Hepatitis+B+in+Pregnancy

=Hepatitis B during Pregnancy= toc Recommnedations for the prevention of vertical transmission to the baby

Diagnosis
Hepatitis B surface antigen positive in pregnancy

Initial Labs/Work-up

 * CBC
 * Liver Function Panel
 * Hepatitis B DNA quant
 * Baseline creat
 * Hep Cab and Hep Ab (can vaccinate against Hep A in pregnancy)
 * vitamin D (low associated with more inflammation in hepatitis)
 * HepBeAg and HepBeAb (helps determine treatment course).

Follow-up
Recheck AST/ALT, and Hep B DNA quant about every 3 months if not already in treatment range. Chart Check/Refer to to Jan Diamond for review

Treatment
Treat with Tenofovir to prevent vertical transmission if viral load >1,000,000, in addition to standard HBIG and vaccine for baby. (Note no longer using lamuvidine as first line) If pt has normal, or near normal lft's, and Hep B quant viral load > 1,000,000, start Tenofovir 300 mg qd sometime @ 26-30 weeks. If pt has evidence of significant liver disease (low platelets, AST, ALT > 2 x normal, etc) and high viral load, refer pt to hepatitis clinic AND can start tenofovir 300 mg by 24 weeks. -- Can check viral load @ 6 weeks after starting tenofovir.

Postpartum Follow-up
See Adult Hep B page to see if patient needs on going treatment. Post delivery stop Tenofovir if used only to prevent vertical transmission. If mom has significant liver disease continue Tenofovir. Mom may breastfeed if on Tenofovir.

Reference
[]

This page has been edited {$pagerevisions} times. The last modification was made by user:{$revisioneditor} on {$revisiondate}