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Are pregnant women routinely tested for hepatitis B?
Yes. When you come in for your first prenatal visit, you'll have a series of routine blood tests, including one to check for the hepatitis B virus (HBV, or Hep B). This virus can cause severe illness, liver damage, and even death.
More than one million people in the United States carry the virus, but many have no symptoms and don't know that they're carriers. If you are, you could pass the virus to your baby at birth.
Finding out if you're a carrier enables your healthcare provider to take special precautions at the time of delivery and to treat your baby immediately after birth, which would most likely prevent her from getting infected.
If you test negative for HBV and haven't received the hepatitis B vaccine, your provider may recommend that you get immunized, especially if you're at high risk for contracting the disease. (See below for a list of high-risk groups.) The vaccine is safe for pregnant women and developing babies.
How could I have become an HBV carrier?
Hepatitis B is a highly infectious virus that's spread through blood, semen, and other bodily fluids. If you're a carrier, you may have contracted the virus:
- Through sexual contact with another carrier
- At birth (if your mother was a carrier)
- By sharing needles or getting stuck by a needle accidentally
- By using a toothbrush or razor that has a small trace of a carrier's blood on it (even if you can't see it)
- By getting a body piercing or tattoo at a place with poor sanitation practices
What are the symptoms of HBV?
If you contract hepatitis B, you may feel very tired. You may also have abdominal pain, nausea and vomiting, appetite loss, joint pain, or jaundice (yellow-tinged skin or eyes). But many people have no symptoms and never even know they've been infected.
About 6 to 10 percent of people who are age 5 or older when they contract HBV end up being carriers of hepatitis B, meaning their body never gets rid of the virus. About 15 to 25 percent of those with a chronic HBV infection eventually end up with a life-threatening liver disease or liver cancer. An estimated 2,000 to 4,000 people in the United States die every year from an HBV-related illness.
What happens if I test positive for HBV?
Your provider may first want to give you a more specific blood test to get more information about your condition and how well your liver is working. And since the virus affects your liver, you need to give up drinking alcohol entirely – not just while you're pregnant. Also, don't take acetaminophen (or other over-the-counter medications that contain acetaminophen) because this drug can harm your liver.
You'll most likely go to a specialist for further care, including periodic evaluations of your liver function. Everyone else in your household, as well as any sexual partners, should also be tested.
If they aren't carriers, they should be vaccinated. Use condoms during sex to avoid infecting your partner.
Your provider may recommend antiviral therapy with a drug called tenofovir, which can lower the risk of transmitting HBV to your baby.
Vaginal deliveries and c-sections are equally safe for HBV carriers. And according to the Society for Maternal-Fetal Medicine, c-sections aren't necessary to reduce the risk of transmitting HBV to your baby.
Within 12 hours after you give birth, your medical team will give your baby a shot of hepatitis B antibodies and her first shot of the hepatitis B vaccine. That should be adequate short-term protection from hepatitis B. Together, the antibodies and the vaccine are about 85 to 95 percent effective at preventing hepatitis B infection in babies whose mothers have HBV.
She should get the second and third doses of the HBV vaccine at her regular well-baby checkups. All three HBV shots are necessary for lifelong protection, and the Centers for Disease Control and Prevention recommends that all babies receive them.
An HBV positive mom can breastfeed as long her baby received hepatitis B immunoglobulin (HBIG) and the HBV vaccination at birth.
It's important for you to get ongoing follow-up care after you deliver because chronic carriers are at risk for serious liver disease.
What would happen if my baby did get hepatitis B?
If you're an HBV carrier, your chances of transmitting the virus to your baby at birth are 10 to 20 percent, unless she receives treatment within 12 hours of birth. The risk varies depending on when you were infected and how much HBV is in your blood. There's an 80 to 90 percent risk if you become infected with hepatitis B during your third trimester.
Infants who become infected might not have any symptoms right away but are much more likely to become chronic carriers than other children or adults. Chronic carriers may spread the virus throughout their lives, and the disease is transmitted so easily children can't even share things like toothbrushes.
Children with HBV are at higher risk of developing and dying from liver disease or cancer. Although there's no cure for hepatitis B, certain drugs may lower the risk of severe liver disease.
Who is most at risk for contracting hepatitis B?
Because hepatitis B is transmitted through exposure to blood and body fluids, those most likely to be infected include healthcare workers, household contacts and sexual partners of carriers, people with multiple sexual partners, and intravenous drug users. Immigrants from Southeast Asia, Africa, the Middle East, the Pacific Islands, and the Amazon basin also have higher rates of infection.
If you're at risk for hepatitis B, be sure to get vaccinated – it can protect you if you don't already have the virus.
Use the Society for Maternal-Fetal Medicine’s Find an MFM Specialist tool to locate a high-risk pregnancy doctor near you.
Visit the Society for Maternal-Fetal Medicine's website for more information.