Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Viral hepatitis and pregnancy

Nature Reviews Gastroenterology & Hepatology volume 18, pages 117–130 (2021)Cite this article

Subjects

Abstract

The management of viral hepatitis in the setting of pregnancy requires special consideration. There are five liver-specific viruses (hepatitis A, B, C, D, E), each with unique epidemiology, tendency to chronicity, risk of liver complications and response to antiviral therapies. In the setting of pregnancy, the liver health of the mother, the influence of pregnancy on the clinical course of the viral infection and the effect of the virus or liver disease on the developing infant must be considered. Although all hepatitis viruses can harm the mother and the child, the greatest risk to maternal health and subsequently the fetus is seen with acute hepatitis A virus or hepatitis E virus infection during pregnancy. By contrast, the primary risks for hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus are related to the severity of the underlying liver disease in the mother and the risk of mother-to-child transmission (MTCT) for HBV and HCV. The prevention of MTCT is key to reducing the global burden of chronic viral hepatitis, and prevention strategies must take into consideration local health-care and socioeconomic challenges. This Review presents the epidemiology of acute and chronic viral hepatitis infection in pregnancy, the effect of pregnancy on the course of viral infection and, conversely, the influence of the viral infection on maternal and infant outcomes, including MTCT.

Key points

  • Acute hepatitis A virus (HAV) infection during pregnancy might increase the rates of adverse pregnancy outcomes; cases leading to fetal liver injury and mother-to-child transmission (MTCT) of HAV have been reported.

  • Pregnant women with chronic hepatitis B virus (HBV) infection might have an increased risk of preterm delivery and gestational diabetes.

  • There is risk of MTCT of HBV, especially in mothers with high levels of HBV DNA, but this risk is reduced with the use of maternal antiviral therapy and prompt administration of infant immunoprophylaxis.

  • Pregnant women with chronic hepatitis C virus (HCV) infection have increased rates of adverse pregnancy outcomes; MTCT occurs in 5% and is linked with invasive fetal monitoring and prolonged rupture of membranes.

  • Risks related to underlying cirrhosis can be more frequent in pregnant women with hepatitis D virus (HDV) infection; MTCT of HDV is rare and management is the same as HBV monoinfection.

  • Acute hepatitis E virus (HEV) infection in pregnancy is associated with an increased risk of maternal death and infant mortality, including higher rates of preterm delivery and stillbirths; MTCT of HEV can occur.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Mother-to-child transmission of virus in women with chronic viral hepatitis.
Fig. 2: Suggested management algorithm for women positive for HBV.

Similar content being viewed by others

References

  1. World Health Organization. Global hepatitis report, 2017 (WHO, 2017).

  2. Jacobsen, K. H. The global prevalence of hepatitis A virus infection and susceptibility: a systematic review (WHO, 2008).

  3. Jacobsen, K. H. Globalization and the changing epidemiology of hepatitis a virus. Cold Spring Harb. Perspect. Med. 8, a031716 (2018).

    PubMed  PubMed Central  Google Scholar 

  4. Cho, G. J. et al. Hepatitis A virus infection during pregnancy in Korea: hepatitis A infection on pregnant women. Obstet. Gynecol. Sci. 56, 368–374 (2013).

    PubMed  PubMed Central  Google Scholar 

  5. Elinav, E. et al. Acute hepatitis A infection in pregnancy is associated with high rates of gestational complications and preterm labor. Gastroenterology 130, 1129–1134 (2006).

    PubMed  Google Scholar 

  6. Chaudhry, S. A. & Koren, G. Hepatitis A infection during pregnancy. Can. Fam. Physician 61, 963–964 (2015).

    PubMed  PubMed Central  Google Scholar 

  7. Simsek, Y. et al. Fulminant hepatitis A infection in second trimester of pregnancy requiring living-donor liver transplantation. J. Obstet. Gynaecol. Res. 38, 745–748 (2012).

    PubMed  Google Scholar 

  8. Casey, L. C. et al. Acute liver failure (ALF) in pregnancy: how much is pregnancy-related? Hepatology https://doi.org/10.1002/hep.31144 (2020).

  9. Leikin, E. et al. Intrauterine transmission of hepatitis A virus. Obstet. Gynecol. 88, 690–691 (1996).

    CAS  PubMed  Google Scholar 

  10. Jiang, W. et al. Sofosbuvir inhibits hepatitis A virus replication in vitro assessed by a cell-based fluorescent reporter system. Antivir. Res. 154, 51–57 (2018).

    CAS  PubMed  Google Scholar 

  11. Advisory Committee on Immunization Practices, Fiore, A. E., Wasley, A. & Bell, B. P. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm. Rep. 55, 1–23 (2006).

    Google Scholar 

  12. Moro, P. L. et al. Reports to the vaccine adverse event reporting system after hepatitis a and hepatitis AB vaccines in pregnant women. Am. J. Obstet. Gynecol. 210, 561.e1–561.e6 (2014).

    CAS  Google Scholar 

  13. Groom, H. C. et al. Uptake and safety of hepatitis A vaccination during pregnancy: a vaccine safety datalink study. Vaccine 37, 6648–6655 (2019).

    PubMed  PubMed Central  Google Scholar 

  14. Revill, P. A. et al. The evolution and clinical impact of hepatitis B virus genome diversity. Nat. Rev. Gastroenterol. Hepatol. 17, 618–634 (2020).

    PubMed  Google Scholar 

  15. MacLachlan, J. H. & Cowie, B. C. Hepatitis B virus epidemiology. Cold Spring Harb. Perspect. Med. 5, a021410 (2015).

    PubMed  PubMed Central  Google Scholar 

  16. Edmunds, W. J. et al. The influence of age on the development of the hepatitis B carrier state. Proc. R. Soc. Lond. B 253, 197–201 (1993).

    CAS  Google Scholar 

  17. Beasley, R. P. et al. Hepatitis B immune globulin (HBIG) efficacy in the interruption of perinatal transmission of hepatitis B virus carrier state. Initial report of a randomised double-blind placebo-controlled trial. Lancet 2, 388–393 (1981).

    CAS  PubMed  Google Scholar 

  18. Hu, Y. C. et al. Seroprevalence of hepatitis B virus in Taiwan 30 years after the commencement of the national vaccination program. PeerJ 6, e4297 (2018).

    PubMed  PubMed Central  Google Scholar 

  19. Hofstraat, S. H. I. et al. Current prevalence of chronic hepatitis B and C virus infection in the general population, blood donors and pregnant women in the EU/EEA: a systematic review. Epidemiol. Infect. 145, 2873–2885 (2017).

    CAS  PubMed  Google Scholar 

  20. Su, W. J. et al. The impact of universal infant hepatitis B immunization on reducing the hepatitis B carrier rate in pregnant women. J. Infect. Dis. 220, 1118–1126 (2019).

    CAS  PubMed  Google Scholar 

  21. Walker, T. Y. et al. Characteristics of pregnant women with hepatitis B virus infection in 5 US public health jurisdictions, 2008-2012. Public Health Rep. 131, 685–694 (2016).

    PubMed  PubMed Central  Google Scholar 

  22. Shepard, C. W. et al. Hepatitis B virus infection: epidemiology and vaccination. Epidemiol. Rev. 28, 112–125 (2006).

    PubMed  Google Scholar 

  23. US Department of Health and Human Services. Hepatitis B basic information. HHS.gov https://www.hhs.gov/hepatitis/learn-about-viral-hepatitis/hepatitis-b-basics/index.html (2019).

  24. Goldstein, S. T. et al. A mathematical model to estimate global hepatitis B disease burden and vaccination impact. Int. J. Epidemiol. 34, 1329–1339 (2005).

    PubMed  Google Scholar 

  25. Torimiro, J. N. et al. Rates of HBV, HCV, HDV and HIV type 1 among pregnant women and HIV type 1 drug resistance-associated mutations in breastfeeding women on antiretroviral therapy. BMC Pregnancy Childbirth 18, 504 (2018).

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Liu, J. et al. Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth: a population-based cohort study. Lancet Glob. Health 5, e624–e632 (2017).

    PubMed  Google Scholar 

  27. Ma, X. et al. Chronic hepatitis B virus infection and preterm labor(birth) in pregnant women–an updated systematic review and meta-analysis. J. Med. Virol. 90, 93–100 (2018).

    PubMed  Google Scholar 

  28. Tse, K. Y., Ho, L. F. & Lao, T. The impact of maternal HBsAg carrier status on pregnancy outcomes: a case-control study. J. Hepatol. 43, 771–775 (2005).

    CAS  PubMed  Google Scholar 

  29. Tan, J. et al. Hepatitis B surface antigen positivity during pregnancy and risk of gestational diabetes mellitus: a systematic review and meta-analysis. J. Viral Hepat. 25, 1372–1383 (2018).

    CAS  PubMed  Google Scholar 

  30. Han, Y.-T. et al. Clinical features and outcome of acute hepatitis B in pregnancy. BMC Infect. Dis. 14, 368 (2014).

    PubMed  PubMed Central  Google Scholar 

  31. Kimmich, N. et al. Liver transplantation during pregnancy for acute liver failure due to HBV infection: a case report. Case Rep. Obstet. Gynecol. 2013, 356560 (2013).

    PubMed  PubMed Central  Google Scholar 

  32. Bzowej, N. H. et al. Total alanine aminotransferase (ALT) flares in pregnant North American women with chronic hepatitis B infection: results from a prospective observational study. Am. J. Gastroenterol. 114, 1283–1291 (2019).

    PubMed  PubMed Central  Google Scholar 

  33. Liu, J. et al. Kinetic changes of viremia and viral antigens of hepatitis B virus during and after pregnancy. Medicine 94, e2001 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Soderstrom, A., Norkrans, G. & Lindh, M. Hepatitis B virus DNA during pregnancy and post partum: aspects on vertical transmission. Scand. J. Infect. Dis. 35, 814–819 (2003).

    PubMed  Google Scholar 

  35. ter Borg, M. J. et al. Exacerbation of chronic hepatitis B infection after delivery. J. Viral Hepat. 15, 37–41 (2008).

    PubMed  Google Scholar 

  36. Lin, H. H. et al. Postpartum subsidence of hepatitis B viral replication in HBeAg-positive carrier mothers. J. Med. Virol. 29, 1–6 (1989).

    CAS  PubMed  Google Scholar 

  37. Joshi, S. S. et al. Peripartum cytokine flares in a multiethnic cohort of chronic hepatitis B carriers does not correlate with hepatitis B virus suppression or increased risk of liver disease. Am. J. Reprod. Immunol. 78, e12707 (2017).

    Google Scholar 

  38. Nguyen, V. et al. Anti-viral therapy for prevention of perinatal HBV transmission: extending therapy beyond birth does not protect against post-partum flare. Aliment. Pharmacol. Ther. 39, 1225–1234 (2014).

    CAS  PubMed  Google Scholar 

  39. Kushner, T. et al. Incidence, determinants and outcomes of pregnancy-associated hepatitis B flares: a regional hospital-based cohort study. Liver Int. 38, 813–820 (2018).

    CAS  PubMed  Google Scholar 

  40. Pan, C. Q. et al. Tenofovir to prevent hepatitis B transmission in mothers with high viral load. N. Engl. J. Med. 374, 2324–2334 (2016).

    CAS  PubMed  Google Scholar 

  41. Greenup, A. J. et al. Efficacy and safety of tenofovir disoproxil fumarate in pregnancy to prevent perinatal transmission of hepatitis B virus. J. Hepatol. 61, 502–507 (2014).

    CAS  PubMed  Google Scholar 

  42. Jourdain, G. et al. Tenofovir versus placebo to prevent perinatal transmission of hepatitis B. N. Engl. J. Med. 378, 911–923 (2018).

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Terrault, N. A. et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology 67, 1560–1599 (2018).

    PubMed  Google Scholar 

  44. Giles, M. et al. Clinical and virological predictors of hepatic flares in pregnant women with chronic hepatitis B. Gut 64, 1810–1815 (2015).

    CAS  PubMed  Google Scholar 

  45. Liu, J. et al. Baseline hepatitis B virus titer predicts initial postpartum hepatic flare: a multicenter prospective study. J. Clin. Gastroenterol. 52, 902–907 (2017).

    Google Scholar 

  46. Funk, A. et al. Efficacy and safety of antiviral prophylaxis during pregnancy to prevent mother-to-child transmission of hepatitis B virus: a systematic review and meta-analysis. Lancet Infect Dis. https://doi.org/10.1016/S1473-3099(20)30586-7 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  47. Brown, R. S. Jr et al. Antiviral therapy in chronic hepatitis B viral infection during pregnancy: a systematic review and meta-analysis. Hepatology 63, 319–333 (2016).

    CAS  PubMed  Google Scholar 

  48. Liu, J. et al. Presence of hepatitis B virus markers in umbilical cord blood: exposure to or infection with the virus? Dig. Liver Dis. 51, 864–869 (2019).

    PubMed  Google Scholar 

  49. Mavilia, M. G. & Wu, G. Y. Mechanisms and prevention of vertical transmission in chronic viral hepatitis. J. Clin. Transl. Hepatol. 5, 119–129 (2017).

    PubMed  PubMed Central  Google Scholar 

  50. Ali, B. A. et al. Expression of hepatitis B virus genes in early embryonic cells originated from hamster ova and human spermatozoa transfected with the complete viral genome. Asian J. Androl. 8, 273–279 (2006).

    CAS  PubMed  Google Scholar 

  51. Nie, R. et al. Presence of hepatitis B virus in oocytes and embryos: a risk of hepatitis B virus transmission during in vitro fertilization. Fertil. Steril. 95, 1667–1671 (2011).

    PubMed  Google Scholar 

  52. Hu, X. L. et al. The presence and expression of the hepatitis B virus in human oocytes and embryos. Hum. Reprod. 26, 1860–1867 (2011).

    CAS  PubMed  Google Scholar 

  53. WHO Publication. Hepatitis B vaccines: WHO position paper — recommendations. Vaccine 28, 589–590 (2010).

    Google Scholar 

  54. Centers for Disease Control and Prevention. Perinatal transmission. CDC https://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm (2020).

  55. Amini, A. et al. Diagnostic accuracy of tests to detect hepatitis B surface antigen: a systematic review of the literature and meta-analysis. BMC Infect. Dis. 17, 698 (2017).

    PubMed  PubMed Central  Google Scholar 

  56. Cheung, K. W. et al. Optimal timing of hepatitis B virus DNA quantification and clinical predictors for higher viral load during pregnancy. Acta Obstet. Gynecol. Scand. 98, 1301–1306 (2019).

    CAS  PubMed  Google Scholar 

  57. Wen, W. H. et al. Quantitative maternal hepatitis B surface antigen predicts maternally transmitted hepatitis B virus infection. Hepatology 64, 1451–1461 (2016).

    CAS  PubMed  Google Scholar 

  58. Samadi Kochaksaraei, G. et al. Cost-effectiveness of quantitative hepatitis B virus surface antigen testing in pregnancy in predicting vertical transmission risk. Liver Int. 36, 1604–1610 (2016).

    PubMed  Google Scholar 

  59. Thilakanathan, C. et al. Mother-to-child transmission of hepatitis B: examining viral cut-offs, maternal HBsAg serology and infant testing. Liver Int. 38, 1212–1219 (2018).

    CAS  PubMed  Google Scholar 

  60. Cheung, K. W. et al. The effect of rupture of membranes and labour on the risk of hepatitis B vertical transmission: prospective multicentre observational study. Eur. J. Obstet. Gynecol. Reprod. Biol. 232, 97–100 (2019).

    PubMed  Google Scholar 

  61. Han, Z. et al. Mother-to-child transmission of hepatitis B virus after amniocentesis: a retrospective matched cohort study. Prenat. Diagn. 39, 431–440 (2019).

    CAS  PubMed  Google Scholar 

  62. Yi, W. et al. Risk of vertical transmission of hepatitis B after amniocentesis in HBs antigen-positive mothers. J. Hepatol. 60, 523–529 (2014).

    CAS  PubMed  Google Scholar 

  63. Xu, D. Z. et al. Role of placental tissues in the intrauterine transmission of hepatitis B virus. Am. J. Obstet. Gynecol. 185, 981–987 (2001).

    CAS  PubMed  Google Scholar 

  64. Mackie, F. L. et al. The accuracy of cell-free fetal DNA-based non-invasive prenatal testing in singleton pregnancies: a systematic review and bivariate meta-analysis. BJOG 124, 32–46 (2017).

    CAS  PubMed  Google Scholar 

  65. Yang, M. et al. Cesarean section to prevent mother-to-child transmission of hepatitis B virus in China: a meta-analysis. BMC Pregnancy Childbirth 17, 303 (2017).

    PubMed  PubMed Central  Google Scholar 

  66. Dunkelberg, J. C. et al. Hepatitis B and C in pregnancy: a review and recommendations for care. J. Perinatol. 34, 882–891 (2014).

    CAS  PubMed  PubMed Central  Google Scholar 

  67. Stevens, C. E. et al. HBeAg and anti-HBe detection by radioimmunoassay: correlation with vertical transmission of hepatitis B virus in Taiwan. J. Med. Virol. 3, 237–241 (1979).

    CAS  PubMed  Google Scholar 

  68. Zou, H. et al. Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg-positive mothers. J. Viral Hepat. 19, e18–e25 (2012).

    CAS  PubMed  Google Scholar 

  69. Wen, W. H. et al. Mother-to-infant transmission of hepatitis B virus infection: significance of maternal viral load and strategies for intervention. J. Hepatol. 59, 24–30 (2013).

    PubMed  Google Scholar 

  70. Cheung, K. W. et al. Immunoprophylaxis failure of infants born to hepatitis B carrier mothers following routine vaccination. Clin. Gastroenterol. Hepatol. 16, 144–145 (2018).

    PubMed  Google Scholar 

  71. Wiseman, E. et al. Perinatal transmission of hepatitis B virus: an Australian experience. Med. J. Aust. 190, 489–492 (2009).

    PubMed  Google Scholar 

  72. Benhammou, V. et al. HBV or HCV coinfection in HIV-1-infected pregnant women in France: prevalence and pregnancy outcomes. J. Acquir. Immune Defic. Syndr. 77, 439–450 (2018).

    PubMed  Google Scholar 

  73. Mave, V. et al. Impact of maternal hepatitis B virus coinfection on mother-to-child transmission of HIV. HIV. Med. 15, 347–354 (2014).

    CAS  PubMed  PubMed Central  Google Scholar 

  74. Chotun, N. et al. Hepatitis B virus infection in HIV-exposed infants in the Western Cape, South Africa. Vaccine 33, 4618–4622 (2015).

    CAS  PubMed  Google Scholar 

  75. Vanclaire, J., Cornu, C. & Sokal, E. M. Fulminant hepatitis B in an infant born to a hepatitis Be antibody positive, DNA negative carrier. Arch. Dis. Child. 66, 983–985 (1991).

    CAS  PubMed  PubMed Central  Google Scholar 

  76. Delaplane, D. et al. Fatal hepatitis B in early infancy: the importance of identifying HBsAg-positive pregnant women and providing immunoprophylaxis to their newborns. Pediatrics 72, 176–180 (1983).

    CAS  PubMed  Google Scholar 

  77. Sacher, M., Unger, F. D. & Eder, G. Vertical hepatitis B transmission by anti-HBe positive hepatitis B carrier mothers. Padiatr. Padol. 21, 141–146 (1986).

    CAS  PubMed  Google Scholar 

  78. Bahn, A. et al. Selection of a precore mutant after vertical transmission of different hepatitis B virus variants is correlated with fulminant hepatitis in infants. J. Med. Virol. 47, 336–341 (1995).

    CAS  PubMed  Google Scholar 

  79. Schaefer, E., Koeppen, H. & Wirth, S. Low level virus replication in infants with vertically transmitted fulminant hepatitis and their anti-HBe positive mothers. Eur. J. Pediatr. 152, 581–584 (1993).

    CAS  PubMed  Google Scholar 

  80. Chen, H. L. et al. Pediatric fulminant hepatic failure in endemic areas of hepatitis B infection: 15 years after universal hepatitis B vaccination. Hepatology 39, 58–63 (2004).

    PubMed  Google Scholar 

  81. Bigna, J. J. et al. Gender development and hepatitis B and C infections among pregnant women in Africa: a systematic review and meta-analysis. Infect. Dis. Poverty 8, 16 (2019).

    PubMed  PubMed Central  Google Scholar 

  82. Wang, Y. et al. Prevalence of chronic hepatitis B and status of HBV care among rural women who planned to conceive in China. Sci. Rep. 7, 12090 (2017).

    PubMed  PubMed Central  Google Scholar 

  83. Segeral, O. et al. Usefulness of a serial algorithm of HBsAg and HBeAg rapid diagnosis tests to detect pregnant women at risk of HBV mother-to-child transmission in Cambodia, the ANRS 12328 pilot study. J. Clin. Virol. 109, 29–34 (2018).

    PubMed  Google Scholar 

  84. Cornberg, M. et al. The role of quantitative hepatitis B surface antigen revisited. J. Hepatol. 66, 398–411 (2017).

    CAS  PubMed  Google Scholar 

  85. European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J. Hepatol. 67, 370–398 (2017).

    Google Scholar 

  86. Fujiko, M. et al. Chronic hepatitis B in pregnant women: is hepatitis B surface antigen quantification useful for viral load prediction? Int. J. Infect. Dis. 41, 83–89 (2015).

    CAS  PubMed  Google Scholar 

  87. Sun, K. X. et al. A predictive value of quantitative HBsAg for serum HBV DNA level among HBeAg-positive pregnant women. Vaccine 30, 5335–5340 (2012).

    CAS  PubMed  Google Scholar 

  88. Patel, N. H. et al. Analysis of serum hepatitis B virus RNA levels in a multiethnic cohort of pregnant chronic hepatitis B carriers. J. Clin. Virol. 111, 42–47 (2019).

    CAS  PubMed  Google Scholar 

  89. Shimakawa, Y. et al. Hepatitis B core-related antigen (HBcrAg): an alternative to HBV DNA to assess treatment eligibility in Africa. Clin. Infect. Dis. 70, 1442–1452 (2019).

    Google Scholar 

  90. Wang, C. et al. Protective effect of an improved immunization practice of mother-to-infant transmission of hepatitis B virus and risk factors associated with immunoprophylaxis failure. Medicine 95, e4390 (2016).

    CAS  PubMed  PubMed Central  Google Scholar 

  91. Kang, W. et al. Risk factors associated with immunoprophylaxis failure against mother to child transmission of hepatitis B virus and hepatitis B vaccination status in Yunnan province, China. Vaccine 32, 3362–3366 (2014).

    PubMed  Google Scholar 

  92. Isaacs, D. et al. Ethical issues in preventing mother-to-child transmission of hepatitis B by immunisation. Vaccine 29, 6159–6162 (2011).

    PubMed  Google Scholar 

  93. Eke, A. C. et al. Hepatitis B immunoglobulin during pregnancy for prevention of mother-to-child transmission of hepatitis B virus. Cochrane Database Syst. Rev. 2, CD008545 (2017).

    PubMed  Google Scholar 

  94. Childs, L., Roesel, S. & Tohme, R. A. Status and progress of hepatitis B control through vaccination in the South-East Asia region, 1992-2015. Vaccine 36, 6–14 (2018).

    PubMed  Google Scholar 

  95. Breakwell, L. et al. The status of hepatitis B control in the African region. Pan Afr. Med. J. 27, 17 (2017).

    PubMed  PubMed Central  Google Scholar 

  96. Wiesen, E., Diorditsa, S. & Li, X. Progress towards hepatitis B prevention through vaccination in the Western Pacific, 1990–2014. Vaccine 34, 2855–2862 (2016).

    PubMed  Google Scholar 

  97. Cui, F. et al. Evaluation of policies and practices to prevent mother to child transmission of hepatitis B virus in China: results from China GAVI project final evaluation. Vaccine 31, J36–J42 (2013).

    PubMed  Google Scholar 

  98. Xeuatvongsa, A. et al. Improving hepatitis B birth dose in rural Lao People’s Democratic Republic through the use of mobile phones to facilitate communication. Vaccine 34, 5777–5784 (2016).

    PubMed  PubMed Central  Google Scholar 

  99. World Health Organization. A systematic review of monovalent hepatitis B vaccine thermostability (WHO, 2016).

  100. Wait, S. et al. Hepatitis B and hepatitis C in southeast and southern Asia: challenges for governments. Lancet Gastroenterol. Hepatol. 1, 248–255 (2016).

    PubMed  Google Scholar 

  101. Antiretroviral Pregnancy Registry Steering Committee. Antiretroviral pregnancy registry interim report for 1 January 1989 through 31 January 2020 (Registry Coordinating Center, 2020).

  102. Ayres, A. et al. Short duration of lamivudine for the prevention of hepatitis B virus transmission in pregnancy: lack of potency and selection of resistance mutations. J. Viral Hepat. 21, 809–817 (2014).

    CAS  PubMed  Google Scholar 

  103. Hu, Y. H. et al. Tenofovir rescue therapy in pregnant females with chronic hepatitis B. World J. Gastroenterol. 21, 2504–2509 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  104. World Health Organization. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection (WHO, 2015).

  105. Shyamala, V. et al. Assessment of the target-capture PCR hepatitis B virus (HBV) DNA quantitative assay and comparison with commercial HBV DNA quantitative assays. J. Clin. Microbiol. 42, 5199–5204 (2004).

    CAS  PubMed  PubMed Central  Google Scholar 

  106. Han, G. R. et al. A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection. J. Hepatol. 55, 1215–1221 (2011).

    CAS  PubMed  Google Scholar 

  107. Sarin, S. K. et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol. Int. 10, 1–98 (2016).

    CAS  PubMed  Google Scholar 

  108. Shi, Z. et al. Breastfeeding of newborns by mothers carrying hepatitis B virus: a meta-analysis and systematic review. Arch. Pediatr. Adolesc. Med. 165, 837–846 (2011).

    PubMed  Google Scholar 

  109. Zheng, Y. et al. Should chronic hepatitis B mothers breastfeed? A meta analysis. BMC Public Health 11, 502 (2011).

    PubMed  PubMed Central  Google Scholar 

  110. World Health Organization. Hepatitis B and breastfeeding (WHO, 1996).

  111. Hu, X., Wang, L. & Xu, F. Guides concerning tenofovir exposure via breastfeeding: a comparison of drug dosages by developmental stage. Int. J. Infect. Dis. 87, 8–12 (2019).

    CAS  PubMed  Google Scholar 

  112. Benaboud, S. et al. Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan, Cote d’Ivoire, in the ANRS 12109 TEmAA Study, Step 2. Antimicrob. Agents Chemother. 55, 1315–1317 (2011).

    CAS  PubMed  Google Scholar 

  113. Grant, P. M. & Cotter, A. G. Tenofovir and bone health. Curr. Opin. HIV AIDS 11, 326–332 (2016).

    CAS  PubMed  PubMed Central  Google Scholar 

  114. Schillie, S. et al. Update: Shortened interval for postvaccination serologic testing of infants born to hepatitis B-infected mothers. Morb. Mortal. Wkly. Rep. 64, 1118–1120 (2015).

    Google Scholar 

  115. Indolfi, G. et al. Hepatitis B virus infection in children and adolescents. Lancet Gastroenterol. Hepatol. 4, 466–476 (2019).

    PubMed  Google Scholar 

  116. Woodring, J. et al. Integrating HIV, hepatitis B and syphilis screening and treatment through the Maternal, Newborn and Child Health platform to reach global elimination targets. West. Pac. Surveill. Response J. 8, 1–5 (2017).

    Google Scholar 

  117. Gavi. Gavi Alliance Programme and Policy Committee meeting 23–24 October 2019 (Gavi, 2019).

  118. World Health Organization. Guidelines on hepatitis B and C testing (WHO, 2016).

  119. Jing, W. et al. Cost-effectiveness of couple-based immunization strategy to prevent mother-to-child transmission of hepatitis B virus in China: a decision-analytic Markov model. EClinicalMedicine 19, 100264 (2020).

    PubMed  PubMed Central  Google Scholar 

  120. Rajbhandari, R. et al. Discontinuity of care for mothers with chronic hepatitis B diagnosed during pregnancy. J. Viral Hepat. 23, 561–568 (2016).

    CAS  PubMed  Google Scholar 

  121. Cheung, K. W. et al. Pattern and predictors of medical care received by hepatitis B carriers during pregnancy and after delivery. Public Health 168, 36–42 (2019).

    CAS  PubMed  Google Scholar 

  122. Davis, C. et al. Highly diverse hepatitis C strains detected in sub-Saharan Africa have unknown susceptibility to direct-acting antiviral treatments. Hepatology 69, 1426–1441 (2019).

    CAS  PubMed  Google Scholar 

  123. Bialek, S. R. & Terrault, N. A. The changing epidemiology and natural history of hepatitis C virus infection. Clin. Liver Dis. 10, 697–715 (2006).

    PubMed  Google Scholar 

  124. Wei, L. & Huang, Y. H. Long-term outcomes in patients with chronic hepatitis C in the current era of direct-acting antiviral agents. Expert Rev. Anti Infect. Ther. 17, 311–325 (2019).

    CAS  PubMed  Google Scholar 

  125. Petruzziello, A. et al. Global epidemiology of hepatitis C virus infection: an up-date of the distribution and circulation of hepatitis C virus genotypes. World J. Gastroenterol. 22, 7824–7840 (2016).

    PubMed  PubMed Central  Google Scholar 

  126. DeMaria, A. Jr Hearing from the silent epidemic. Ann. Intern. Med. 166, 846–847 (2017).

    PubMed  Google Scholar 

  127. Gower, E. et al. Global epidemiology and genotype distribution of the hepatitis C virus infection. J. Hepatol. 61, S45–S57 (2014).

    PubMed  Google Scholar 

  128. Onofrey, S. et al. Hepatitis C virus infection among adolescents and young adults: Massachusetts, 2002-2009. Morb. Mortal. Wkly. Rep. 60, 537–541 (2011).

    Google Scholar 

  129. Ly, K. N. et al. Hepatitis C virus infection among reproductive-aged women and children in the United States, 2006 to 2014. Ann. Intern. Med. 166, 775–782 (2017).

    PubMed  Google Scholar 

  130. American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. HCV guidance: recommendations for testing, managing, and treating hepatitis C (AASLD/IDSA, 2020).

  131. Chaillon, A. et al. Cost-effectiveness of universal hepatitis C virus screening of pregnant women in the United States. Clin. Infect. Dis. 69, 1888–1895 (2019).

    PubMed  PubMed Central  Google Scholar 

  132. US Preventive Services Task Force et al. Screening for hepatitis C virus infection in adolescents and adults: US preventive services task force recommendation statement. JAMA 323, 970–975 (2020).

    Google Scholar 

  133. Waruingi, W. et al. Hepatitis C virus universal screening versus risk based selective screening during pregnancy. J. Neonatal Perinat. Med. 8, 371–378 (2015).

    CAS  Google Scholar 

  134. El-Kamary, S. S. et al. Reliability of risk-based screening for hepatitis C virus infection among pregnant women in Egypt. J. Infect. 70, 512–519 (2015).

    PubMed  Google Scholar 

  135. Chibber, R., El-Saleh, E. & El Harmi, J. Female circumcision: obstetrical and psychological sequelae continues unabated in the 21st century. J. Matern. Fetal Neonatal Med. 24, 833–836 (2011).

    PubMed  Google Scholar 

  136. Society for Maternal-Fetal Medicine, Hughes, B. L., Page, C. M. & Kuller, J. A. Hepatitis C in pregnancy: screening, treatment, and management. Am. J. Obstet. Gynecol. 217, B2–B12 (2017).

    Google Scholar 

  137. Kaberg, M. & Weiland, O. Hepatitis C elimination - macro-elimination. Liver Int. 40, 61–66 (2020).

    PubMed  Google Scholar 

  138. Yu, M. L. et al. 2020 Taiwan consensus statement on the management of hepatitis C: part (II) special populations. J. Formos. Med. Assoc. 119, 1135–1157 (2020).

    PubMed  Google Scholar 

  139. Yang, L. et al. Effect of hepatitis C virus infection on the outcomes of in vitro fertilization. Int. J. Clin. Exp. Med. 8, 6230–6235 (2015).

    PubMed  PubMed Central  Google Scholar 

  140. Post, J. J. Update on hepatitis C and implications for pregnancy. Obstet. Med. 10, 157–160 (2017).

    PubMed  PubMed Central  Google Scholar 

  141. Shaw-Jackson, C. et al. In vitro fertilization for women infected by hepatitis C virus: a matched case-control study and a systematic literature review. J. Assist. Reprod. Genet. 34, 587–597 (2017).

    PubMed  PubMed Central  Google Scholar 

  142. Money, D. et al. Obstetrical and neonatal outcomes among women infected with hepatitis C and their infants. J. Obstet. Gynaecol. Can. 36, 785–794 (2014).

    PubMed  Google Scholar 

  143. Huang, Q. T. et al. Chronic hepatitis C virus infection is associated with increased risk of preterm birth: a meta-analysis of observational studies. J. Viral Hepat. 22, 1033–1042 (2015).

    PubMed  Google Scholar 

  144. Rezk, M. & Omar, Z. Deleterious impact of maternal hepatitis-C viral infection on maternal and fetal outcome: a 5-year prospective study. Arch. Gynecol. Obstet. 296, 1097–1102 (2017).

    PubMed  Google Scholar 

  145. Belay, T. et al. Intrahepatic cholestasis of pregnancy with concomitant hepatitis C virus infection, Joan C. Edwards SOM, Marshall University. Eur. J. Gastroenterol. Hepatol. 27, 372–374 (2015).

    PubMed  Google Scholar 

  146. Wijarnpreecha, K. et al. Hepatitis C infection and intrahepatic cholestasis of pregnancy: a systematic review and meta-analysis. Clin. Res. Hepatol. Gastroenterol. 41, 39–45 (2017).

    PubMed  Google Scholar 

  147. Kushner, T. & Terrault, N. A. Hepatitis C in pregnancy: a unique opportunity to improve the hepatitis C cascade of care. Hepatol. Commun. 3, 20–28 (2019).

    PubMed  Google Scholar 

  148. Conte, D. et al. Prevalence and clinical course of chronic hepatitis C virus (HCV) infection and rate of HCV vertical transmission in a cohort of 15,250 pregnant women. Hepatology 31, 751–755 (2000).

    CAS  PubMed  Google Scholar 

  149. Benova, L. et al. Vertical transmission of hepatitis C virus: systematic review and meta-analysis. Clin. Infect. Dis. 59, 765–773 (2014).

    PubMed  PubMed Central  Google Scholar 

  150. Mok, J. et al. When does mother to child transmission of hepatitis C virus occur? Arch. Dis. Child. Fetal Neonatal Ed. 90, F156–F160 (2005).

    CAS  PubMed  PubMed Central  Google Scholar 

  151. Cottrell, E. B. et al. Reducing risk for mother-to-infant transmission of hepatitis C virus: a systematic review for the U.S. Preventive Services Task Force. Ann. Intern. Med. 158, 109–113 (2013).

    PubMed  Google Scholar 

  152. Freriksen, J. J. M. et al. Review article: direct-acting antivirals for the treatment of HCV during pregnancy and lactation – implications for maternal dosing, foetal exposure, and safety for mother and child. Aliment. Pharmacol. Ther. 50, 738–750 (2019).

    PubMed  PubMed Central  Google Scholar 

  153. Chappell C. A. et al. A phase 1 study of ledipasvir/sofosbuvir in pregnant women with hepatitis C virus [abstract 87]. Presented at the Conference on Retroviruses and Opportunistic Infections (2019).

  154. El-Sayed, M. et al. THU-137-DAA therapy in women of child bearing age: accidental conception during therapy and pregnancy outcome [abstract]. J. Hepatol. 70, e221 (2019).

    Google Scholar 

  155. El-Sayed, M. H.& Indolfi, G. Hepatitis C virus treatment in children: a challenge for hepatitis C virus elimination. Semin. Liver Dis. 40, 213–224 (2020).

    PubMed  Google Scholar 

  156. Indolfi, G. et al. Hepatitis C virus infection in children and adolescents. Lancet Gastroenterol. Hepatol. 4, 477–487 (2019).

    PubMed  Google Scholar 

  157. Dahl, E. H. et al. Leaving no one behind: towards equitable global elimination of hepatitis C. J. Glob. Health 10, 010308 (2020).

    PubMed  PubMed Central  Google Scholar 

  158. Kushner, T. et al. Evaluating women’s preferences for hepatitis C treatment during pregnancy. Hepatol. Commun. 2, 1306–1310 (2018).

    PubMed  PubMed Central  Google Scholar 

  159. Gagnon, A. et al. Prenatal invasive procedures in women with hepatitis B, hepatitis C, and/or human immunodeficiency virus infections. J. Obstet. Gynaecol. Can. 36, 648–653 (2014).

    PubMed  Google Scholar 

  160. Garcia-Tejedor, A. et al. Risk factors for vertical transmission of hepatitis C virus: a single center experience with 710 HCV-infected mothers. Eur. J. Obstet. Gynecol. Reprod. Biol. 194, 173–177 (2015).

    PubMed  Google Scholar 

  161. Mast, E. E. et al. Risk factors for perinatal transmission of hepatitis C virus (HCV) and the natural history of HCV infection acquired in infancy. J. Infect. Dis. 192, 1880–1889 (2005).

    PubMed  Google Scholar 

  162. Polywka, S. et al. Low risk of vertical transmission of hepatitis C virus by breast milk. Clin. Infect. Dis. 29, 1327–1329 (1999).

    CAS  PubMed  Google Scholar 

  163. Zimmermann, R. et al. Hepatitis C virus in breast milk. Lancet 345, 928 (1995).

    CAS  PubMed  Google Scholar 

  164. European Paediatric Hepatitis C Virus Network. Effects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus. BJOG 108, 371–377 (2001).

    Google Scholar 

  165. Pfaender, S. et al. Inactivation of hepatitis C virus infectivity by human breast milk. J. Infect. Dis. 208, 1943–1952 (2013).

    CAS  PubMed  Google Scholar 

  166. Hillemanns, P. et al. Obstetric risks and vertical transmission of hepatitis C virus infection in pregnancy. Acta Obstet. Gynecol. Scand. 79, 543–547 (2000).

    CAS  PubMed  Google Scholar 

  167. Bal, A. & Petrova, A. Single clinical practice’s report of testing initiation, antibody clearance, and transmission of hepatitis C virus (HCV) in infants of chronically HCV-infected mothers. Open Forum Infect. Dis. 3, ofw021 (2016).

    PubMed  PubMed Central  Google Scholar 

  168. Polywka, S. et al. Accuracy of HCV-RNA PCR tests for diagnosis or exclusion of vertically acquired HCV infection. J. Med. Virol. 78, 305–310 (2006).

    CAS  PubMed  Google Scholar 

  169. Mack, C. L. et al. NASPGHAN practice guidelines: diagnosis and management of hepatitis C infection in infants, children, and adolescents. J. Pediatric Gastroenterol. Nutr. 54, 838–855 (2012).

    Google Scholar 

  170. Gross, M. S., Ruth, A. R. & Rasmussen, S. A. Respect women, promote health and reduce stigma: ethical arguments for universal hepatitis C screening in pregnancy. J. Med. Ethics 46, 674–677 (2020).

    PubMed  Google Scholar 

  171. US Preventive Services Task Force. Screening for hepatitis B virus infection in pregnant women: US Preventive Services Task Force reaffirmation recommendation statement. JAMA 322, 349–354 (2019).

    Google Scholar 

  172. Chappell, C. A. et al. Hepatitis C virus screening among children exposed during pregnancy. Pediatrics 141, e20173273 (2018).

    PubMed  Google Scholar 

  173. Kuncio, D. E. et al. Failure to test and identify perinatally infected children born to hepatitis C virus-infected women. Clin. Infect. Dis. 62, 980–985 (2016).

    PubMed  Google Scholar 

  174. Alvarado-Mora, M. V. et al. An update on HDV: virology, pathogenesis and treatment. Antivir. Ther. 18, 541–548 (2013).

    PubMed  Google Scholar 

  175. Stockdale, A. J. et al. The global prevalence of hepatitis D virus infection: systematic review and meta-analysis. J. Hepatol. 73, 523–532 (2020).

    PubMed  PubMed Central  Google Scholar 

  176. Chen, H. Y. et al. Prevalence and burden of hepatitis D virus infection in the global population: a systematic review and meta-analysis. Gut 66, 381–382 (2018).

    Google Scholar 

  177. Mansour, W. et al. Prevalence, risk factors, and molecular epidemiology of hepatitis B and hepatitis delta virus in pregnant women and in patients in Mauritania. J. Med. Virol. 84, 1186–1198 (2012).

    PubMed  Google Scholar 

  178. Aftab, M. et al. Characterization of hepatitis delta virus among pregnant women of Pakistan. Viral Immunol. 32, 335–340 (2019).

    CAS  PubMed  Google Scholar 

  179. Chen, X. et al. A novel quantitative microarray antibody capture assay identifies an extremely high hepatitis delta virus prevalence among hepatitis B virus-infected mongolians. Hepatology 66, 1739–1749 (2017).

    CAS  PubMed  Google Scholar 

  180. Hughes, S. A., Wedemeyer, H. & Harrison, P. M. Hepatitis delta virus. Lancet 378, 73–85 (2011).

    PubMed  Google Scholar 

  181. Hagstrom, H. et al. Outcomes of pregnancy in mothers with cirrhosis: a national population-based cohort study of 1.3 million pregnancies. Hepatol. Commun. 2, 1299–1305 (2018).

    PubMed  PubMed Central  Google Scholar 

  182. Sellier, P. O. et al. Hepatitis B virus-hepatitis D virus mother-to-child co-transmission: a retrospective study in a developed country. Liver Int. 38, 611–618 (2018).

    CAS  PubMed  Google Scholar 

  183. Dusheiko, G. Treatment of HBeAg positive chronic hepatitis B: interferon or nucleoside analogues. Liver Int. 33, 137–150 (2013).

    CAS  PubMed  Google Scholar 

  184. Aggarwal, R. Diagnosis of hepatitis E. Nat. Rev. Gastroenterol. Hepatol. 10, 24–33 (2013).

    CAS  PubMed  Google Scholar 

  185. Li, R. C. et al. Seroprevalence of hepatitis E virus infection, rural southern People’s Republic of China. Emerg. Infect. Dis. 12, 1682–1688 (2006).

    PubMed  PubMed Central  Google Scholar 

  186. Khuroo, M. S., Khuroo, M. S. & Khuroo, N. S. Transmission of hepatitis E virus in developing countries. Viruses 8, 253 (2016).

    PubMed Central  Google Scholar 

  187. Debing, Y. et al. Update on hepatitis E virology: implications for clinical practice. J. Hepatol. 65, 200–212 (2016).

    PubMed  Google Scholar 

  188. Dagnew, M. et al. Hepatitis E virus infection among pregnant women in Africa: systematic review and meta-analysis. BMC Infect. Dis. 19, 519 (2019).

    PubMed  PubMed Central  Google Scholar 

  189. Bisayher, S. et al. Seroprevalence and risk factors of hepatitis E among women of childbearing age in the Xieng Khouang province (Lao People’s Democratic Republic), a cross-sectional survey. J. Viral Hepat. 113, 298–304 (2019).

    Google Scholar 

  190. Li, P. et al. The global epidemiology of hepatitis E virus infection: a systematic review and meta-analysis. Liver Int. 40, 1516–1528 (2020).

    PubMed  PubMed Central  Google Scholar 

  191. Aggarwal, R. Hepatitis E: clinical presentation in disease-endemic areas and diagnosis. Semin. Liver Dis. 33, 30–40. (2013).

    CAS  PubMed  Google Scholar 

  192. Berglov, A., Hallager, S. & Weis, N. Hepatitis E during pregnancy: maternal and foetal case-fatality rates and adverse outcomes–a systematic review. J. Viral Hepat. 26, 1240–1248 (2019).

    Google Scholar 

  193. Khuroo, M. S. & Kamili, S. Aetiology, clinical course and outcome of sporadic acute viral hepatitis in pregnancy. J. Viral Hepat. 10, 61–69 (2003).

    CAS  PubMed  Google Scholar 

  194. Zhuang, H., Cao, X. Y., Liu, C. B. & Wang, G. M. Epidemiology of hepatitis E in China. Gastroenterol. Jpn. 26 (Suppl. 3), 135–138 (1991).

    PubMed  Google Scholar 

  195. Li, M. et al. Hepatitis E virus infection and its associated adverse feto-maternal outcomes among pregnant women in Qinhuangdao, China. J. Matern. Fetal Neonatal. Med. 33, 3647–3651 (2020).

    CAS  PubMed  Google Scholar 

  196. El Sayed Zaki, M., El Razek, M. M. A. & El Razek, H. M. A. Maternal-fetal hepatitis E transmission: is it underestimated? J. Clin. Transl. Hepatol. 2, 117–123 (2014).

    PubMed  PubMed Central  Google Scholar 

  197. Kamar, N. et al. Hepatitis E virus infection. Clin. Microbiol. Rev. 27, 116–138 (2014).

    PubMed  PubMed Central  Google Scholar 

  198. Gouilly, J. et al. Genotype specific pathogenicity of hepatitis E virus at the human maternal-fetal interface. Nat. Commun. 9, 4748 (2018).

    PubMed  PubMed Central  Google Scholar 

  199. Knegendorf, L. et al. Hepatitis E virus replication and interferon responses in human placental cells. Hepatol. Commun. 2, 173–187 (2018).

    CAS  PubMed  PubMed Central  Google Scholar 

  200. Gad, Y. Z. et al. Seroprevalence of subclinical HEV infection in asymptomatic, apparently healthy, pregnant women in Dakahlya Governorate, Egypt. Asian J. Transfus. Sci. 5, 136–139 (2011).

    PubMed  PubMed Central  Google Scholar 

  201. Yang, C. et al. Increased oestradiol in hepatitis E virus-infected pregnant women promotes viral replication. J. Viral Hepat. 25, 742–751 (2018).

    CAS  PubMed  Google Scholar 

  202. Kumar, A. et al. Impact of maternal nutrition in hepatitis E infection in pregnancy. Arch. Gynecol. Obstet. 296, 885–895 (2017).

    PubMed  Google Scholar 

  203. Rein, D. B. et al. The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology 55, 988–997 (2012).

    PubMed  Google Scholar 

  204. Gurley, E. S. et al. Estimating the burden of maternal and neonatal deaths associated with jaundice in Bangladesh: possible role of hepatitis E infection. Am. J. Public Health 102, 2248–2254 (2012).

    PubMed  PubMed Central  Google Scholar 

  205. Sharma, S. et al. Risk factors for vertical transmission of hepatitis E virus infection. J. Viral Hepat. 24, 1067–1075 (2017).

    CAS  PubMed  Google Scholar 

  206. Nishiyama, T. et al. Screening of novel drugs for inhibiting hepatitis E virus replication. J. Virol. Methods 270, 1–11 (2019).

    CAS  PubMed  Google Scholar 

  207. Bertuzzo, V. R. et al. Pregnant woman saved with liver transplantation from acute liver failure due to hepatitis E virus. Transpl. Int. 27, e87–e89 (2014).

    PubMed  Google Scholar 

  208. Li, S. W. et al. The development of a recombinant hepatitis E vaccine HEV 239. Hum. Vaccin. Immunother. 11, 908–914 (2015).

    PubMed  PubMed Central  Google Scholar 

  209. Cao, Y. et al. Development of new hepatitis E vaccines. Hum. Vaccin. Immunother. 14, 2254–2262 (2018).

    PubMed  PubMed Central  Google Scholar 

  210. Zaman, K. et al. HEV study protocol: design of a cluster-randomised, blinded trial to assess the safety, immunogenicity and effectiveness of the hepatitis E vaccine HEV 239 (Hecolin) in women of childbearing age in rural Bangladesh. BMJ Open 10, e033702 (2020).

    CAS  PubMed  PubMed Central  Google Scholar 

  211. Zhao, Y. et al. A preliminary cost-effectiveness analysis of hepatitis E vaccination among pregnant women in epidemic regions. Hum. Vaccin. Immunother. 12, 2003–2009 (2016).

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Keck School of Medicine, University of Southern California, Los Angeles, USA

    Norah A. Terrault

  2. Department of Gastroenterology and Liver, Liverpool Hospital, University of New South Wales, Sydney, New South Wales, Australia

    Miriam T. Levy

  3. Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong

    Ka Wang Cheung

  4. French National Research Institute for Sustainable Development (IRD), Marseille, France

    Gonzague Jourdain

  5. Chiang Mai University, Chiang Mai, Thailand

    Gonzague Jourdain

Authors
  1. Norah A. Terrault
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Miriam T. Levy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ka Wang Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gonzague Jourdain
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed equally to this article.

Corresponding author

Correspondence to Norah A. Terrault.

Ethics declarations

Competing interests

N.A.T. has received institutional grant support unrelated to this work from Gilead Sciences and Roche/Genentech. M.T.L. is an adviser or has received research grants from AbbVie, Gilead Sciences, Merck/MSD and Bayer. G.J. owns equities in Sanofi and has received grants from Gilead. K.W.C. has no competing interests.

Additional information

Peer review information

Nature Reviews Gastroenterology & Hepatology thanks T. Chen and the other, anonymous, reviewers for their contribution to the peer review of this work.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Related link

Gavi, The Vaccine Alliance: https://www.gavi.org/

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Terrault, N.A., Levy, M.T., Cheung, K.W. et al. Viral hepatitis and pregnancy. Nat Rev Gastroenterol Hepatol 18, 117–130 (2021). https://doi.org/10.1038/s41575-020-00361-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41575-020-00361-w

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing