Are pregnant women routinely tested for hepatitis B?

Yes. When you come in for your first prenatal visit, you'll be given a series of routine blood tests, including one that checks for the presence of the hepatitis B virus (HBV), which can cause severe illness, liver damage, and even death.

More than a million people in the United States carry the virus, but many have no symptoms and don't know they're carriers. If you're one of them, you could pass the virus to your baby at birth. Determining that you're a carrier would allow your healthcare practitioner to treat your baby immediately after delivery, which would most likely prevent her from becoming infected.

If you test negative for HBV and have not received the hepatitis B vaccine, your practitioner may recommend that you get immunized if you're at high risk for contracting the disease (see below for groups at high risk). The shot is safe for pregnant women and has no effect on your developing baby.

How would I have become an HBV carrier?

Hepatitis B (also referred to as hep B) is a highly infectious virus that's spread through blood, semen, and other bodily fluids. If you're a carrier, you may have contracted the virus:

  • Through sexual contact with another carrier
  • At birth, if your mother was a carrier
  • By sharing needles or getting stuck by a needle accidentally
  • By using a toothbrush or razor that has even a small trace of a carrier's blood on it (even one you can't see)
  • By getting a body piercing or tattoo at a place where good health practices aren't followed

What are the symptoms of HBV?

If you contract hepatitis B, you may feel very tired. You may also have abdominal pain, nausea and vomiting, a loss of appetite, joint pain, or jaundice (your eyes and skin take on a yellow tinge). But many people have no symptoms and never even know they've been infected.

About 10 to 15 percent of people who are 5 years of age or older when they contract HBV end up as hepatitis B carriers — meaning that their body never gets rid of the virus. About a quarter of those with a chronic HBV infection will eventually end up with a life-threatening liver disease, and about 20 percent of those with liver disease develop liver cancer. An estimated 5,000 people in the United States die every year from illness caused by HBV.

What happens if I test positive for HBV?

For starters, your practitioner may ask you to take a more detailed blood test to get additional information about your condition and your liver function. He may give you a shot of hepatitis B immunoglobulin (HBIG), which are antibodies that will help you avoid severe symptoms. Because the virus affects your liver, you'll need to avoid alcohol completely — not just while you're pregnant.

You'll most likely go to a specialist for further care, including periodic evaluations of your liver function. Everyone else in your household, as well as any sexual partners, should be tested. If they aren't carriers, they should be vaccinated. (Use condoms during sex to avoid infecting your partner.)

Vaginal deliveries and c-sections are equally safe for HBV carriers. And HBV positive moms can breastfeed provided they protect their nipples from cracking and bleeding.

Immediately after you give birth, your medical team will give your baby a shot of hepatitis B antibodies that should protect her from infection in the short term. She should also receive her first shot of hepatitis B vaccine within 12 hours of birth. She can get the second and third doses at her regular doctor's visits.

All three shots are necessary for lifelong protection, and the Centers for Disease Control and Prevention recommends that all babies receive them. Together, the antibodies and the vaccine are about 90 percent effective at preventing hepatitis B infection in babies.

Get ongoing follow-up care after you deliver, because chronic carriers are at risk for serious liver disease.

What would happen if my baby did get hepatitis B?

If you're an HBV carrier and have not received the antibodies, your chances of transmitting the virus to your baby at birth are about 10 to 20 percent unless she receives treatment within 12 hours of birth. (The risk of transmission is 80 to 90 percent if you became infected with hepatitis B during your third trimester.)

Infants who become infected might not have any symptoms right away but are much more likely than adults (90 percent instead of 5 to 10 percent) to become chronic carriers. Chronic carriers may spread the virus throughout their lives and are at higher risk of developing and dying from liver disease or cancer. There's no cure for hepatitis B, although certain drugs are effective at controlling liver disease in about 40 percent of infected people.

Who is most at risk for contracting hepatitis B?

Because hepatitis B is transmitted through exposure to blood and body fluids, those most likely to be infected include healthcare workers, household contacts and sexual partners of carriers, people with multiple sexual partners, and intravenous drug users. Immigrants from Southeast Asia, Africa, the Middle East, the Pacific Islands, and the Amazon basin also have higher rates of infection.

The good news is that the vaccination can protect you if you don't already have the virus. If you're at risk for hepatitis B, be sure to get vaccinated.