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Commentary: Pregnancy and HBV
Patient Perspective: HBV Diagnosis During Pregnancy

Released: August 11, 2023

Alice Chan
Alice Chan,
Activity Information

Activity

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Key Takeaways
  • Overcoming barriers to perinatal HBV screening, vaccination, and treatment and infant immunoprophylaxis are key to preventing perinatal HBV transmission.
  • Continuity of health insurance coverage is key for pregnant people to continue receiving HBV care after delivery so that cost and access are not barriers to ongoing HBV care.

Diagnosis

I was diagnosed with hepatitis B virus (HBV) when I was 31 years old and pregnant with my first child. I was shocked to receive this diagnosis. I was unaware of perinatal HBV transmission until I received my diagnosis. Having learned this, I deduced that I was likely infected by my mother, who also is living with chronic hepatitis B (CHB). I was born and raised in Hong Kong, where it was taboo to talk about infectious diseases and illnesses for fear that it would bring bad luck to the family. Because of this stigma, we never discussed HBV as a family. When I received my HBV diagnosis, I did not share this information with anyone outside of my immediate family for fear of rejection and isolation. 

My Pregnancy Experience

I was screened for HBV early in my pregnancy and had the opportunity to work with my obstetrician to prevent mother-to-child transmission of HBV. I was fortunate to have comprehensive insurance coverage that covered my HBV-related healthcare expenses both during and after my pregnancy.

Some pregnant patients who do not have insurance receive Medicaid insurance during pregnancy but then are not covered after delivery. It is important for a pregnant person living with CHB to have ongoing insurance coverage so that their HBV care continues throughout the pregnancy and postpartum without gaps in coverage. 

My Postpartum Experience

My infant received hepatitis B immunoglobulin (HBIG) and the hepatitis B vaccine within 12 hours of birth; the HBV vaccination series was completed in 6 months. I was so relieved when my child was retested for HBV and tested negative.

It is important to educate pregnant patients on the safety and efficacy of the HBIG. It also is crucial for parents to understand the importance of the HBV vaccine and completing the 3-dose series so that their newborn is protected from acquiring HBV infection. When a healthcare professional educates a person about these interventions for their newborn, it is important to highlight the benefits, allow time for questions to be asked, and present the information in a culturally and linguistically appropriate manner.

HBV and Breastfeeding

I was reassured by my obstetrician that breastfeeding as a person living with CHB was safe. I attempted breastfeeding my infant after delivery because it was safe for me to do so without risk of passing HBV to my infant via breastmilk. Unfortunately, as a new mother, I experienced a lot of difficulties with breastfeeding and was frustrated because I did not know how to do it. I would advocate that all pregnant patients—including those living with CHB—receive breastfeeding education early in the pregnancy with assistance from a lactation consultant.

How to Destigmatize HBV Infection

Raising awareness of HBV screening is key to avoiding untreated cases of CHB and preventing the long-term health consequences of serious liver diseases, such as liver cancer and/or cirrhosis. Because discussing HBV is often taboo, it is important to normalize having discussions about HBV to eliminate the shame of stigma. Healthcare professionals should create a welcoming environment where a patient feels comfortable asking questions and having a candid discussion. Healthcare professionals should talk to their patients accurately about the effectiveness of HBV interventions. I also think that healthcare professionals should be as knowledgeable about CHB as they are about other chronic conditions, such as hypertension and diabetes.

For educating a diverse population of people, it could be beneficial to reach out to them in common places outside traditional healthcare settings. This could include holiday celebration fairs, churches, and adult language schools.

Conclusion

The treatment that my child received at birth—HBIG and HBV vaccine—is an effective intervention capable of reducing the risk of perinatal HBV transmission. Our current priority, therefore, is to increase HBV vaccination uptake at birth. If we can educate more people about HBV and prevent perinatal transmission, we have the opportunity to potentially eliminate HBV infections. I am passionate about advocating for HBV screening, diagnosis, vaccination, and treatment. I hope others who share my passion will work closely to ensure that all pregnant people are screened and then managed appropriately to prevent infection if they test negative and transmission if they test positive.

Your Thoughts?

How do you ensure that pregnant people living with CHB are educated about perinatal transmission? Join the discussion by posting a comment