Management of mother-to-child transmission of hepatitis B virus: Propositions and challenges

Graphical abstract Chronic hepatitis B virus infection due to mother-to-child transmission during perinatal period is an important global health problem. Standard passive-active immunoprophylaxis with HBIG plus HBV vaccine in neonates within 12 h after delivery is proved to be successful in preventing approximately 90% of newborns from MTCT of HBV. For up to 9% of newborns acquired MTCT of HBV after standard immunoprophylaxis, the main reason is intrauterine transmission of HBV associated with high levels of viremia in mothers (serum HBV DNA ≥ 6 log10 copies/ml, 5.3 log10 IU/ml). Administration of antiviral agents such as tenofovir or telbivudine during pregnancy beginning at 28–32 weeks of gestation is reasonable in high viremic pregnancies. Based on standard passive-active immunoprophylaxis regimen, breastfeeding is recommended in HBsAg-positive mothers.