Summary
Objective. To analyze the course of chronic hepatitis B (CHB) and the prescribing antiviral treatment for women of fertile age, as well as to evaluate the risk, consequences, and prevention of perinatal transmission of hepatitis B virus (HBV).
Methodology. The study presents two clinical cases: data on the observation and treatment of a patient with CHB for more than 20 years and treatment of CHB during pregnancy, as well as data on the disease in her son, infected vertically with HBV. A literature review was conducted to analyze the main interactions between HBV infection and pregnancy, principles of HBV infection treatment in pregnant women, risk, consequences, and prevention of perinatal HBV infection.
Discussion. The course of the disease, dynamics of HBV lab tests, and results of antiviral treatment with standard interferon alfa-2b and lamivudine, followed by the development of resistance, are described for a woman diagnosed with CHB at the age of 22, over a 20-year period (2002–2024). The patient was treated with standard interferon alfa-2b, lamivudine, which gradually developed resistance. In 2008, the patient became pregnant. Due to a high HBV-DNA level, previous unsuccessful treatment with lamivudine, and unavailability of other antiviral drugs in Lithuania, antiviral treatment during pregnancy was not administered. The patient gave birth naturally to a full-term infant who was vaccinated with hepatitis B vaccine and injected with specific hepatitis B immunoglobulin (HBIG) within the first 24 hours after birth; however, the boy later was diagnosed with active HBV infection. In 2010, the patient became pregnant for the second time. Due to a high HBV-DNA concentration in the third trimester of pregnancy, lamivudine therapy was prescribed. In 2011, the patient gave birth via planned Cesarean section, delivering a premature infant. The newborn was vaccinated with hepatitis B vaccine and injected with specific HBIG within the first 12 hours after birth. Subsequent analyses showed that the infant developed protective immunity, and there were no signs of active HBV infection.
Conclusions. Proper monitoring of pregnant women allows timely detection of severity of HBV infection and implementation of necessary measures for its management. Antiviral treatment during pregnancy can reduce the level of HBV-DNA, thus reducing the risk of perinatal infection. It is also important to ensure that newborns receive appropriate post-exposure immunoprophylaxis within the first hours of life, significantly reducing the risk of maternal infection transmission to the newborn. All these factors contribute to effective management of chronic HBV infection and prevention of perinatal infection.
