Hépato-Gastro & Oncologie Digestive


Hepatitis B virus and pregnancy Volume 16, issue 6, novembre-décembre 2009


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Unité d’hépatologie, université Paris-Descartes, APHP, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France, Inserm U567, institut Cochin, 22, rue Méchain, 75014 Paris, France

If pregnancy does impact only slightly on the natural history of acute or chronic HBV infection, its raises three main questions: 1) the risk of mother to child transmission prevented by the systematic screening in pregnant women of HBsAg at the second trimester and the systematic serovaccination of newborns of infected mothers. In mother with a high viral load, the prevention of in utero mother to child transmission based on the use of analogues such lamivudine, telbivudine or tenofovir. Obstetrical procedures (amniocentesis, forceps, etc.) do not clearly increase the risk of transmission; 2) breast-feeding is not contra-indicated with the serovaccination nor if mothers are treated by tenofovir; 3) the monitoring of the antiviral treatment: without complete viral suppression under lamivudine, the choosen therapy will be tenofovir; without complete viral suppression under adefovir, the choosen therapy will be tenofovir, the tenofovir-emtricitabine combination or lamivudine in the absence of previous lamivudine resistance which would had result in a lamivudine-adefovir add-on policy. With a complete viral suppression under analogues, lamivudine or telbivudine should be continued, entecavir switched to lamivudine, telbivudine or tenofovir; adefovir or telbivudine should be switched to tenofovir, lamivudine or telbivudine without previous lamivudine resistance (allowing only tenofovir).