Hepatitis B infection of newborns can lead to chronic hepatitis B in about 90% of cases. For this reason, all pregnant women should be tested for hepatitis B during the first trimester of pregnancy.
In people with hepatitis B who have a high viral load, normal liver enzymes, and no documented liver fibrosis, treatment of the mother is still not considered necessary in most cases. guidelines national and international. This is the phase formerly known as “immunotolerant”when there is host tolerance to the B virus. It usually occurs up to the age of 30 in a person who has been vertically infected.
However, even if there is no indication of treatment for the mother, there are certain rules to protect the newborn from contamination. In mothers with a B viral load greater than 200,000 IU/ml (or its equivalent 1,000,000 copies/ml) or HBsAg levels greater than 4 log10 IU/ml, antiviral prophylaxis with tenofovir should be initiated between weeks 24 and 28 of pregnancy and continued until at 12 weeks postpartum. There are no contraindications to normal childbirth.
Newborns of HBsAg positive mothers should receive immunoglobulin and vaccine within 12 hours of delivery and follow the usual immunization schedule. Breastfeeding should not be avoided. Even in those using tenofovir, its bioavailability is limited and neonates are exposed to low levels.
In mothers using entecavir before pregnancy, it is recommended to switch to tenofovir. After delivery, the decision to stop tenofovir is based on liver safety in mothers in whom the decision to start the drug was focused on preventing mother-to-child transmission. To this end, they must carry out a stratification of liver damage and define whether or not to maintain antiviral drugs, according to the clinical protocol of the therapeutic guidelines for hepatitis B in force in Brazil.
All pregnant women without indication of maternal treatment for hepatitis B should use antiviral prophylaxis of vertical transmission of hepatitis B, if the HBV load is greater than 200,000 IU/ml. Antiviral, when indicated, should be started from the 24th week of pregnancy and maintained until the 12th week after delivery.
The newborn should receive immunoglobulins and a vaccine against hepatitis B.
See more advantages of being a user of the PEBMED portal:
See more benefits of being a user
7 days free with Whitebook
Application made for you, doctor, designed to bring security and objectivity to your clinical decision.
Free access to the Nursebook
Access fundamental information for your daily life such as anamnesis, semiology.
Free access to forums
Space for exchanging experiences and constructive comments on topics related to medicine and health.
Access news, studies, updates and more content written and reviewed by experts
Test your knowledge
Answer our quizzes and study in a simple and fun way
Receive studies, updates, new behaviors and other specialty-segmented content via email