8.0 Antenatal and Perinatal Testing

Posted in: HBV

8.1 Routine testing

Women contemplating pregnancy or seeking antenatal care should be made aware of the benefits of diagnosis of hepatitis B infection and management, and prevention strategies available to protect the infant from infection.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) guidelines state that all pregnant women should be screened using the HBsAg test. If a woman is identified as HBsAg positive, further testing (HBeAg and HBV DNA) should be performed to determine the risk of transmission to the infant and the degree of infectivity in general, to inform clinical decision making.

The risk of perinatal HBV transmission is determined by maternal hepatitis B viral factors; highly replicative infection characterised by high HBV DNA viral load and HBeAg positivity is associated with a higher risk of transmission. Timely administration of hepatitis B vaccination and hepatitis B immunoglobulin (HBIG) to the infant within 12 hours of birth will prevent the majority of hepatitis B transmission. Women with a high viral load should receive specialist advice to consider the role of antiviral treatment to further reduce the risk of transmission.

Any woman diagnosed with hepatitis B infection in pregnancy should be assessed by an experienced clinician who will determine the phase and stage of her hepatitis B so that appropriate recommendations about treatment and monitoring can be made. 

Jurisdictions should develop operational directives that support the RANZCOG guidelines through education, feedback on compliance and periodic auditing of antenatal medical records to provide evidence of recommended best practice.

8.2 Testing of infants born to HBsAg positive mothers

Infants born to HBsAg positive mothers should be tested for HBsAg and anti-HBs at least 3 months after the final dose of hepatitis B vaccine. Testing for anti-HBc is not useful in the first years of life as maternal antibody is still detectable. A positive anti-HBs indicates a successful response to vaccination. A positive HBsAg test indicates infection and, in this case, the child should be referred to a paediatric gastroenterology or Infectious Diseases Unit for monitoring of liver function.

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National HBV Testing Policy v1.2 (PDF)

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Development of this site and the 2014 and 2017 revisions of the testing policies was supported by: Australian Government Department of Health and Ageing