M HAVE LIFELONG INFECTION

MORTALITY

ONE OUT OF FOUR CARRIERS WILL

EVENTUALLY DIE OF LIVER FAILURE OR
LIVER CANCER
(UNTREATED/UNMONITORED)
1M DIE YEARLY FROM CIRRHOSIS OR
LIVER CANCER
MOST ARE ASIAN

HBV & API ISLANDERS

Of the 400M chronic carriers of HBV, 75%

reside in Asia
In the USA: 1 of 10 APIs chronically infected
vs. 1 of 1000 in general population
1 of 4 will die from liver cancer/failure, without
treatment/monitoring

HBV TRANSMISSION

EXTREMELY VIRULENT VIRUS (100x

MORE INFECTIOUS THAN HIV)
SURVIVES OUTSIDE THE BODY UP TO 7
DAYS IN INFECTED BLOOD

HBV is transmitted through

transfer of infected blood in the

following
ways:
FROM MOTHER
TO CHILD AT BIRTH (most

common among APIs)

CONTACT WITH INFECTED BLOOD (open
wounds, blood transfusions, shared razors &
toothbrushes)
UNPROTECTED SEX
SHARED NEEDLES (drug use, tattoos, piercings)
REUSING NEEDLES

HBV is not transmitted

through:

CONTAMINATED FOOD
SALIVA, TEARS, SWEAT, URINE or STOOL
COUGHING or SNEEZING
SHARING FOOD or EATING UTENSILS
KISSING
BREASTFEEDING
CASUAL CONTACT (such as kissing or hugging)

SYMPTOMS of HBV
INFECTION
Hepatitis B is a silent killer, it is
asymptomatic, so many carriers
feel perfectly normal.

SYMPTOMS OF HBV
INFECTION

ONLY 30% DEVELOP SYMPTOMS

JAUNDICE
FATIGUE
ABDOMINAL PAIN
LOSS OF APPETITE

MOST APIs ARE INFECTED AT BIRTH OR

EARLY CHILDHOOD WHEN SYMPTOMS MAY
NEVER DEVELOP.
CHRONIC CARRIERS HAVE NO SYMPTOMS
UNTIL CIRRHOSIS OR CANCER HAS
DEVELOPED
ABDOMINAL DISTENSION/PAIN
GI BLEEDING
FATIGUE
EDEMA
JAUNDICE

THREE POSSIBLE RESPONSES

TO INFECTION
1.

2.

3.

ACUTE HEPATITIS B WITH FULMINANT

LIVER FAILURE
ACUTE HEPATITIS B WITH FULL
RECOVERY and DEVELOPMENT of
IMMUNITY
CHRONIC INFECTION WITH HEPATITIS B

SPECIAL CONCERNS for

INFANTS & APIs
FOR INFANTS:
Those infected as NEWBORNS have 90% chance
of becoming carriers.
Those infected during CHILDHOOD have
30% - 50% chance.
FOR APIs:
Prevention of perinatal transmission
Screening is essential
Sexually active adults should be vaccinated

DIAGNOSING HEPATITIS B
BECAUSE OVER 10% OF THE ASIAN and
PACIFIC ISLANDER COMMUNITY IS
CHRONICALLY INFECTED WITH
HEPATITIS B, ALL MEMBERS OF THE API
COMMUNITY SHOULD BE SCREENED.

DIAGNOSING HEPATITIS B
1.

IDENTIFY CHRONIC CARRIERS

Hepatitis B surface antigen blood test
(HBsAg):
(+) =
Hepatitis B carrier
Has chronic infection
(-) =
Not a Hepatitis B carrier
Does not have chronic
Hepatitis B

2.

CHECK FOR IMMUNITY AGAINST HBV

Hepatitis B surface antibody blood test
(HBsAb or anti-HBs):
(+) = Protected from hepatitis B infection
Has immunity against HBV
Vaccination & booster shots
not needed
(-) = Not protected from hepatitis B infection
If negative for HBsAg, individual is not a carrier, and
vaccination is needed for future protection

DIAGNOSING HEPATITIS B
ANOTHER TEST THAT MAY BE OF
INTEREST:
Hepatitis B core total antibody Blood Test
(HBcAb or Anti-HBc):
Main purpose is to indicate prior
infection from hepatitis B (past or ongoing). It does not indicate any
protection from future infection.

Anti- HBc test result:

(+) = Indicates past or current
infection with hepatitis B
= Does not indicate protection
from chronic hepatitis B
(-) = Indicates that this patient
has never been infected
with HBV

HEPATITIS B TEST
INTERPRETATION
HBsAg (+)
chronic carrier
Anti-HBs (-)

HBsAg (-)
immune to HBV
Anti-HBs (+)

HBsAg (-)
needs vaccination
Anti-HBs (-)

IMPORTANT STEPS for

PREGNANT MOTHERS and
their
NEWBORNS
1.
EXPECTING
MOTHERS SHOULD BE

2.

TESTED FOR HBsAg BECAUSE

PERINATAL TRANSMISSION AT BIRTH
CAN OCCUR.
ALL NEWBORNS SHOULD BE
VACCINATED AND RECEIVE THE FIRST
DOSE OF THE HEPATITIS B VACCINE
SERIES WITHIN 12-24 HRS OF BIRTH.

3.

INFANTS BORN TO HEALTHY, HBsAgNEGATIVE MOTHERS SHOULD BE

VACCINATED BEFORE LEAVING THE
HOSPITAL. SUBSEQUENT DOSES:
1ST DOSE: within 12 hrs of birth
2nd DOSE: Age 1 2 months
3rd DOSE: Age 6 months

4.

INFANTS BORN TO HBsAg-POSITIVE

MOTHERS SHOULD GET THE HEPATITIS B
IMMUNE GLOBULIN (HBIg) IN ADDITION TO
TO RECEIVING THE FIRST SHOT OF THE
HEPATITIS B VACCINE SERIES WITHIN 12
HOURS OF BIRTH.
1ST DOSE/HBIg: Within 12 hrs of birth
(shots can be given at the
same time)
2nd DOSE: Age 1 2 months
3rd DOSE: Age 6 months
Testing for HBsAg/Anti-HBs: Age 915
months

5.

INFANTS BORN TO MOTHERS WHOSE HBsAg

STATUS IS UNKNOWN:
MOTHERS TESTED FOR HBsAg. IF POSITIVE,
INFANT SHOULD RECEIVE HBIg AS SOON AS
POSSIBLE, BEFORE AGE 1 WEEK.
1ST DOSE: Within 12 hours of birth
If mother is HBsAg+, HBIg dose within first
week after birth
2ND DOSE: Age 1 -2 months
3RD DOSE: Age 6 months
If mother is HBsAg+, TESTING FOR HBsAg/
Anti-HBs at Age 9 15 months

THANK YOU!!!