. Author manuscript; available in PMC: 2023 Mar 1.

Published in final edited form as: Am J Obstet Gynecol. 2021 Sep 10;226(3):335–346. doi: 10.1016/j.ajog.2021.09.002

Table 1.

Summary of Transmission Mechanism and Recommendations for Diagnosis and Prevention of Viral Hepatitis A-E in Pregnancy

Type of Hepatitis	Transmission	Diagnosis	Maternal Prevention	Maternal Treatment	Mode of Delivery	Neonatal post-exposure prophylaxis	Breastfeeding
Hepatitis A⁹⁶ (RNA virus)	Fecal-oral transmission due to contaminated food or direct contact with an infected person.	Testing only recommended if symptomatic. Maternal serologic testing for HAV IgM antibodies. Infection is usually brief but can persist for up to 6 months. Those with prior infection or vaccination will have HAV IgG	HAV vaccination in pregnancy is available and recommended for those at high risk of HAV acquisition, pre-existing liver disease or severe outcomes of infection	Supportive Care	Per usual obstetric indications. Elective Cesarean delivery for prevention of vertical HAV transmission is NOT RECOMMENDED	HAV IgG 0.1 mL/kg Recommend appropriate hygiene practices by those caring for the neonate	Yes, provided appropriate hygienic precautions taken
Hepatitis B (DNA virus)^96–98	Parenteral Sexual or environmental with direct contact with infected body fluids (blood, cervicovaginal fluid, semen.) Vertical	Universal screening recommended. Maternal serologic testing for HBsAg. If HbsAg positive, perform additional testing including HBV DNA viral load	HBV vaccination recommended for pregnant women who are HBsAg-and at high risk of HBV acquisition.^* Serologic testing for immunity (HBsAb) prior to vaccination is not required but may be cost effective.	Tenofovir Disoproxil Fumarate (TDF) recommended for pregnant women with elevated HBV viral load starting at 28 weeks. Details in table 2.	Per usual obstetric indications. Elective Cesarean delivery for prevention of vertical HBV transmission is NOT RECOMMENDED	HBIG and HBV vaccine within 12 hours of birth for infants born to women with HBSAg+ or unknown HBV status. Universal HBV vaccination within 24 hours of birth for medically stable infants >2kg born to women with HBSAg-status. Birth dose vaccine is followed by completion of the 3-dose infant vaccine series.	Yes, provided the infant receives HBIG and HBV vaccination at birth
Hepatitis C⁹⁶ (RNA virus)	Parenteral Sexual due to direct contact with infected body fluids (mostly blood). Veryuncommon with vaginal sex in serodiscordant heterosexual couples. Vertical	ACOG, CDC, USPSTF recommend universal screening pregnancy. SMFM recommends risk based screening and are reviewing their recommendations. Maternal serologic testing for HCV Ab by 2^nd or 3^rd generation enzyme immunoassay (ELISA) If HCV Ab positive, perform HCV RNA PCR testing to assess for active infection. Genotype testing can also be considered.	No maternal vaccination available Risk reduction or avoidance of drug use and/or sex partners with HCV.	Supportive Care Antiviral therapy during pregnancy is under investigation. At this time, use outside of a clinical trial is not recommended	Per usual obstetric indications. Elective Cesarean delivery for prevention of vertical HCV transmission is NOT RECOMMENDED	None	Yes, provided there are no cracked maternal nipples
Hepatitis D(DNA virus)⁹⁹ Incomplete viral particle that only causes disease in presence of HBV	Parenteral Sexual or environmental with direct contact with infected body fluids (blood, cervicovaginal fluid, semen.) Vertical	Screening is not recommended. Maternal antigen or antibody testing for HDAg in serum or hepatic tissue can be performed. Confirmatory testing with HDV DNA PCR.	Vaccine is not available	Supportive care Treatment protocol for HBV co-infection as above	Per usual obstetric indications. Elective Cesarean delivery for prevention of vertical HDV transmission is NOT RECOMMENDED	Neonatal treatment protocol as above for HBV. No treatment specific to HDV.	Yes, provided the infant receives HBIG and HBV vaccination at birth
Hepatitis E(RNA virus)^99,100	Fecal-oral Ingestion of raw/undercooked shellfish or meat Parenteral transmission (infected blood) Vertical/Perinatal	Maternal serologic testing for HEV IgM antibodies. Confirmatory testing and viral load can be determined with HEV RNA PCR	Vaccine is not available	Supportive care	Per usual obstetric indications. Elective Cesarean delivery for prevention of vertical HEV transmission is NOT RECOMMENDED	None	Yes, provided appropriate hygienic precautions taken

HAV: Hepatitis A virus; HAIG: Hepatitis A Immune globulin; HBV: Hepatitis B virus; HBsAg: Hepatitis B surface antigen; Anti-HBc: Total Hepatitis B core antibody; IgM Anti-HBc: IgM antibody to the Hepatitis B core antigen; Anti-HBs: Hepatitis B surface antibody; HBIG: Hepatitis B Immune globulin; HCV: Hepatitis C virus; HCV Ab: Hepatitis C antibody; HDV: Hepatitis D virus; HEV: Hepatitis E virus

Risk of HBV acquisition is defined by: HbsAg+ sexual partner, receiving hemodialysis, HIV positive, >1 sexual partner in the past 6 months, recent sexually transmitted infection, recent injection drug use.