What to do about hepatitis B when pregnant?

Around the world, the most common mode of hepatitis B transmission is from mother to child. Unfortunately, pregnant mothers who have hepatitis B can transmit the virus to their newborn during the delivery process. About 90 per cent of hepatitis B infected babies have lifelong chances of the infection progressing and putting them at increased risk of serious liver disease or liver cancer later in life.

Minimising the risk of babies being infected requires that all pregnant women should be screened early for hepatitis B, to prevent the viral infection from being passed to newborns.”It is important that all pregnant people get a blood test for hepatitis B as part of antenatal care,” Dr Wole Lawal, Director, Public Health, Oyo State Ministry of health.

“To protect children, pregnant women need to be screened because hepatitis B, if not detected on time can be transmitted from mother to child. They need to get appropriate care throughout their pregnancy to help to reduce the chances of transmitting the virus to the baby at birth.”

Although relatively rare in the West, in regions where hepatitis B remains endemic like Asia, the Western Pacific region and Africa, chronic hepatitis B infection is common and individuals are often first exposed to the virus as infants or children.   Also, transmission from a mother to child around the time of birth or during breastfeeding is very common in areas endemic for hepatitis.

Hepatitis B is a viral infection of the liver that can cause liver disease and liver cancer. And, while it’s common to have it without knowing it, liver failure or liver cancer is a known complications that could be prevented by screening and treatment.

Moreover, the younger an individual is when they contract hepatitis B, the higher the likelihood that they will develop the chronic form. Left untreated, about one in four children who have chronic hepatitis B will eventually die of health problems related to their infection, such as liver damage, liver disease or liver cancer.

Dr Olubunmi Ayinde, Deputy Director at the Oyo State Ministry of Health, who coordinates hepatitis programme, said newborns are routinely vaccinated for hepatitis B virus shortly after birth to also protect them from hepatitis.

“The baby should get four doses of the hepatitis B vaccine. The first dose is the most important dose which must be taken within 24 to 72 hours after birth and then the remaining three doses afterwards to ensure that the baby will be immune for life against hepatitis B,” said Dr Ayinde.

After the first dose of the vaccine is given in the hospital, the next dose is usually given at one month of age. The last two shots are given subsequently afterwards at six weeks interval till the schedule is completed.

According to Dr Ayinde, when a pregnant woman has hepatitis B, alongside the vaccine, her baby is also given a shot called hepatitis B immune globulin (HBIG) also within 24 hours of birth.

HBIG is a medicine that gives the baby’s body a “boost” or extra help to fight the virus as soon as he or she is born. The HBIG shot is only given to babies of mothers who have hepatitis B.

The U.S. Centers for Disease Control and Prevention (CDC) recommends that all newborns born to hepatitis B positive women be given two shots in the delivery room – the first dose of hepatitis B vaccine (5 mcg dose) and one dose of hepatitis B immune globulin (HBIG, 0.5 mL dose). The infant will need to complete the hepatitis B vaccine according to schedule.

Also, CDC recommends follow up testing to confirm immunity or protection against hepatitis B at nine months or at the baby’s one-year checkup.

Mr Marcus Williams, state coordinator, Network of NGOs that Work with Children in Oyo state while speaking at a free community testing and awareness creation on hepatitis B for pregnant women and women of reproductive age groups, in making the 2020 World hepatitis day in Ibadan North-East local government said if hepatitis B infection in children is not stopped at birth, the infection could rob the children of their future.

“Stopping hepatitis at this level is key to keeping our children safe and secure and to give them a meaningful life in the future. To be able to eliminate hepatitis B from Nigeria in the coming years, there is a need for us to sensitise mothers, pregnant women, and those that interface with pregnant women on the importance of testing and treatment for hepatitis B after they have tested positive.

“There is a need for them to continue to spread information on how to prevent getting hepatitis, including knowing the hepatitis status of the partner that they will have sex with so that they will not continue to spread the virus.”

On 2020 World Hepatitis Day, WHO, Director General, Dr Tedros Adhanom Ghebreyesus, also said “No infant should grow up only to die of hepatitis B because they were not vaccinated ─ today’s milestone means that we have dramatically reduced the number of cases of liver damage and liver cancer in future generations.”

He declared: “Preventing mother-to-child transmission of hepatitis B is the most important strategy for controlling the disease and saving lives. Even in the midst of the COVID-19 pandemic, we must ensure that mothers and newborns have access to life-saving services including hepatitis B vaccinations.”

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