| Summary: | Chronic hepatitis B virus (HBV) infection due to mother-to-child transmission during perinatal period remains as an important global health problem. Being infected with HBV at early ages is associated with increased risk of chronic disease. Therefore, hepatitis B surface antigen (HBsAg)-positive mothers must be immunized with HBV vaccine and hepatitis B immunoglobulin (HBIG). Despite standard passive-active immunoprophylaxis with HBIG and HBV vaccine in neonates, some of these newborns still acquire HBV infection. The aim of this paper was to review the literature on the risk factors associated with HBV infection in infants born to HBsAg-positive women, effects of HBsAg positivity on mother and infants, practices, and follow-up algorithms to be done during and after pregnancy and childbirth. We analyzed review articles, original articles and case reports related to HBsAg positivity during pregnancy published in the last five year. In many countries, investigation of HBsAg during pregnancy is not at the desired levels. Babies of mothers whose HBV serology is not checked during pregnancy, may develop chronic disease because of incomplete immunization.Hepatitis B e-antigen positivity and HBV DNA levels greater than 106 IU/ml in pregnancy as well as presence of chronic HBV infection in older sibling are important risk factors for transmission of HBV to infant in pregnancy. Despite standard passive-active immunoprophylaxis with HBIG and hepatitis B vaccine in neonates, some of these newborns still acquire HBV infection. Therefore, in pregnant women with a serum HBV DNA level of >106 IU/ml, lamivudine, telbivudine or tenofovir could be started in the third trimester to further reduce the transmission rate. As a result, the risk of premature birth, premature membrane rupture and hemorrhage is higher in HBsAg-positive pregnant women than in HBsAg-negative pregnant women. There are contradictory publications and reviews on the effect of delivery mode on the transmission of HBV infection. However, cesarean birth is more recommended to reduce the risk of mother-to-child transmission. In conclusion, all pregnant women must be tested for HBV infection during pregnancy and babies born to HBsAg-positive mother should be immunized with HBV vaccine and HBIG. For pregnant women with a serum level of HBV DNA >106-7 IU/ml antiviral therapy may be started to further reduce the transmission rate.
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