Hepatitis Vaccination in Pregnancy

Direct Recommendation

• The American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention recommend that pregnant women at high risk for hepatitis B infection should receive the hepatitis B vaccine during pregnancy, as it is safe and does not increase adverse pregnancy outcomes 1, 2, 3
• The European Association for the Study of the Liver guidelines recommend that hepatitis A vaccine can also be safely administered to pregnant women at risk of exposure 4

Hepatitis B Vaccination in Pregnancy

Who Should Be Vaccinated

• Pregnant women meeting high-risk criteria, such as having more than one sex partner during the previous 6 months, should receive hepatitis B vaccination 1, 2, 5
• The Centers for Disease Control and Prevention recommend that pregnant women with a history of sexually transmitted infections, recent or current injection-drug use, or an HBsAg-positive sex partner should also receive hepatitis B vaccination 1, 2
• Any pregnant patient who requests the vaccine can be offered vaccination, according to the American College of Obstetricians and Gynecologists 3

Critical Distinction: Maternal vs. Neonatal Protection

• The vaccine does not prevent infant infection from maternal transmission if the mother is already HBsAg-positive, and infants born to HBsAg-positive mothers require both HBIG and vaccine within 12 hours of birth for protection 1, 3, 5

Hepatitis A Vaccination in Pregnancy

Indications

• Vaccination of pregnant women identified to be at risk for hepatitis A infection during pregnancy is recommended by the European Association for the Study of the Liver 4
• Both hepatitis A vaccine and immunoglobulin for postexposure prophylaxis can be used in pregnancy, with 100% consensus support from the European Association for the Study of the Liver guidelines 4

Universal Screening Requirements

• All pregnant women should be tested for HBsAg during the first trimester of each pregnancy, even if previously vaccinated or tested, according to the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists 1, 3, 4
• Testing identifies chronically infected women who need antiviral therapy consideration and ensures infants of HBsAg-positive mothers receive timely prophylaxis 1, 5

Counseling Beyond Vaccination

• Pregnant women at risk should be counseled on additional prevention methods beyond vaccination, including avoidance of high-risk behaviors and exposure reduction strategies, according to the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists 2, 3

Implementation in Clinical Practice

• Healthcare providers should implement standing orders to identify and vaccinate pregnant women at risk as part of routine prenatal services, according to the Centers for Disease Control and Prevention 2

CDC Guidelines for Hepatitis B Vaccination and Screening in Pregnancy

Vaccination Indications

• Pregnant women who have any of the following high‑risk exposures should be offered the hepatitis B vaccine: more than one sexual partner in the past 6 months, evaluation or treatment for a sexually transmitted infection, recent or current injection‑drug use, or a sexual partner who is HBsAg‑positive. [Centers for Disease Control and Prevention] 6

Neonatal Prophylaxis

• Infants born to mothers who are HBsAg‑positive must receive both hepatitis B immune globulin (HBIG) and the hepatitis B vaccine within 12 hours of birth to prevent perinatal transmission. [Centers for Disease Control and Prevention] [7][6]

Universal Screening

• All pregnant women are required to be screened for HBsAg during the first trimester of every pregnancy, regardless of prior vaccination or testing history. [Centers for Disease Control and Prevention] 6
• Pregnant women identified as high‑risk who test HBsAg‑negative in the first trimester should undergo repeat HBsAg testing later in pregnancy. [Centers for Disease Control and Prevention] 6

Breastfeeding Considerations

• Hepatitis B vaccination is safe for lactating women and does not need to be withheld during breastfeeding. [Centers for Disease Control and Prevention] 7
• Infants of HBsAg‑positive mothers may be breastfed immediately after birth, provided they receive the recommended HBIG and vaccine prophylaxis. [Centers for Disease Control and Prevention] 7

Hepatitis B Vaccination During Pregnancy: Safety, Indications, and Implementation

Indications for Vaccination

• Pregnant women who have any of the following high‑risk exposures should be offered the hepatitis B vaccine: multiple sexual partners in the past 6 months, evaluation or treatment for a sexually transmitted infection, recent or current injection‑drug use, or a sexual partner who is HBsAg‑positive. 8, 9
• The vaccine is recommended for all at‑risk pregnant women and should not be delayed or withheld because of pregnancy status. 8

Safety Profile in Pregnancy

• The hepatitis B vaccine contains non‑infectious HBsAg particles and poses no biological risk to the developing fetus. 10
• Extensive clinical experience shows no apparent increase in miscarriage, stillbirth, congenital malformations, or sudden infant death syndrome among vaccinated pregnant persons. 10
• Pregnancy and lactation are not contraindications to hepatitis B vaccination. 10

Administration Guidelines

• The vaccine must be given intramuscularly in the deltoid muscle; administration in the gluteal region markedly reduces immunogenicity and should be avoided. 10
• If a scheduled dose is missed, it should be administered as soon as possible without restarting the series. 10

Maternal Screening and Neonatal Prophylaxis

• All pregnant persons should be screened for HBsAg during the first trimester of every pregnancy, irrespective of prior vaccination history. 8, 9
• Infants born to mothers who test HBsAg‑positive require hepatitis B immune globulin (HBIG) and the hepatitis B vaccine within 12 hours of birth to prevent perinatal transmission. 9

Clinical Implementation Strategies

• Healthcare providers should establish standing orders to identify and vaccinate at‑risk pregnant women as part of routine prenatal services. 8
• Delivery hospitals should adopt policies that ensure universal HBsAg testing of all pregnant patients. 8
• Electronic medical record (EMR) alerts or prompts can facilitate the timely identification of at‑risk pregnant individuals for vaccination. 8