Written by: Pharm. Nweke Maureen Chinyere

LinkedIn

Key Takeaways:

• Hepatitis B is a Viral disease that causes inflammation of the liver.
• It can be transmitted from mother to child through the amniotic fluid.
• Hepatitis B poses several dangers to both the mother and the child.
• Every pregnant woman must go for screening to detect it early and get treatment.

Introduction

Pregnancy is actually a beautiful journey; a time filled with unusual cravings and kicks. In the midst of ultrasound excitement, belly rubs, and baby showers, one silent danger that expectant mothers don’t seem to notice is Hepatitis B, which doesn’t get the attention that it needs.

In Nigeria, this virus is common; it can be transmitted from the mother to the child during delivery, and the effects can last a lifetime. Many pregnant women in Nigeria are unaware of its presence, how dangerous it can be, and how it can be prevented and managed. So, if you’re expecting a baby or hoping to conceive soon, this article is not just another health write-up. It is a love letter wrapped in science and aimed at protecting you and your child’s future. Read on to understand the impacts of hepatitis B on pregnancy and how to avoid its tragedy.

What is Hepatitis B?

Hepatitis B is a viral infection that affects the liver, causing inflammation. It is caused by the hepatitis B virus (HBV). Both acute and chronic diseases may arise from the infection. Acute hepatitis B is a short-term illness without any noticeable symptoms that clears up on its own without any treatment. While chronic hepatitis B is a long-term condition where the infected person may show no signs of symptoms or may develop serious liver problems like liver scarring (cirrhosis) or even liver cancer.[1]

According to estimates from the World Health Organisation (WHO), 254 million individuals worldwide had a chronic hepatitis B infection as of 2022.[2]

Can the Hepatitis B virus be transmitted?

HBV can be transmitted from an infected person to an uninfected person. HBV can spread through various routes, including:

Horizontal transmission

 This is the spread of the virus from person to person through:

• Body fluids like blood, sexual fluids 
• Unsafe sex
• Fecal-oral transmission
• Sharing sharp objects or needles during drug use.[1]

Vertical transmission 

This involves mother-to-child transmission through the amniotic fluid, a water-like fluid that surrounds and protects the baby in the womb.[1] 

Symptoms of Hepatitis B infection

If you get infected with HBV, it can take 30 to 180 days for your symptoms to appear [1], [2]. Some clinical manifestations of hepatitis B are:

• Tiredness 
• Stomach pain
• Loss of appetite
• Nausea
• Serum sickness, which is characterised by joint pain, fever, rash, headache, and facial swelling
• Jaundice [1], [2] 

Understanding hepatitis B in the Nigeria context

In 2023, the WHO reported a high rate of hepatitis B prevalence in Nigeria, with more than 20 million people in the country living with it, exposing the individuals to serious health complications. Many of the cases go undiagnosed due to little knowledge about the viral infection.[3]

How does hepatitis B affect your pregnancy?

The most common transmission route of HBV is mother-to-child transmission. HBV does not pass through the placenta during pregnancy. It can infect the baby if there are any breaks in the protective barrier between you and your baby, and also during delivery.  If you have a high level of the virus in your blood, or are positive for hepatitis B e-antigen (HBeAg), there is 90% chance that your child will be chronically infected without proper preventive strategies. This is why  50% of global  HBV cases come from vertical transmission.[4] 

Risk of hepatitis B to the mother

For pregnant women with liver damage from hepatitis B, the most common cause of death is severe internal bleeding called variceal haemorrhage. Chronic infection during pregnancy can lead to gestational hypertension, gestational diabetes, [5] and detachment of the placenta from the uterus, causing severe bleeding.[4]

Risk of hepatitis B to the baby

If your baby is infected with hepatitis B, it is at risk of:

• Premature birth
• 90% chance of chronic HBV infection
• Detachment of the placenta from the uterine wall leading to hypoxia [4], [5]

Screening and diagnosis of hepatitis B during  pregnancy

If you are pregnant, you should be tested for the hepatitis B virus during your first antenatal visit. The testing is done to identify if you need treatment or intervention to prevent the risk of mother-to-child transmission. Blood tests are done to check for HBV.[1] They include:

• HBsAg (Hepatitis B surface antigen): This test determines whether you are infected. If the test is positive, the virus is present. HBsAg can be found in your blood 1 to 12 weeks after infection
• Anti-HBs (antibody against HBsAg): HBsAg disappears within 6 months if the infection resolves, followed by the appearance of anti-HBs. The detection of anti-HBs in your blood indicates immunity through recovery or vaccination  
• Anti-HBe (antibody against HBe): The detection of this antibody in your blood suggests that the infection has transitioned from an active to a less active disease state.[1]

Treatment and management of hepatitis B during pregnancy

About 95% of acute hepatitis B resolves on its own without long-term complications.[1] The treatment and management strategies for chronic HBV during pregnancy include:

• Administration of antiviral drugs if the HBV DNA is above 200,000 IU/ml. This will help to prevent vertical transmission.[6]
• Breastfeeding is safe even though HBV can be found in breast milk. Studies show no increased risk of HBV transmission through breastfeeding than those who are fed with baby formula.[7]
• Vaccination of the baby at 12 to 24 hours after birth, 1 month, and 6 months.[4]

What every pregnant woman should do

• Request for HBV screening during your first antenatal visit
• If you’re positive, request a referral for specialist care and a follow-up test
• After delivery, make sure that your baby receives the birth dose of the hepatitis B vaccine within 24 hours
• Make sure you complete the full vaccine schedule for your baby
• If you feel overwhelmed, speak to a counselor, health worker, or join a support group
• Educate your partner and family on hepatitis B infection

Summary 

Hepatitis B infection is preventable and manageable. It is not a death sentence. Timely screening, care, and ensuring your baby is protected help to break the cycle of silent suffering and regrets. You can consult a doctor online to ask questions about how to get screened and also speak to him or her if you feel overburdened. Your doctor may prescribe some antiviral medication for you to take if you test positive with a high viral load. You can buy the prescribed medication online quickly and safely to prevent missing your recommended dose.

Frequently Asked Questions

Question: Do I need a hepatitis B test while pregnant?
Answer: Yes. Doctors recommend that all people get a Hepatitis B and pregnancy screening during their first prenatal visit. This is a simple blood test called the HBsAg test. Knowing your status early allows your medical team to create a personalized plan that ensures both you and your baby stay healthy throughout your pregnancy and delivery.

Question: Can Hepatitis B affect my baby during pregnancy?
Answer: While the virus rarely crosses the placenta to affect the baby during development, the main concern is Hepatitis B transmission from mother to child during delivery. Without proper medical intervention at birth, babies born to infected mothers have a 90% chance of developing a lifelong chronic infection. Fortunately, modern medical protocols are over 95% effective at preventing this.

Question: How is Hepatitis B transmission from mother to child prevented?
Answer: Prevention relies on a “safety net” provided immediately after birth. To stop Hepatitis B transmission from mother to child, your baby will receive two specific injections in the delivery room:
1. The first dose of the Hepatitis B vaccine for newborn babies.
2. A shot of Hepatitis B Immune Globulin (HBIG), which provides immediate antibodies.

Question: Can I breastfeed if I have Hepatitis B?
Answer: Yes, you can safely breastfeed your baby. The virus is not spread through breast milk. As long as your baby receives the Hepatitis B vaccine for newborn infants and the HBIG shot at birth, the risk of transmission through breastfeeding is essentially zero. If you have cracked or bleeding nipples, speak with your doctor for temporary guidance.

Question: When should my baby get the Hepatitis B vaccine for newborns?
Answer: Your baby should receive the first dose of the Hepatitis B vaccine for newborn babies within 12 to 24 hours of birth. This “birth dose” is critical because it starts building the baby’s immune system right away. Your child will then need two or three additional “booster” shots over the following six months to ensure lifelong protection.

Reference

1. Tripathi N, Mousa OY. Hepatitis B. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: http://www.ncbi.nlm.nih.gov/books/NBK555945/.
2. Hepatitis B [Internet]. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b.
3. In Nigeria, boosting viral hepatitis awareness and treatment | WHO | Regional Office for Africa [Internet]. 2023. Available from: https://www.afro.who.int/countries/nigeria/news/nigeria-boosting-viral-hepatitis-awareness-and-treatment-0.
4. Asafo-Agyei, K. O., & Samant, H. (2025). Pregnancy and viral hepatitis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK556026/
5. Afraie, M., Moradi, G., Zamani, K., Azami, M., & Moradi, Y. (2023). The effect of hepatitis B virus on the risk of pregnancy outcomes: A systematic review and meta-analysis of cohort studies. Virology Journal, 20(1), 213. https://doi.org/10.1186/s12985-023-02182-0
6. Dionne-Odom, J., Cozzi, G. D., Franco, R. A., Njei, B., & Tita, A. T. N. (2022). Treatment and prevention of viral hepatitis in pregnancy. American Journal of Obstetrics and Gynecology, 226(3), 335–346. https://doi.org/10.1016/j.ajog.2021.09.002
7. Ayoub, W. S., & Cohen, E. (2016). Hepatitis b management in the pregnant patient: An update. Journal of Clinical and Translational Hepatology, 4(3), 241–247. https://doi.org/10.14218/JCTH.2016.00014