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JAMA Patient Page
July 23/30, 2019

Screening for Hepatitis B in Pregnant Women

JAMA. 2019;322(4):376. doi:10.1001/jama.2019.9229

The US Preventive Services Task Force (USPSTF) has recently published recommendations on screening for hepatitis B virus infection in pregnant women.

What Is Hepatitis B?

Hepatitis B is a virus that infects and harms the liver. It can be transmitted sexually or through blood (such as by sharing needles). It can also be transmitted during pregnancy from mother to fetus. Symptoms of initial hepatitis B infection include fever, fatigue, abdominal pain, nausea, and sometimes yellowing of the eyes and skin (jaundice). This is called acute hepatitis B infection. Most people recover fully from acute hepatitis B without treatment. However, about 1 in 20 people with acute infection are not able to clear the virus from their body and as a result develop chronic hepatitis B infection. In people with chronic hepatitis B infection, the virus stays in the liver and, over the course of years or decades, can cause liver cirrhosis or failure, liver cancer, and death.

Not everyone needs treatment right away for chronic hepatitis B infection. Treatment involves antiviral medications, such as tenofovir. For pregnant women with high levels of hepatitis B in their blood during the third trimester, antiviral medications may decrease the risk of transmission to the fetus. An antibody given to these infants at birth called hepatitis B immunoglobulin (HBIG) can also help prevent infection. A hepatitis B vaccine is also available and is routinely given to all infants at birth in the United States.

What Tests Are Used to Screen for Hepatitis B in Pregnant Women?

Screening for hepatitis B infection is usually done by blood tests. Different blood tests can detect current infection as opposed to past infection or immunization. For pregnant women, the best test to detect current infection is the hepatitis B surface antigen (HBsAg) test.

What Is the Patient Population Under Consideration for Screening for Hepatitis B in Pregnant Women?

This USPSTF recommendation applies to all pregnant women.

What Are the Potential Benefits and Harms of Screening for Hepatitis B in Pregnant Women?

There is convincing evidence that universal screening for hepatitis B in pregnant women substantially reduces transmission to babies, thereby preventing future development of chronic hepatitis B infection. There is also evidence that treating infants at birth with HBIG in addition to routine hepatitis B vaccination is effective in preventing infection. Potential harms of screening are small because false-positive rates are low (the HBsAg test is very accurate) and treatments are rarely harmful.

How Strong Is the Recommendation to Screen for Hepatitis B in Pregnant Women?

Based on current evidence, the USPSTF concludes with high certainty that the net benefit of screening for hepatitis B virus infection in pregnant women is substantial.

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Article Information

Conflict of Interest Disclosures: None reported.

Source: US Preventive Services Task Force. Screening for hepatitis B virus infection in pregnant women: US Preventive Services Task Force reaffirmation recommendation statement [published July 23, 2019]. JAMA. doi:10.1001/jama.2019.9365

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