Resumen
Introducción: la infección por el virus de la hepatitis B constituye un importante problema de salud pública a nivel mundial, pues genera una gran carga de morbilidad y mortalidad relacionada con cirrosis y hepatocarcinoma. En áreas de alta prevalencia la transmisión vertical constituye una fuente importante de infección. Objetivo: revisar la presentación de la infección por virus de la hepatitis B en el embarazo y ofrecer pautas para el manejo de esta entidad. Metodología de búsqueda: se realizó una búsqueda bibliográfica en las bases de datos Pubmed, LILACS, SciELO y el motor de búsqueda Google Scholar, de artículos publicados hasta agosto de 2017, utilizando los términos hepatitis B virus AND infection AND pregnancy. Se restringió la búsqueda a artículos de los últimos quince años, en inglés y español, incluyendo artículos de revisión, estudios clínicos controlados y metaanálisis. Se obtuvieron en total 535 manuscritos para revisión, de los cuales 52 fueron referenciados. Desarrollo del tema: los hijos de madres seropositivas para el antígeno de superficie de la hepatitis B deberían recibir inmunoglobulina y vacunación contra la hepatitis B en las primeras doce horas de nacimiento, lográndose reducir la tasa de transmisión vertical desde más del 90% a menos del 10%. La terapia antiviral, al ser administrada en el tercer trimestre de gestación, puede prevenir la falla inmunoprofiláctica, y debería utilizarse en madres con alto riesgo de trasmisión vertical. Datos recientes apuntan acerca de la seguridad de Tenofovir en el embarazo, siendo actualmente el medicamento de elección. Conclusiones: el tamizaje universal en la gestante para la infección por el virus de la hepatitis B es una medida costoefectiva para reducir la transmisión vertical. Los niveles elevados de antígeno de superficie del virus de la hepatitis B y la carga viral materna, así como la presencia de antígeno e, se asocian a mayor riesgo de transmisión vertical. La combinación de inmunoglobulina y vacunación para hepatitis B, administradas dentro de las doce horas posteriores al nacimiento, se asocian a reducción de la tasa de transmisión vertical. El Tenofovir es la mejor opción terapéutica como terapia antiviral iniciado en las semanas 28-32 de gestación en aquellas gestantes con alto riesgo de transmisión de la infección. MÉD.UIS. 2018;31(2):49-56.
Referencias
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2. Lampertico P, Agarwal K, Berg T, Buti M, Janssen HLA, Papatheodoridis G, et al. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370-398
3. World Health Organizaton. Guidelines for the Prevention, Care and Treatment of Persons with Chronic Hepatitis B Infection. Guidel Prev Care Treat Pers with Chronic Hepat B Infect [Internet]. 2015 [citado el ]. Disponible en: http://apps.who.int/iris/bitstream/handle/10665/154590/9789241549059_eng.pdf;jsessionid=769197BF35F15E266EABE3B375BFAE49?sequence=1
4. Terrault NA, Bzowej NH, Chang K-M, Hwang JP, Jonas MM, Murad MH. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2015;63(1):261–83.
5. Association E. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol. European Association for the Study of the Liver; 2012;57(1):167–85.
6. Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat. 2004;11:97–107.
7. Tran TT. Hepatitis B in Pregnancy. Clin Infect Dis. 2016;62(4):314–17.
8. Kubo A, Shlager L, Marks AR, Lakritz D, Colette Beaumont, Gabellini K, et al. Prevention of Vertical Transmission of Hepatitis B: An Observation Study. Ann Intern Med. 2014;160(12):828–35.
9. Chamroonkul N, Piratvisuth T. Hepatitis B During Pregnancy in Endemic Areas: Screening, Treatment, and Prevention of Motherto-Child Transmission. Pediatr Drugs. 2017;19(3):173–81.
10. Dionne-odom J, Tita A, Silverman NS. Hepatitis B in pregnancy screening, treatment, and prevention of vertical transmission. Am J Obstet Gynecol. 2016;214(1):6–14.
11. Kar P, Mishra S. Management of hepatitis B of during pregnacy. Expert Opin Pharmacother. 2016;17(3):301–10.
12. Ter MJ, Leemans WF, De Man RA, Janssen HLA. Exacerbation of chronic hepatitis B infection after delivery. J Viral Hepat. 2008;15(1):37–41.
13. Patton H, Tran TT. Management of hepatitis B during pregnancy. Nat Rev Gastroenterol Hepatol. 2014;11(7):402–9.
14. Pol S, Corouge M, Fontaine H. Hepatitis B virus infection and pregnancy. Clin Res Hepatol Gastroenterol. 2011;35(10):618–22.
15. Castillo E, Murphy K. Hepatitis B and Pregnancy. J Obs Gynecol.2017;39(3):181–90.
16. Liu C-P, Zeng Y-L, Zhou M, Chen L-L, Hu R, Wang L, et al. Factors associated with mother-to-child transmission of hepatitis B virus despite immunoprophylaxis. Intern Med. 2015;54(7):711–6.
17. Wen WH, Chang MH, Zhao LL, Ni YH, Hsu HY, Wu JF, et al. Motherto-infant transmission of hepatitis B virus infection: Significance of maternal viral load and strategies for intervention. J Hepatol.2013;59(1):24–30.
18. Lu L-L, Chen B-X, Wang J, Wang D, Ji Y, Yi H-G, et al. Maternal transmission risk and antibody levels against hepatitis B virus e antigen in pregnant women. Int J Infect Dis. 2014;28:41–4.
19. Zou H, Chen Y, Duan Z, Zhang H, Pan C. Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg-positive mothers. J Viral Hepat. 2012;19(2):18–25.
20. Ott J, Stevens G, Wiersma S. The risk of perinatal hepatitis B virus transmission: hepatitis B e antigen (HBeAg) prevalence estimates for all world regions. BMC Infect Dis. 2012;12(12):131.
21. Wu Q, Huang H, Sun X, Pan M, He Y, Tan S, et al. Telbivudine Prevents Vertical Transmission of Hepatitis B Virus From Women With High Viral Loads: A Prospective Long-Term Study. Clin Gastroenterol Hepatol. 2015;13(6):1170–6.
22. Han G, Wang Y, Zhang H, Zou H, Zhu B, Zhao W. Tenofovir to Prevent Hepatitis B Transmission in Mothers with High Viral Load. N Engl J Med. 2016;374(24):2324–34.
23. Deng M, Zhou X, Gao S, Yang S-G, Wang B, Chen H-Z, et al. The effects of telbivudine in late pregnancy to prevent intrauterine transmission of the hepatitis B virus: a systematic review and meta-analysis. Virol J. Virology Journal. 2012;9(185):1–13.
24. Shao Z, Al Tib M, Wakim-Fleming J. Update on viral hepatitis in pregnancy. Cleve Clin J Med. 2017;84(3):202–6.
25. Lee C, Gong Y, Brok J, Boxall EH, Gluud C. Hepatitis B immunisation for newborn infants of hepatitis B surface antigenpositive mothers. Cochrane database Syst Rev. 2006;(2):1–107.
26. Beasley RP, Hwang LY, Lee GC, Lan CC, Roan CH, Huang FY, et al. Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immune globulin and hepatitis B vaccine. Lancet. 1983;12(8359):1099–102.
27. Li XM, Shi MF, Yang YB, Shi ZJ, Hou HY, Shen HM, et al. Effect of hepatitis B immunoglobulin on interruption of HBV intrauter ineinfection. World J Gastroenterol. 2004;10(21):3215–7.
28. Yuan J, Lin J, Xu A, Li H, Hu B, Chen J, et al. Antepartum immunoprophylaxis of three doses of hepatitis B immunoglobulin is not effective: A single-centre randomized study. J Viral Hepat. 2006;13(9):597–604.
29. Ac E, Gu E, Ua E, Xia Y, Liu J. Hepatitis B immunoglobulin during pregnancy for prevention of mother-to-child transmission of hepatitis B virus. Cochrane Database Syst Rev. 2017;(2):1–103.
30. Pan CQ, Duan ZP, Bhamidimarri KR, Zou HBIN, Liang XF, Li JIE. An Algorithm for Risk Assessment and Intervention of Mother to Child. Clin Gastroenterol Hepatol. 2012;10(5):452–9.
31. Brown RS, McMahon BJ, Lok ASF, Wong JB, Ahmed AT, Mouchli MA, et al. Antiviral therapy in chronic hepatitis B viral infection during pregnancy: A systematic review and meta-analysis. Hepatology. 2016;63(1):319–33.
32. Wang W, Wang J, Dang S, Zhuang G. Cost-effectiveness of antiviral therapy during late pregnancy to prevent perinatal transmission of hepatitis B virus. PeerJ. 2016;24(4):1–19.
33. Sarkar M, Terrault NA. Ending vertical transmission of hepatitis B: The third trimester intervention. Hepatology. 2014;60(2):448–51.
34. Chang CY, Aziz N, Poongkunran M, Javaid A, Trinh HN, Lau D, et al. Serum Alanine Aminotransferase and Hepatitis B DNA Flares in Pregnant and Postpartum Women with Chronic Hepatitis B. Am J Gastroenterol. 2016;111(10):1–6.
35. Giles M, Visvanathan K, Lewin S, Bowden S, Locarnini S, Spelman T, et al. Clinical and virological predictors of hepatic flares in pregnant women with chronic hepatitis B. Gut. 2014;64(11):1810–5.
36. Wen WH, Huang CW, Chie WC, Yeung CY, Zhao LL, Lin WT, et al. Quantitative maternal hepatitis B surface antigen predicts maternally transmitted hepatitis B virus infection. Hepatology. 2016;64(5):1451–61.
37. Zonneveld M, Nunen A, Niesters HGM, Man R., Schalm SW, Janssen HL. Lamivudine treatment during pregnancy to prevent perinatal transmission of hepatitis B virus infection. J Viral Hepat. 2003;10(4):294–7.
38. Ayres A, Yuen L, Jackson KM, Manoharan S, Glass A, Maley M, et al. Short duration of lamivudine for the prevention of hepatitis B virus transmission in pregnancy: Lack of potency and selection of resistance mutations. J Viral Hepat. 2014;21(11):809–17.
39. Han GR, Cao MK, Zhao W, Jiang HX, Wang CM, Bai SF, et al. A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection. J Hepatol. European Association for the Study of the Liver. 2011;55(6):1215–21.
40. Jaffe A, Brown RS. A Review of Antiviral Use for the Treatment of Chronic Hepatitis B Virus Infection in Pregnant Women. Gastroenterol Hepatol (N Y). 2017;13(3):154–63.
41. Seifer M, Patty A, Serra I, Li B, Standring DN. Telbivudine, a nucleoside analog inhibitor of HBV polymerase, has a different in vitro cross-resistance profile than the nucleotide analog inhibitors adefovir and tenofovir. Antiviral Res. 2009;81(2):147–55.
42. Chen J, Liao Z, Huang F, Su RK, Wang W, Cheng X, et al. Efficacy and safety of tenofovir disoproxil fumarate in preventing vertical transmission of hepatitis B in pregnancies with high viral load. Sci Rep. Springer US; 2017;7(1):4132.
43. Jourdain G, Ngo-Giang-Huong N, Cressey TR, Hua L, Harrison L, Tierney C, et al. Prevention of mother-to-child transmission of hepatitis B virus: a phase III, placebo-controlled, double-blind, randomized clinical trial to assess the efficacy and safety of a short course of tenofovir disoproxil fumarate in women with hepatitis B virus . BMC Infect Dis. BMC Infectious Diseases; 2016;16:393.
44. Hill J, Sheffield J, Kim J E. Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers. Gynecol Obs. 2002;99(6):1049–52. 45. Shi Z. Breastfeeding of Newborns by Mothers Carrying Hepatitis B Virus. Arch Pediatr Adolesc Med. 2011;165(9):837.
46. The American Academy of Pediatrics. Breastfeeding and the Use of Human Milk. Pediatrics. 2012;129(3):827–41.
47. Benaboud S, Pruvost A, Coffie PA, Ekouévi DK, Urien S, Arrivé E, et al. Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan, Côte d’Ivoire, in the ANRS 12109 TEmAA Study, step 2. Antimicrob Agents Chemother. 2011;55(3):1315–7.
48. Brown RS, Verna EC, Pereira MR, Tilson HH, Aguilar C, Leu CS, et al. Hepatitis B virus and human immunodeficiency virus drugs in pregnancy: Findings from the Antiretroviral Pregnancy Registry. J Hepatol. 2012;57(5):953–9.
49. Ayoub WS, Cohen E. Review Article Hepatitis B Management in the Pregnant Patient: An Update. J Clin Transl Hepatol. 2016;4(1):241–7.
50. Hu Y, Chen J, Wen J, Xu C, Zhang S, Xu B, et al. Effect of elective cesarean section on the risk of mother-to-child transmission of hepatitis B virus. BMC Pregnancy Childbirth. BMC Pregnancyand Childbirth; 2013;13(1):119.
51. Yang J, Zeng X, Men Y, Zhao L. Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus – a systematic review. Virol J. 2008;5:100.
52. Visvanathan K, Dusheiko G, Giles M, Wong ML, Phung N, Walker S, et al. Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow-up: position paper produced by Australian, UK and New Zealand key opinion leaders. Gut. 2016;65(2):340–50.
2. Lampertico P, Agarwal K, Berg T, Buti M, Janssen HLA, Papatheodoridis G, et al. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370-398
3. World Health Organizaton. Guidelines for the Prevention, Care and Treatment of Persons with Chronic Hepatitis B Infection. Guidel Prev Care Treat Pers with Chronic Hepat B Infect [Internet]. 2015 [citado el ]. Disponible en: http://apps.who.int/iris/bitstream/handle/10665/154590/9789241549059_eng.pdf;jsessionid=769197BF35F15E266EABE3B375BFAE49?sequence=1
4. Terrault NA, Bzowej NH, Chang K-M, Hwang JP, Jonas MM, Murad MH. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2015;63(1):261–83.
5. Association E. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol. European Association for the Study of the Liver; 2012;57(1):167–85.
6. Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat. 2004;11:97–107.
7. Tran TT. Hepatitis B in Pregnancy. Clin Infect Dis. 2016;62(4):314–17.
8. Kubo A, Shlager L, Marks AR, Lakritz D, Colette Beaumont, Gabellini K, et al. Prevention of Vertical Transmission of Hepatitis B: An Observation Study. Ann Intern Med. 2014;160(12):828–35.
9. Chamroonkul N, Piratvisuth T. Hepatitis B During Pregnancy in Endemic Areas: Screening, Treatment, and Prevention of Motherto-Child Transmission. Pediatr Drugs. 2017;19(3):173–81.
10. Dionne-odom J, Tita A, Silverman NS. Hepatitis B in pregnancy screening, treatment, and prevention of vertical transmission. Am J Obstet Gynecol. 2016;214(1):6–14.
11. Kar P, Mishra S. Management of hepatitis B of during pregnacy. Expert Opin Pharmacother. 2016;17(3):301–10.
12. Ter MJ, Leemans WF, De Man RA, Janssen HLA. Exacerbation of chronic hepatitis B infection after delivery. J Viral Hepat. 2008;15(1):37–41.
13. Patton H, Tran TT. Management of hepatitis B during pregnancy. Nat Rev Gastroenterol Hepatol. 2014;11(7):402–9.
14. Pol S, Corouge M, Fontaine H. Hepatitis B virus infection and pregnancy. Clin Res Hepatol Gastroenterol. 2011;35(10):618–22.
15. Castillo E, Murphy K. Hepatitis B and Pregnancy. J Obs Gynecol.2017;39(3):181–90.
16. Liu C-P, Zeng Y-L, Zhou M, Chen L-L, Hu R, Wang L, et al. Factors associated with mother-to-child transmission of hepatitis B virus despite immunoprophylaxis. Intern Med. 2015;54(7):711–6.
17. Wen WH, Chang MH, Zhao LL, Ni YH, Hsu HY, Wu JF, et al. Motherto-infant transmission of hepatitis B virus infection: Significance of maternal viral load and strategies for intervention. J Hepatol.2013;59(1):24–30.
18. Lu L-L, Chen B-X, Wang J, Wang D, Ji Y, Yi H-G, et al. Maternal transmission risk and antibody levels against hepatitis B virus e antigen in pregnant women. Int J Infect Dis. 2014;28:41–4.
19. Zou H, Chen Y, Duan Z, Zhang H, Pan C. Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg-positive mothers. J Viral Hepat. 2012;19(2):18–25.
20. Ott J, Stevens G, Wiersma S. The risk of perinatal hepatitis B virus transmission: hepatitis B e antigen (HBeAg) prevalence estimates for all world regions. BMC Infect Dis. 2012;12(12):131.
21. Wu Q, Huang H, Sun X, Pan M, He Y, Tan S, et al. Telbivudine Prevents Vertical Transmission of Hepatitis B Virus From Women With High Viral Loads: A Prospective Long-Term Study. Clin Gastroenterol Hepatol. 2015;13(6):1170–6.
22. Han G, Wang Y, Zhang H, Zou H, Zhu B, Zhao W. Tenofovir to Prevent Hepatitis B Transmission in Mothers with High Viral Load. N Engl J Med. 2016;374(24):2324–34.
23. Deng M, Zhou X, Gao S, Yang S-G, Wang B, Chen H-Z, et al. The effects of telbivudine in late pregnancy to prevent intrauterine transmission of the hepatitis B virus: a systematic review and meta-analysis. Virol J. Virology Journal. 2012;9(185):1–13.
24. Shao Z, Al Tib M, Wakim-Fleming J. Update on viral hepatitis in pregnancy. Cleve Clin J Med. 2017;84(3):202–6.
25. Lee C, Gong Y, Brok J, Boxall EH, Gluud C. Hepatitis B immunisation for newborn infants of hepatitis B surface antigenpositive mothers. Cochrane database Syst Rev. 2006;(2):1–107.
26. Beasley RP, Hwang LY, Lee GC, Lan CC, Roan CH, Huang FY, et al. Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immune globulin and hepatitis B vaccine. Lancet. 1983;12(8359):1099–102.
27. Li XM, Shi MF, Yang YB, Shi ZJ, Hou HY, Shen HM, et al. Effect of hepatitis B immunoglobulin on interruption of HBV intrauter ineinfection. World J Gastroenterol. 2004;10(21):3215–7.
28. Yuan J, Lin J, Xu A, Li H, Hu B, Chen J, et al. Antepartum immunoprophylaxis of three doses of hepatitis B immunoglobulin is not effective: A single-centre randomized study. J Viral Hepat. 2006;13(9):597–604.
29. Ac E, Gu E, Ua E, Xia Y, Liu J. Hepatitis B immunoglobulin during pregnancy for prevention of mother-to-child transmission of hepatitis B virus. Cochrane Database Syst Rev. 2017;(2):1–103.
30. Pan CQ, Duan ZP, Bhamidimarri KR, Zou HBIN, Liang XF, Li JIE. An Algorithm for Risk Assessment and Intervention of Mother to Child. Clin Gastroenterol Hepatol. 2012;10(5):452–9.
31. Brown RS, McMahon BJ, Lok ASF, Wong JB, Ahmed AT, Mouchli MA, et al. Antiviral therapy in chronic hepatitis B viral infection during pregnancy: A systematic review and meta-analysis. Hepatology. 2016;63(1):319–33.
32. Wang W, Wang J, Dang S, Zhuang G. Cost-effectiveness of antiviral therapy during late pregnancy to prevent perinatal transmission of hepatitis B virus. PeerJ. 2016;24(4):1–19.
33. Sarkar M, Terrault NA. Ending vertical transmission of hepatitis B: The third trimester intervention. Hepatology. 2014;60(2):448–51.
34. Chang CY, Aziz N, Poongkunran M, Javaid A, Trinh HN, Lau D, et al. Serum Alanine Aminotransferase and Hepatitis B DNA Flares in Pregnant and Postpartum Women with Chronic Hepatitis B. Am J Gastroenterol. 2016;111(10):1–6.
35. Giles M, Visvanathan K, Lewin S, Bowden S, Locarnini S, Spelman T, et al. Clinical and virological predictors of hepatic flares in pregnant women with chronic hepatitis B. Gut. 2014;64(11):1810–5.
36. Wen WH, Huang CW, Chie WC, Yeung CY, Zhao LL, Lin WT, et al. Quantitative maternal hepatitis B surface antigen predicts maternally transmitted hepatitis B virus infection. Hepatology. 2016;64(5):1451–61.
37. Zonneveld M, Nunen A, Niesters HGM, Man R., Schalm SW, Janssen HL. Lamivudine treatment during pregnancy to prevent perinatal transmission of hepatitis B virus infection. J Viral Hepat. 2003;10(4):294–7.
38. Ayres A, Yuen L, Jackson KM, Manoharan S, Glass A, Maley M, et al. Short duration of lamivudine for the prevention of hepatitis B virus transmission in pregnancy: Lack of potency and selection of resistance mutations. J Viral Hepat. 2014;21(11):809–17.
39. Han GR, Cao MK, Zhao W, Jiang HX, Wang CM, Bai SF, et al. A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection. J Hepatol. European Association for the Study of the Liver. 2011;55(6):1215–21.
40. Jaffe A, Brown RS. A Review of Antiviral Use for the Treatment of Chronic Hepatitis B Virus Infection in Pregnant Women. Gastroenterol Hepatol (N Y). 2017;13(3):154–63.
41. Seifer M, Patty A, Serra I, Li B, Standring DN. Telbivudine, a nucleoside analog inhibitor of HBV polymerase, has a different in vitro cross-resistance profile than the nucleotide analog inhibitors adefovir and tenofovir. Antiviral Res. 2009;81(2):147–55.
42. Chen J, Liao Z, Huang F, Su RK, Wang W, Cheng X, et al. Efficacy and safety of tenofovir disoproxil fumarate in preventing vertical transmission of hepatitis B in pregnancies with high viral load. Sci Rep. Springer US; 2017;7(1):4132.
43. Jourdain G, Ngo-Giang-Huong N, Cressey TR, Hua L, Harrison L, Tierney C, et al. Prevention of mother-to-child transmission of hepatitis B virus: a phase III, placebo-controlled, double-blind, randomized clinical trial to assess the efficacy and safety of a short course of tenofovir disoproxil fumarate in women with hepatitis B virus . BMC Infect Dis. BMC Infectious Diseases; 2016;16:393.
44. Hill J, Sheffield J, Kim J E. Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers. Gynecol Obs. 2002;99(6):1049–52. 45. Shi Z. Breastfeeding of Newborns by Mothers Carrying Hepatitis B Virus. Arch Pediatr Adolesc Med. 2011;165(9):837.
46. The American Academy of Pediatrics. Breastfeeding and the Use of Human Milk. Pediatrics. 2012;129(3):827–41.
47. Benaboud S, Pruvost A, Coffie PA, Ekouévi DK, Urien S, Arrivé E, et al. Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan, Côte d’Ivoire, in the ANRS 12109 TEmAA Study, step 2. Antimicrob Agents Chemother. 2011;55(3):1315–7.
48. Brown RS, Verna EC, Pereira MR, Tilson HH, Aguilar C, Leu CS, et al. Hepatitis B virus and human immunodeficiency virus drugs in pregnancy: Findings from the Antiretroviral Pregnancy Registry. J Hepatol. 2012;57(5):953–9.
49. Ayoub WS, Cohen E. Review Article Hepatitis B Management in the Pregnant Patient: An Update. J Clin Transl Hepatol. 2016;4(1):241–7.
50. Hu Y, Chen J, Wen J, Xu C, Zhang S, Xu B, et al. Effect of elective cesarean section on the risk of mother-to-child transmission of hepatitis B virus. BMC Pregnancy Childbirth. BMC Pregnancyand Childbirth; 2013;13(1):119.
51. Yang J, Zeng X, Men Y, Zhao L. Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus – a systematic review. Virol J. 2008;5:100.
52. Visvanathan K, Dusheiko G, Giles M, Wong ML, Phung N, Walker S, et al. Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow-up: position paper produced by Australian, UK and New Zealand key opinion leaders. Gut. 2016;65(2):340–50.
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