Hepatitis B Virus Infection during Pregnancy: Transmission and Prevention Review Article ABSTRACT Hepatitis B virus (HBV) infection is a global public health problem. In endemic areas, HBV infection occurs mainly during infancy and early childhood, with mother to child transmission (MTCT) account- ing for approximately half of the transmission routes of chronic HBV infections. Prevention of MTCT is an essential step in reducing the global burden of chronic HBV. Natal transmission accounts for most of MTCT, and providing immunoprophylaxis to newborns is an excellent way to block natal transmission. Prenatal transmission is responsible for the minority of MTCT not preventable by immunoprophylaxis. Be- cause of the correlation between prenatal transmission and the level of maternal viremia, some authors find it sound to offer lamivudine in women who have a high viral load (more than 8 to 9 log 10 copies/mL). In addition to considerations regarding the transmission of HBV to the child, the combination of HBV infection and pregnancy raises several unique management issues. Chronic HBV infection during pregnancy is usually mild but may flare after delivery or with discontinuing thera- py. Management of chronic HBV infection in pregnancy is mostly sup- portive with antiviral medications indicated in a small subset of HBV infected women with rapidly progressive chronic liver disease. KeywoRdS Hepatitis B; Pregnancy; Transmission; Prevention digestive disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran 1. Behrouz Navabakhsh 1 , Narges Mehrabi 1 , Arezoo estakhri 1 , Mehdi Mohamadnejad 1 Hossein Poustchi 1* * Corresponding Author: Hossein Poustchi M.d, Phd digestive disease Research Center Shariati Hospital, North Kargar Ave. Tehran, Iran Tel: +98 21 82415300 Fax:+98 21 82415400 email: h.poustchi@gmail.com Recieved: 14 May. 2011 Accepted: 1 Jul. 2011 INTRodUCTIoN Hepatitis B virus (HBV) infection is a global public health problem. The wHo estimates that more than 2 billion people have been infected with HBV virus at some point in their lives and 350 million people across the world continue to carry chronic HBV infection, of whom almost one million die annually from HBV-related liver disease. 1 HBV is considered to be the cause of 60% of cases of primary liver cancer in the world and the most common carcinogen after cigarette smoking. 2 Although the true prevalence of hepatocellular carcinoma (HCC) in Iran is unknown, it is not an uncommon malignancy; 80% of HCC cases in Iran are positive for at least one of the markers of HBV, and this virus appears to be the most common cause of HCC in Iran. 3, 4 The prevalence of HBV infection varies worldwide with approximately half the world’s population living in regions where HBV infection is endemic, including most of Asia and the Pacific Islands, Africa and the Middle east. 5 The prevalence of HBV 92 Middle east Journal of digestive diseases/ Vol.3/ No.2/ September 2011