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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

Gastroenterology and hepatology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

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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.
  • Every infant born to an HBsAg-positive mother needs monovalent hepatitis B vaccine promptly after birth and completion of the current selective schedule.
  • Add HBIG within the recommended birth window for higher-infectivity pregnancies and specified low-birth-weight infants; vaccine must not be delayed if HBIG is unavailable.
  • HCV is not part of the universal NHS infectious-diseases pregnancy screen; test when risk or clinical indication exists and confirm exposure with HCV RNA.
  • No delivery intervention or neonatal immunoglobulin reliably prevents HCV transmission, so minimise avoidable blood exposure and ensure paediatric virological follow-up.
  • HAV vaccination can be used when indicated after risk assessment, while acute HEV in pregnancy merits urgent specialist review because severe liver failure is possible.

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.

Acute HEV concern

A pregnant traveller or resident returning from an endemic area with hepatitis and jaundice needs urgent HEV testing and liver-centre awareness because rapid failure can occur.

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.

  1. 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.
  2. Measure HBV DNA and infectivity markers, assess maternal liver disease and coinfections, and decide whether late-pregnancy tenofovir is indicated under current NICE guidance.
  3. Create a confidential written birth plan specifying vaccine, whether named HBIG is required, neonatal samples, responsible teams and failsafes for transfers, home birth or unplanned labour.

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.Check renal function, phosphate and bone risk, test for HIV and avoid unreviewed nephrotoxins. Do not stop after birth without a documented HBV flare-monitoring plan; maternal antiviral treatment never replaces prompt neonatal vaccine and indicated HBIG.
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Sources and review status6 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

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.

  • NHS infectious diseases in pregnancy screening requirementsCurrent universal antenatal HBV offer, referral timing, failsafes and screening pathway requirements.
  • UKHSA HBV antenatal and neonatal pathwayCurrent maternal assessment, higher-infectivity, vaccine, HBIG, delivery and definitive infant-testing pathway.
  • UKHSA hepatitis B Green Book chapterNational neonatal vaccine and HBIG indications plus current selective schedule.
  • NICE CG165 chronic hepatitis B recommendationsMaternal HBV assessment, tenofovir disoproxil threshold and specialist postpartum monitoring recommendations.
  • NHS infectious diseases pregnancy programme handbookOperational screening, communication and follow-up framework for maternal and infant infection prevention.
NHS hepatitis C information
Current NHS testing, transmission, treatment and pregnancy-related patient information.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom