Perinatal Transmission

Prgnant woman holding a glass and looking out a window.

Hepatitis B virus (HBV) infection in a pregnant woman poses a serious risk to her infant at birth. Without postexposure immunoprophylaxis, approximately 40% of infants born to HBV-infected mothers in the United States will develop chronic HBV infection, approximately one-fourth of whom will eventually die from chronic liver disease.

Perinatal HBV transmission can be prevented by identifying HBV-infected (i.e., hepatitis B surface antigen [HBsAg]-positive) pregnant women and providing hepatitis B immune globulin and hepatitis B vaccine to their infants within 12 hours of birth.

Preventing perinatal HBV transmission is an integral part of the national strategy to eliminate hepatitis B in the United States. National guidelines call for the following:

  • Universal screening of pregnant women for HBsAg during each pregnancy
  • Screening all HBsAg-positive pregnant women for HBV DNA to guide the use of maternal antiviral therapy during pregnancy. AASLD suggests maternal antiviral therapy when HBV DNA is >200,000 IU/mL
  • Case management of HBsAg-positive mothers and their infants
  • Provision of immunoprophylaxis for infants born to infected mothers, including hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth
  • Routine vaccination of all infants with the hepatitis B vaccine series, with the first dose administered within 24 hours of  birth

Guidelines and Recommendations

Scientific Tools and Resources

Interpretation of Hepatitis B Serologic Test Results

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One page Summary Table pdf icon[PDF- 1 page] describes the four most common tests used in hepatitis B serologic testing and provides guidance to interpret different patterns of test results.

Screening and Referral Algorithm for Hepatitis B Virus (HBV) Infection among Pregnant Women

Thumbnail image of the Clinical Algorithm document

This is a clinical algorithm for screening and referral of pregnant women who are HBsAg-positive.
Tool pdf icon[PDF – 1 page]


Policies and Procedures for Prenatal Care and Delivery Hospitals

Delivery Hospitals

Algorithms illustrating delivery hospital procedures to prevent perinatal HBV transmission when maternal HBsAg test results are available pdf icon[PDF – 1 page] and unavailable pdf icon[PDF – 555 KB]

Guidelines for Standing Orders in Labor & Delivery & Nursery Units to Prevent Hepatitis B Virus (HBV) Transmission to Newborns pdf icon[PDF – 2 pages]external icon

Sources for HBIG

Additional Resources

Patient Education Tools

Fact Sheets


Educational Slide Presentations

Hepatitis B and a Healthy Baby
This slide presentation is audio-visual educational tool that describes the importance of getting babies vaccinated against hepatitis B if a mother has hepatitis B infection. The 13 page slide set uses simple language and has audio in: Mandarin Chinese, Hmong, Korean, and Vietnamese, as well as English. Tagalog, in the form of Taglish, is available in a written format only.

Hepatitis B and Your Healthy Baby
This slide presentation is a 24 page illustrated educational tool for pregnant women who have hepatitis B. The slide presentation explains the importance of getting babies vaccinated against hepatitis B to prevent transmission of the disease. The text is in easy to understand English, and is also available in Spanish.