Perinatal Transmission
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 persons for HBsAg during each pregnancy
- HBV DNA testing for HBsAg-positive pregnant persons at 26-28 weeks 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
Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices
MMWR 2018; 67 (RR 1);1–31
One page Summary Table [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.
This is a clinical algorithm for screening and referral of pregnant women who are HBsAg-positive.
Tool [PDF – 1 page]
This document describes management of infants born to HBV-infected persons, guidance on interpreting post vaccination serologic testing (PVST) results, and frequently asked questions.
Ordering Prenatal Hepatitis B Surface Antigen (HBsAg) Tests from Major Commercial Laboratories
All pregnant women should be tested for HBsAg during an early prenatal visit in each pregnancy, and all HBsAg-positive pregnant women should be tested for HBV DNA to guide the use of maternal antiviral therapy during pregnancy.
ARUP Laboratories
Test Option
Test Option
Test Name
Test Name
Test Code/ID
Test Code/ID
CPT Code
CPT Code
Panel
Panel
0095044
0095044
87340*
87340*
Standalone
Standalone
2007573
2007573
87340
87340
Labcorp
Test Option
Test Option
Test Name
Test Name
Test Code/ID
Test Code/ID
CPT Code
CPT Code
Panel
Panel
202945
202945
87340*
87340*
Standalone
Standalone
144510
144510
87340
87340
Standalone (reflex to DNA)
Standalone (reflex to DNA)
144523
144523
87340*
87340*
Mayo Medical Laboratories
Test Option
Test Option
Test Name
Test Name
Test Code/ID
Test Code/ID
CPT Code
CPT Code
Panel
Panel
PHSP
PHSP
87340*
87340*
Standalone
Standalone
HBAGP
HBAGP
87340
87340
Quest Diagnostics
Test Option
Test Option
Test Name
Test Name
Test Code/ID
Test Code/ID
CPT Code
CPT Code
Panel
Panel
20210
20210
80055
80055
Standalone
Standalone
N/A
N/A
N/A
N/A
N/A
N/A
N/A=not available
*This CPT code corresponds only to the HBsAg screening component; additional CPT codes might be associated with other component tests.
Notes: CDC recommends healthcare providers use prenatal HBsAg tests (vs. non-specific tests) for pregnant women, which allows for reporting of positive results along with pregnancy status to public health jurisdictions. Refer all HBsAg positive pregnant women to Perinatal Hepatitis B Prevention Program coordinators for case management of mother and infant: https://www.cdc.gov/vaccines/vpd/hepb/hcp/perinatal-contacts.html.
Laboratories reserve the right to add, modify, or stop performing tests at any time – providers should review any test notifications from laboratories for changes.
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 – 1 page] and unavailable [PDF – 555 KB]
- Guidelines for Standing Orders in Labor & Delivery & Nursery Units to Prevent Hepatitis B Virus (HBV) Transmission to Newborns [PDF – 2 pages]
- Sources for HBIG
Additional Resources
- Perinatal Hepatitis B Prevention Coordinator List – Contact information for state, territorial, and local coordinators who work in the health department and provide case management to prevent perinatal transmission of HBV infection
- Childhood Immunization Schedule
- Laboratory Reporting of Pregnancy Status for hepatitis B-positive Women
- PVST Panels for Infants Born to HBV-infected Women and information on an effort to improve PVST among this group by recruiting laboratories to offer hepatitis B PVST panels for infants.
- Menu of State Health care Facility Hepatitis B Vaccination Laws from the CDC Public Health Law Program
- Give birth to the end of Hep B from Immunization Action Coalition
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)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.