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Hepatitis remains one of the most critical global health challenges today. Among the five strains of hepatitis (A, B, C, D, E), the most worrying is Hepatitis B (HBV) due to its potential for chronic infection and covert transmission, especially vertical transmission (from mother to child). The WHO reports that, as of 2022, there were 254 million people chronically infected with hepatitis B, and 1.2 million new infections each year.
In the same year, hepatitis B was responsible for approximately 1.1 million deaths, primarily due to cirrhosis and hepatocellular carcinoma (a major liver cancer). India has roughly 40 million cases of chronic hepatitis B infection, which poses a significant challenge for the Indian healthcare system (Source: WHO, ICMR). As alarming as these numbers are, vertical transmission is one of the most common ways the infection is spread, significantly increasing the chances of the child developing chronic hepatitis and liver disease in later life.
Hepatitis B virus (HBV) infection occurs through skin contact and body fluids, giving the virus entry through unprotected sexual intercourse, sharing of needles, transfusion with unscreened blood, and, most significantly in obstetrics, from an infected mother to her child during the delivery process. The expectant mother constitutes a special risk group, since the carrier of the virus can be asymptomatic. In the absence of a proper diagnosis, the virus may remain unaddressed. Chronic Hepatitis B infection has a 90% likelihood of developing in a child who is infected during the birth process, and those infected remain untreated.
In addition to ensuring the best health outcomes for the mother and child, mitigating the risk of virus transmission during childbirth is crucial. Traditionally, the gold standard for HBV diagnosis involved blood sampling sent to specialised laboratories, which is often unavailable in low-resource settings. One of the long-standing hurdles in India has been the lack of timely, accessible, and accurate diagnostic tools at the point of care. However, recent innovations such as the Truenat system have made testing faster, more accessible, and more reliable. These portable, point-of-care tests enable healthcare providers to diagnose hepatitis B quickly, in as little as 60 minutes, during prenatal visits, ensuring timely intervention.
Prevention strategies for hepatitis B in pregnant women necessitate comprehensive vaccination, screening, and antiviral therapy. Once diagnosed, the following preventive steps can be taken to prevent further transmission:
• Antiviral therapy during pregnancy for women with high viral loads to mitigate transmission risks.
• Immediate vaccination and hepatitis B immunoglobulin (HBIG) for the newborn within 12 hours of birth.
• Routine antenatal screening including for viral hepatitis during early pregnancy for women
• Healthcare providers must follow specific infection control measures during delivery to mitigate infection risk.
Partner testing, counselling, and other follow-up care, including education for families, coordination of infant immunisations, and general care, are critical and must remain confidential.
Frontline health workers have to be well-trained and equipped with the right tools to be empowered in the fight against viral hepatitis. By 2030, India aims to eliminate it as a public health issue in alignment with WHO guidelines. Screening for HBV should be part of the routine antenatal care for obstetricians, midwives, and primary healthcare workers. Vaccination and treatment to prevent the spread of infection to children should be ensured.
Screening is much simpler, aiding prompt testing and decision-making thanks to new technologies such as rapid testing devices. In addition, practitioners must educate women about the consequences of transmitting the virus and safe practices to ensure they do not further contribute to its spread. Preventing Hepatitis B in pregnant women is not just a medical issue; it’s a multi-sectoral investment towards healthier communities and families.
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