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Background/Aim: To evaluate the use of antivirals in pregnancy to prevent vertical transmission of chronic hepatitis B in a gastroenterology practice specializing in treatment of pregnant women. Methods: Retrospectively identified 226 pregnant women with chronic hepatitis B seen by hepatologists at the Center for Women’s Gastrointestinal Health at Women and Infants Hospital, Providence, Rhode Island from January 1, 2009 December 31, 2014. 150 met inclusion criteria. Results: 13% (19) women had HBV DNA levels > 1,000,000 IU/ml in the third trimester of pregnancy which qualified them for initiation of treatment for chronic hepatitis B to prevent vertical transmission. However, 10 of the eligible 19 patients (53%) were not initiated on treatment during pregnancy to prevent vertical transmission. 7 of the 10 patients (64%) were never offered antiviral therapy by their hepatologist during their third trimester to prevent vertical transmission. 3 of the 10 patients declined (27%) antiviral prophylaxis. 9 of the 19 women (47%) initiated antiviral therapy in third trimester to prevent vertical transmission: Five were initiated on tenofovir, three on lamivudine, and one on telbivudine. HBIG and vaccines were successfully administered in a timely fashion in all 93 (100%) infants for whom this data was available. Conclusions: This study reveals a lack of consistency in physician antiviral use for highly viremic mothers in their third trimester. Our finding highlights the urgent need for clearly defined consensus guidelines from the liver societies on the threshold HBV DNA level for initiation of antivirals in pregnancy.

Inadequate Antiviral Use in Pregnant Women with Chronic Hepatitis B at High Risk for Vertical Transmission