Question: A young woman in her first trimester of pregnancy has a HBV viral load of 600,000 IU/mL. She is worried about vertical transmission and asks whether a series of HBV vaccination is appropriate for her. What should you recommend?
A. begin the vaccination series right away
B. steer her towards once daily adefovir instead
C. any kind of treatment during pregnancy is unsafe
D. tell her there is no proven benefit of HBV vaccination during pregnancy
Answer: Hepatitis B treatment during pregnancy is an important topic to understand. Unfortunately, immunization is not an option, as there have been no randomized trials proving its efficacy for reducing vertical transmission. You should think of the vaccine as prophylaxis, not treatment. The link below is to a Cochrane database article that details as much.
Treatment during pregnancy, however, can still be considered. Of all the available antivirals, two are considered safe during pregnancy, and fortunately for you, they are easily remembered because they each begin with the letter ‘T’: tenofovir and telbivudine. The other oral antivirals are not used. These can be considered particularly in women with high viral loads.
It is also worthwhile to remember that the newborn should begin the vaccination process at the time of birth and also receive the immunoglobulin HBIg. Without proper treatment at the time of birth, the rate of chronic HBV infection can be as high as 90%, particularly with HBsAg+ mothers with a high viral load.