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Physicians want all pregnant women to get screened for hepatitis B during their first prenatal visit. Getty Images
  • Only 84 to 88 percent of women report getting hepatitis B screening during pregnancy.
  • If a pregnant woman is diagnosed with hepatitis B, physicians can take steps to reduce the risk of transmission to the fetus.
  • Infants who contract hepatitis B during delivery are significantly more likely to develop chronic liver disease later in life.

Today, the U.S. Preventive Services Task Force (USPSTF) affirmed their recommendation that all pregnant women should be screened for the hepatitis B virus (HBV) at their first prenatal visit.

This supports a previous recommendation from the volunteer panel of national health and medicine experts, said Dr. Lisa Valle, OBGYN at Providence Saint John’s Health Center in Santa Monica, California. It also builds on the recommendations of other national organizations.

“The American College of Obstetrics and Gynecology has previously endorsed screening for hepatitis B in all pregnant women in the first trimester too,” Valle said.

However, despite the affirmation for advice issued over a decade ago, only 84 to 88 percent of pregnant women report being screened during their pregnancies.

Just 26 states require all pregnant women be screened for hepatitis B (HBV,) and just 19 of those require it be done at the first prenatal visit or shortly after confirming pregnancy.

Screening expectant mothers is the easiest way to identify an HBV infection early.

This can help healthcare providers and parents prevent a child from acquiring the infection from their mother before or during birth

They can also provide care for the mother and prevent symptoms or complications of the infection, including pain and jaundice, during the pregnancy.

“Vertical transmission — transmission from mother to child — remains a significant cause of new hepatitis B infections, so prenatal screening is a way to try to intervene early in patients with a high viral load and potentially reduce the risk of transmission during pregnancy,” said Dr. Elizabeth Dierking, FACOG, residency program director in the Department of Obstetrics and Gynecology at St Luke’s University Health Network in Bethlehem, Pennsylvania.

“It also allows physicians and nurses to take additional precautions during the labor, delivery, and initial newborn period that can further reduce this risk of transmission.”

Hepatitis B is a viral infection of the liver. It’s spread through contact with infected blood or bodily fluids. This includes vaginal blood and secretions during childbirth.

Research suggests about 850,000 people in the United States have an HBV infection, but this number may actually be higher. Certain high-risk groups may not be properly accounted for in the investigators’ modeling.

HBV is primarily transmitted through sexual intercourse or intravenous drug use. But it can also be shared between mother and infant during pregnancy or delivery.

Without prophylaxis treatment, an infant born to a woman with HBV has a 40 percent chance of contracting a chronic form of the disease, according to the Centers for Disease Control and Prevention (CDC)

Avoiding transmitting the infection from mother to infant is a strategic concern for healthcare providers, as a hepatitis B infection can lead to lasting health consequences, including “chronic infection, liver cirrhosis, and cancer,” Valle said.

According to the (CDC), a quarter of infants who develop a chronic form of HBV will eventually die from chronic liver disease.

Dr. Heather Figueroa, OBGYN at Loma Linda University Children’s Hospital, added that women who at higher risk of an HBV infection include “healthcare workers, [people with a] history of HIV drug use, certain sexual exposures, immune-compromised individuals, and individuals who were born or live in higher prevalence areas,” but all pregnant women are also considered high risk.

After the initial screening at the first prenatal visit, Figueroa said some doctors will repeat screenings at 26 to 28 weeks and again at 36 weeks, immediately prior to delivery. Other screenings may be given at this time too.

“All women in our practice have hepatitis B and hepatitis C screening at the first visit for prenatal care,” says Dr. David Garry, DO, director of maternal fetal medicine at Stony Brook Medicine.

“NY State has required hepatitis B screening in pregnancy for more than 20 years.”

If an infection is found, treatment can help prevent complications and transmission.

“Several treatment options can help reduce vertical transmission rates. These include antiviral medications for those with high viral load and/or a hep B immunoglobulin treatment for the neonate,” said Dr. Ruofan Yao, MD, OBGYN at Loma Linda University Children’s Hospital.

A three-part hepatitis B vaccine is often given to newborns too, no matter the mother’s HBV status. The first dose should be delivered within hours of delivery, Figueroa said.

But the USPSTF report says only 71 percent of infants born in the United States get their first HBV vaccine within three days of birth. By age 3, approximately 90 percent of children born in the United States have received all three vaccines.

With the introduction of the hepatitis B vaccine and increased screening during pregnancy, acute hepatitis B infections have drastically lowered from 9.6 per 100,000 people in 1982 to 0.9 per 100,000 in 2014, according to the CDC.

That tells researchers a combination of screening and vaccines are likely having the intended results they’re seeking — keeping both mother and infant safe and healthy throughout the pregnancy and beyond.

The renewed focus on hepatitis B screening in all pregnant women draws attention to the importance of identifying an infection early. Treatment is possible, and this can help prevent complications in the mother and transmission to the infant.

If you’re pregnant or suspect you may be pregnant, talk with your doctor or healthcare provider at your next appointment. Ask about an HBV screening, as well as any other screenings that might be vital for your health and the health of a developing fetus.

“This is a disease with consequence that can be prevented by immunization,” Figueroa said.