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Hepatitis B: a guide to your care in pregnancy and after your baby is born

Updated 11 January 2021

Your screening test result and what it means

You recently had some blood tests taken. One result has shown that you have an infection called hepatitis B.

This guide will explain what hepatitis B is and what it means for you, your baby and your family.

This guide contains information about the care you will need in your pregnancy to keep you healthy and the care needed for your baby and other family members.

During your pregnancy you will be cared for by a specialist team who will explain all the information in this leaflet, including details of the care available where you live and answer any questions you or your partner may have.

The team may include a screening midwife, a specialist nurse, a doctor specialising in liver care, an obstetrician, a pharmacist and your GP, practice nurse and health visitor.

What is hepatitis B?

Hepatitis B is an infection caused by a virus. A virus is a type of germ that can cause infection and disease.

The virus can cause many problems with your health including inflammation (swelling) of the liver and can result in serious liver problems, including scarring (cirrhosis) and cancer. The liver is the largest organ in the body and very important. It does many jobs including:

• cleaning your blood
• producing bile to help digest the food you eat
• storing sugar from your food to give you energy

How did you get hepatitis B?

Hepatitis B infection is more common in some parts of the world. An infection is an illness you can catch from someone else. It can also be spread to other people.

The hepatitis B virus is found in the blood or body fluids of an infected person. Body fluids are things like blood, semen, saliva and vaginal fluids. It is not spread by kissing, holding hands, hugging, coughing, sneezing, or sharing crockery and utensils.

It can be spread in these ways:

• from mother to baby during pregnancy or birth
• during sex without a condom
• sharing infected needles or drug equipment
• through unsterilised equipment used having a tattoo, body piercing, or medical or dental treatment
• by small amounts of blood found on toothbrushes or razors
• within families (child to child) in countries where the infection is common

Planning your care

It is very important to take care of yourself and attend all your appointments.

The specialist team will work with you to plan your care throughout your pregnancy and birth. They will give you information about:

• how to protect your baby with vaccinations (injections) at birth and up to 12 months old
• testing for your partner, other children or any other family or household members

You will need to have some more blood tests to find out how much hepatitis B virus is in your blood. These will tell us if you have a ‘lower infectivity’ or ‘higher infectivity’.

We can then plan the best treatment and care for you and your baby based on these results. If the level of virus is high your specialist team may ask you to take tablets to keep the levels of virus lower. You might also have a scan to check the health of your liver.

We will see you near the end of your pregnancy to discuss what will happen when your baby is born and answer any questions you may have. Hepatitis B does not affect the way your baby is born. It is not a reason on its own to have a caesarean birth.

You can breast feed your baby safely. It is very important to attend all your appointments after the baby is born to keep you and your baby well. The team are there to answer any questions you or your family have.

Monitoring your treatment and care

The UK Health Security Agency (UKHSA) has a legal duty to carry out infectious disease surveillance of notifiable diseases, such as hepatitis B. This means keeping a watch on the virus and disease to see if it changes and check the vaccine we use continues to work.

It is important to know if the virus is passed onto your baby, when and how this happened. To do this we will ask your permission to take samples of blood from you and your baby to send for specialist testing.

For all women and babies we will need:

• a small sample of your blood early in pregnancy
• a small blood sample from your baby at 12 months old

If you are higher infectivity we also need:

• a small sample of your blood after your baby is born
• 3 small spots of blood from your baby’s heel at birth^{[footnote 1]}

It can then can then be compared to the test done when the baby is a year old and this will help the scientists to understand how the virus is behaving.

Your baby’s care

Hepatitis B infection can be prevented if you make sure your baby has their vaccinations on time.

The vaccinations will greatly reduce the chance of your baby becoming infected.

Babies born to mothers with hepatitis B need extra protection. The extra injections are given straight after the birth of your baby and when they are 4 weeks and 12 months old.

If you had high levels of virus during your pregnancy your baby will also need another extra injection called hepatitis B immunoglobulin (HBIG) just after they are born.

When your baby is 8 weeks old they will start the routine childhood vaccinations all children are offered. These have the hepatitis B vaccine included.

At twelve months, when your baby has had all their vaccinations, a blood test is needed to see if your baby has or has not got hepatitis B infection.

Your baby’s vaccination schedule

Your baby will need a total of 6 vaccinations to protect them from hepatitis B. It is very important that your baby gets all of them.

Vaccination 1 – single hepatitis B	Before the baby is one day old in hospital. Some babies need a second injection of immunoglobulin (HBIG) for extra protection as well.
Vaccination 2 – single hepatitis B	At 4 weeks – make sure you have registered the baby with a GP.
Vaccination 3	At 8 weeks with the routine childhood vaccination which includes hepatitis B.
Vaccination 4	At 12 weeks with the routine childhood vaccination which includes hepatitis B.
Vaccination 5	At 16 weeks with the routine childhood vaccination which includes hepatitis B.
Vaccination 6 – single hepatitis B	At 12 months your baby will also need to have a blood test taken to see if they have hepatitis B. This is very important.

When you go home

Register your baby’s birth

All births in England, Wales and Northern Ireland must be registered within 42 days of the child being born. If you are married your husband can do this alone. You will be given a birth certificate.

Register your baby with your GP

You and your baby need to be registered with a GP to make sure you receive all the care you need.

Register your baby as soon as they are born so you can book in for the baby’s 4-week vaccination. It will be easier to do this if you have the birth certificate. Tell your midwife or health visitor if you have any problems with this.

Future care

It is important to keep all the appointments made for you and your baby including any hospital ones with the specialist team.

You and your baby will need a visit to your GP when the baby is six weeks old to check all is well after the birth.

Remember to take your red book to all appointments or remind health professionals to fill it in online.

Who needs to know about you and your baby

We need to tell everybody involved in caring for you and your baby that you have hepatitis B so we can:

• plan and deliver your care safely
• make all the appointments you need with the specialist teams
• make all the appointments for your baby’s care and future vaccinations

We need your permission to tell other professionals about you having hepatitis B.

These include:

• GP
• your health visitor
• Child Health Information Service who record all your baby’s vaccinations and results from new-born screening tests

UKHSA collects information to ensure that screening and immunisation programmes are safe and effective.

Further information is available on how UKHSA and the NHS use and protect your information.

Further information

Hepatitis NHS.UK.

Registering your baby’s birth.

Registering your baby with a GP.

Your baby’s personal child health record (red book).

1. Your baby’s sample of blood taken at birth is different to the ‘heel prick’ test taken when your baby is 5 days old and it is very important that your baby has that screening test done as well. ↩