Clinical Guidance for Perinatal Hepatitis B Testing

Key points

  • CDC recommends all pregnant people be screened for hepatitis B virus (HBV) infection during each pregnancy.
  • Testing, screening, and timely treatment are essential for preventing perinatal transmission of HBV infection.
  • CDC has tools and resources to help clinicians prevent perinatal hepatitis B transmission.

Why it's important

When a pregnant person has HBV infection, it can pose a serious risk to their infant. Infants with perinatal HBV infection have a 90% chance of developing chronic HBV infection. 1

Testing pregnant people for hepatitis B and providing pregnant people and infants with appropriate treatment and vaccination is the best way to prevent perinatal HBV infection.

Preventing perinatal HBV transmission is an integral part of the national strategy to eliminate hepatitis B in the United States.

How to make decisions on whether to screen or test

HBV infection can be identified in pregnant people and infants by a confirmed positive hepatitis B surface antigen (HBsAg) test result.

All pregnant people who are HBsAg-positive should be referred to their jurisdiction's Perinatal Hepatitis B Prevention Program (PHBPP)2 for case management to ensure that their infants receive timely postexposure immunoprophylaxis and follow-up.

Clinicians should provide a copy of the original laboratory report indicating the pregnant person's HBsAg-positive test result to the:

  • Hospital or birthing facility where the delivery is planned.
  • Health care provider (HCP) who will care for the newborn.

To learn more about post-vaccination serologic testing (PVST) for infants, see Perinatal Postvaccination Testing guidelines.

Screening and testing guidelines

Clinicians should screen all pregnant people for HBsAg during each pregnancy, preferably in the first trimester, regardless of:

  • Vaccination status
  • Chronic infection
  • Testing history

Recommended tests

Pregnant people

A confirmed positive HBsAg test result indicates current HBV infection.

Clinicians should test all pregnant people who are HBsAg-positive for HBV DNA. This information will help the clinician make the decision to prescribe maternal antiviral therapy to prevent perinatal HBV transmission.

Infants and children

CDC recommends PVST for infants born to a person with a confirmed positive HBsAg test result. Serologic testing confirms whether the child has developed immunity or has HBV infection.

Clinicians should test all infants born to pregnant people who are HBsAg-positive or have other evidence of HBV infection for HBsAg and antibody to hepatitis B surface antigen (anti-HBs) at 9–12 months of age, or 1–2 months after vaccine series completion if the series is delayed.

For information on how to interpret PVST results, refer to CDC's Management of Infants Born to Women with HBV Infection for Pediatricians.

What to do next

If a pregnant person tests HBsAg-negative, clinicians should assess them to see if they're at a high risk for acquiring HBV infection.

If a pregnant person tests HBsAg-positive, there are important steps to take to help inform care and prevent perinatal transmission to the infant.

Tip sheets

For more information on management of pregnant people and infants born to people with HBV infection, see the following resources:

Reporting cases

CDC recommends reporting all HBsAg-positive test results of pregnant people to the state PHBPP. 2 Coordinators can follow up and ensure infants are evaluated appropriately.

Laboratory reporting

In 2013 and 2014, approximately 88% of commercially insured women and 84% of Medicaid-enrolled women were tested for HBsAg during pregnancy.3 Yet, fewer than half of the expected births to HBsAg-positive people were identified.

CDC encourages all laboratories providing HBsAg testing services to capture pregnancy status to identify pregnant people with HBV infection.

Clinicians and health departments can play a critical role in laboratory reporting of pregnancy status. HBsAg screening tests should be designated as "prenatal" or on a prenatal/obstetric panel when being ordered for a pregnant person. Additionally, health departments should be aware of how laboratories reporting to their jurisdiction are reporting pregnancy information (e.g., including the word "prenatal," providing International Classification of Diseases, 10th Revision [ICD-10] codes, etc.).

Resources

Information from American Society of Reproductive Medicine (ASRM)

For clinicians seeking more information, CDC has several resources available concerning perinatal HBV:

  • Sources for HBIG
    • Resource includes information on hepatitis B immune globulin (HBIG) manufacturers.
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Content Source:
Division of Viral Hepatitis
  1. Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2018;67(No. RR-1):1–31.
  2. Koneru A, Fenlon N, Schillie S, et al. National Perinatal Hepatitis B Prevention Program: 2009–2017. Pediatrics March 2021;147(3) e20201823.
  3. Kolasa MS, Tsai Y, Xu J, Fenlon N, Schillie S. Hepatitis B Surface Antigen Testing Among Pregnant Women, United States 2014. Pediatr Infect Dis J 2017;36:e175–80.