Management and Elimination of mother-to-child transmission of hepatitis B virus: A therapeutical Approach

A major worldwide health issue is the persistent transmission of the chronic form of the hepatitis B virus (HBV) from mothers to their unborn children (MTCT) during the perinatal period. In endemic areas, HBV infection occurs mainly during infancy and early childhood, with MTCT accounting for approximately half of the transmission routes of chronic HBV infections. Prevention of MTCT is an important step in reducing the global burden of chronic HBV. In addition to such considerations regarding the transmission of HBV to the child, the combination of HBV infection and pregnancy raises several unique management issues. Up to 9% of newborns still acquire HBV infection, especially from mothers who have the hepatitis B e antigen (HBeAg), despite routine passive-active immunoprophylaxis with hepatitis B immunoglobulin (HBIG) and the hepatitis B vaccine. The failure of passive-active immunoprophylaxis in newborns, the impact and requirement of routine hepatitis B immunoglobulin (HBIG) injections to mothers, the safety of antiviral prophylaxis, and the safety of nursing are some of the complications associated with managing HBV infection throughout pregnancy. Chronic HBV infection during pregnancy is usually but may flare after delivery. These unresolved issues are highlighted in this review and we aim to an optimal approach to the management of preventing MTCT of HBV infection. Keywords: Hepatitis B, perinatal period transmission, immunoprophylaxis, breastfeeding, viremia.