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Untreated Hepatitis B in a pregnant lady and breast feeding

Sheryl Chettiar, Aditi Gupta, Reepa Agrawal, Ira Shah
Department of Pediatric Infectious Diseases, B J Wadia Hospital for Children, Mumbai, India

Address for Correspondence: Sheryl Vincent, Vasant Galaxy, Mars-C-Wing, Flat No: 402, Bangur Nagar, Goregaon (W), Mumbai. Email: sherylchettiar12@gmail.com

Keywords: HBsAg, pregnancy, high HBV viral load, transmission

Clinical Problem:
A 28-year-old married female presented with incidental finding of positive hepatitis B surface antigen (HBsAg) during her routine 4th month antenatal workup. Pregnancy was confirmed using a urine pregnancy kit followed by ultrasonography (USG) of abdomen. On presentation, she had no symptoms and examination findings were normal. Hepatitis B viral (HBV) load(quantitative) at time of presentation was 19,791 IU/ml with log value of 4.30. She was not started on anti-viral therapy and advised to repeat HBV DNA levels at 28 weeks of gestation. Her husband’s HBsAg was negative and was advised to take 3 doses of Hepatitis B vaccine. However, she did not follow up at 28 weeks and presented at gestational age of 38 + 2 weeks with HBV viral load of 65,38,475 IU/ml, log value 6.8 with normal liver function tests (LFTs) and was started on tenofovir disoproxil fumarate (TDF) 300 mg OD. She delivered a male baby with birth weight of 3.255 kgs by vaginal delivery at 39+1 weeks of gestation. He cried immediately after birth and was given hepatitis B immunoglobulin (HBIG) 100 IU and Hepatitis B vaccine immediately. Baby’s HbsAg at birth was reactive and viral load was 65 IU/mL. Hepatitis B immunization was repeated at 1 month+17 days, 2 months+ 22 days and 3 months+26 days. Mother’s viral load was negative at 6 months of treatment and TDF was stopped. Eight months later, she had HBV viral load of 64,925 IU/ml,log of 4.8. USG and LFT was normal. Baby was tested for HBsAg at 9 and 12 months of age which was negative and Anti HBs levels of 396.18 mIU/mL.

Should the mother be restarted on antiviral therapy? Should she breast feed her baby?

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