hepatosplenomegaly. Extrahepatic manifestations may include arthritis, generalized vasculitis, glomerulonephritis, pericarditis, myocarditis, transverse myelitis, and peripheral neuropathy. One risk factor for chronic disease is age at acquisition. It is more than 90 percent in newborns, 50 percent in young children, and less than 10 percent in immunocompetent adults. Another risk is an immunocompromised state such as those with human immunodeiciency virus (HIV) infection, transplant recipients, or persons receiving chemotherapy. Chronically infected persons may be asymptomatic carriers or have chronic disease with or without cirrhosis. Patients with chronic disease have persistent HBsAg serum positivity. he patients with evidence of high viral replication-HBV DNA with or without HBeAg-have the highest likelihood of developing cirrhosis and hepatocellular carcinoma. The WHO considers hepatitis B to be second only to tobacco among human carcinogens. HBV DNA has been found to be the best correlate of liver injury and disease progression risk.
Hepatitis B infection is not a cause of excessive maternal morbidity and mortality. It is often asymptomatic and found only on routine prenatal screening (Stewart, 2013). A review of data from the National Inpatient Sample reported a modest increase in preterm birth rates in HBV-positive mothers but no efect on fetal growth restriction or preeclampsia rates (Reddick, 2011). Others have shown similar results (Chen, 2015). Transplacental viral infection is uncommon, and Towers and associates (2001) reported that viral DNA is rarely found in amnionic luid or cord blood. Interestingly, HBV DNA has been found in the ovaries of HBV-positive pregnant women, although this may not be a significant factor in perinatal transmission Gin, 2016b). The highest HBV DNA levels were found in women who transmitted the virus to their fetuses (Dunkelberg, 2015; Society for Maternal-Fetal Medicine, 2016).
In the absence of HBV immunoprophylaxis, 10 to 20 percent of women positive for HBsAg transmit viral infection to their infant. This rate increases to almost 90 percent if the mother is HBsAg and HBeAg positive. Immunoprophylaxis and hepatitis B vaccine given to newborns ofHBV-infected mothers has decreased transmission dramatically and prevented approximately 90 percent of infections (Smith, 2012). But, women with high HBV viralloads-1 06 to 108 copies/ mL-or those who are HBeAg positive still have approximately a 10-percent vertical transmission rate, regardless of immunoprophylaxis (Yi, 2016).