Key takeaways: Babies born to parents with hepatitis B should receive the hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth. Completing the vaccine series and follow-up testing protects most babies. Breastfeeding is generally safe.
Hepatitis B is a virus that infects the liver. Without protection, a baby born to a parent with hepatitis B has a high chance of becoming infected, and about 90 percent of babies infected at birth develop lifelong infection. The good news: timely treatment prevents most infections.
Testing in Pregnancy
All pregnant people should be tested for hepatitis B surface antigen (HBsAg) in pregnancy. If you test positive, your provider may also check your viral load. If it’s high, antiviral medicine during the third trimester may be recommended to further lower the risk of passing the virus to your baby.
At Birth
Within 12 hours of birth, babies born to HBsAg-positive parents should receive:
- Hepatitis B vaccine (first dose).
- Hepatitis B immune globulin (HBIG), which provides immediate antibodies.
If a parent’s hepatitis B status is unknown at delivery, the baby should receive the vaccine within 12 hours, and the parent should be tested promptly. Depending on results and the baby’s birth weight, HBIG may also be given.
From the author
From First Breath to First Birthday is my month-by-month guide to your baby’s first year, written as a NICU and postpartum nurse. My book starts in the first hours after birth and walks you through every newborn check and the weeks that follow.
Completing the Series
Your baby needs to complete the full hepatitis B vaccine series on schedule. Babies with very low birth weight may need an extra dose.
Follow-Up Testing
After the series is complete, usually at 9 to 12 months of age (or 1 to 2 months after the final dose if it’s later), your baby should have blood tests to confirm:
- They don’t have hepatitis B infection.
- They have protective antibodies.
If antibodies are low, your doctor may recommend additional doses.
Breastfeeding
Breastfeeding is generally considered safe for babies of parents with hepatitis B, especially once the baby has received the vaccine and HBIG. If your nipples are cracked or bleeding, talk with your provider or a lactation consultant.
Your Own Care
Follow up with a liver specialist or your primary care provider for ongoing monitoring of your hepatitis B. Household members and sexual partners should also be tested and vaccinated if needed.
The Bottom Line
With the hepatitis B vaccine and HBIG within 12 hours of birth, completion of the series, and follow-up testing, most babies born to parents with hepatitis B are protected.
Want more support for your baby’s first year? My book, From First Breath to First Birthday, is available on Amazon.
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Sources
- American Academy of Pediatrics. Red Book: 2024-2027 Report of the Committee on Infectious Diseases. 33rd ed. American Academy of Pediatrics; 2024. Hepatitis B.
- American Academy of Pediatrics. Hepatitis B vaccine frequently asked questions. https://www.aap.org/en/patient-care/hepatitis-b/
- Centers for Disease Control and Prevention. Perinatal hepatitis B. https://www.cdc.gov/hepatitis-b
- Dionne-Odom J, Tita AT, Silverman NS; Society for Maternal-Fetal Medicine. #38: Hepatitis B in pregnancy screening, treatment, and prevention of vertical transmission. Am J Obstet Gynecol. 2016;214(1):6-14.
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
