Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Viral hepatitis in pregnancy and prevention of transmission
Essential points for quick revision.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate
A pregnant or postpartum person with jaundice, confusion, hypoglycaemia, increasing INR, severe vomiting, abdominal pain, hypertension or thrombocytopenia needs urgent obstetric and liver assessment because acute viral hepatitis, acute fatty liver of pregnancy, HELLP, drug injury and biliary disease can overlap. Suspected acute liver failure requires immediate regional transplant-centre discussion. At delivery, do not postpone the newborn hepatitis B vaccine while locating HBIG; give vaccine promptly and obtain urgent UKHSA or screening-team advice for incomplete or unknown maternal results.
Synopsis
Coordinate maternal viral hepatitis care with obstetric and neonatal pathways, prevent perinatal HBV transmission, and secure appropriate follow-up for HCV and acute HAV or HEV.
The NHS offers and recommends HBsAg screening in every pregnancy, even when hepatitis B is already known or a previous pregnancy screen was negative.
A confirmed HBsAg-positive result needs prompt screening-team and specialist referral, quantitative HBV DNA, infectivity markers, liver assessment and a written birth plan.
Maternal tenofovir disoproxil is offered in late pregnancy when HBV viral load meets the NICE threshold, with specialist planning for postpartum continuation or cessation.
Key red flags
Unscreened labour presentation
No reliable accredited result at delivery demands urgent maternal testing and newborn vaccination planning; undocumented verbal reassurance from a previous pregnancy is insufficient.
Investigation priorities
01
Antenatal HBsAg screening and confirmationFirst step
Detect maternal current HBV infection early enough to protect both pregnant person and baby.
Management branches
ScreenBuild the antenatal HBV plan
Pregnancy is booked, HBV is already known, or HBsAg screening is confirmed positive.
Offer HBsAg screening in every pregnancy and refer a confirmed positive result immediately to the screening team, then to specialist hepatology within the national pathway timescale.
Measure HBV DNA and infectivity markers, assess maternal liver disease and coinfections, and decide whether late-pregnancy tenofovir is indicated under current NICE guidance.
Key medicines
Tenofovir disoproxil in HBV pregnancyUse the licensed adult 245 mg once-daily tablet with food when the specialist team selects it; initiation timing and postpartum duration follow NICE, maternal viral load, renal safety and the individual's own HBV indication.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.