The Society for Maternal-Fetal Medicine (2016) recommends antiviral therapy to decrease vertical transmission in women at highest risk because of high HBV DNA levels. Although lamivudine, a cytidine nucleoside analogue, signiicantly lowers the risk of fetal HBV infection in women with high HBV viral loads, recent data indicate that lamivudine may be less efective in the third trimester. Moreover, it is associated with the development of resistant mutations and is no longer recommended at a firstline agent. Newer drugs include the adenosine nucleoside analogue tenofovir and the thymidine analogue telbivudine. Both are associated with a lower risk of resistance than lamivudine (Ayres, 2014; Yi, 2016). T enofovir has been recommended as the irst-line agent during pregnancy by the Society for Maternal-Fetal Medicine (2016). These antiviral medications appear safe in pregnancy and are not associated with higher rates of congenital malforma tions or adverse obstetrical outcomes (Brown, 2016). Hepatitis B immunoglobulin (HBIG) given antepartum to women at highest risk of transmission is also cost-efective (Fan, 2016).
Newborns of seropositive mothers are given HBIG very soon after birth. This is accompanied by the first of a three dose hepatitis B recombinant vaccine. Hill and colleagues the 2.4-percent transmission rate was not increased with breast feeding if vaccination was completed. Although virus is present in breast milk, the incidence of transmission is not lowered by formula feeding (Shi, 201l). he American Academy of Pedi atrics and the American College of Obstetricians and Gyne contraindication to breastfeeding.
For high-risk mothers who are seronegative, hepatitis B vaccine can be given during pregnancy. he eicacy is similar to that for nonpregnant adults, and overall seroconversion rates approach 95 percent after three doses (Stewart, 2013). he traditional vaccination schedule of 0, 1, and 6 months may be diicult to complete during pregnancy, and compliance rates decline after delivery. Sheield and coworkers (2011) reported that the three-dose regimen given prenatally-initially and at 1 and 4 months-resulted in seroconversion rates of 56, 77, and 90 percent, respectively. This regimen was easily completed during routine prenatal care.
Also called delta hepatitis, this is a defective RNA virus that is a hybrid particle with an HBsAg coat and a delta core. he virus must co-infect with hepatitis B either simultaneously or secondarily. It cannot persist in serum longer than hepatitis B virus. Transmission is similar to hepatitis B. Chronic coinfection with Brand D hepatitis is more severe and accelerated than with HBV alone, and up to 75 percent of afected patients develop cirrhosis. HDV infection is detected by the presence of anti-HDV and HDV DNA. Neonatal transmission is unusual, as neonatal HBV vaccination usually prevents delta hepatitis.