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Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow-up: position paper produced by Australian, UK and New Zealand key opinion leaders
  1. Kumar Visvanathan1,2,
  2. Geoff Dusheiko3,
  3. Michelle Giles4,
  4. May-Ling Wong5,
  5. Nghi Phung6,7,
  6. Susan Walker8,9,
  7. Suong Le10,
  8. Seng Gee Lim11,
  9. Ed Gane12,
  10. Meng Ngu13,
  11. Winita Hardikar14,15,16,
  12. Ben Cowie17,18,
  13. Scott Bowden18,
  14. Simone Strasser19,
  15. Miriam Levy20,21,
  16. Joe Sasaduesz17
  1. 1St. Vincent's Hospital, Fitzroy, Australia
  2. 2Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
  3. 3Institute of Liver and Digestive Health, Royal Free Hospital London, London, UK
  4. 4Department of Infectious Diseases and Department of Obstetrics and Gynaecology Monash Health, The Alfred Hospital, The Royal Women's Hospital, Melbourne, Victoria, Australia
  5. 5Department of Gastroenterology, Box Hill Hospital, Melbourne, Victoria, Australia
  6. 6Liver Addiction Research Unit and Storr Liver Unit, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, New South Wales, Australia
  7. 7Drug Health Western Sydney Local Health District, Westmead, New South Wales, Australia
  8. 8Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Victoria, Australia
  9. 9Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
  10. 10Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Victoria, Australia
  11. 11Department of Hepatology, National University Health System, Singapore, Singapore
  12. 12Liver Transplant Unit, Auckland City Hospital Auckland, Auckland, New Zealand
  13. 13Gastroenterology and Hepatology Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
  14. 14Department of Gastroenterology, Royal Children's Hospital, Melbourne, Victoria, Australia
  15. 15Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
  16. 16Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  17. 17Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  18. 18Victorian Infectious Disease Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
  19. 19AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, Australia
  20. 20Liverpool Hospital, Sydney, New South Wales, Australia
  21. 21Department of Medicine, University of NSW, Sydney, New South Wales, Australia
  1. Correspondence to Associate Professor Kumar Visvanathan, Infectious Diseases Physician, St. Vincent's Hospital and The University of Melbourne, 4th Floor, Clinical Sciences Building, St. Vincents Hospital, Fitzroy, VIC 3065, Australia; kv{at}unimelb.edu.au

Abstract

Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These include the lack of a current cohesive strategy for treatment and follow-up of mothers and their babies; the uncertain risk of postpartum HBV flares; the lack of randomised trial data on the safety and efficacy of antiviral treatment in pregnancy; the lack of head-to-head studies comparing different antivirals in pregnancy; and the lack of epidemiologic information regarding infection across different populations globally. This position paper provides a comprehensive review of the management of women with HBV infection prior to conception, throughout each stage of pregnancy and postpartum, as well as recommendations and clinical approaches for the follow-up of children born to infected mothers, based on available evidence in the literature and recommendations from international experts. Prevention of perinatal transmission is an important component of global efforts to reduce the burden of chronic HBV since vertical transmission is responsible for most of the chronic infection worldwide.

  • IMMUNOLOGY
  • HEPATITIS B

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