Can a mother with "big three positive" (positive for HBsAg, HBeAg, and anti-HBc) pass it on to her child?

Mother having "big three positives" generally does not genetically pass the condition to her child, but she may transmit the infection. The specific analysis is as follows:

"Big three positives" refers to positive results for hepatitis B surface antigen, hepatitis B e-antigen, and hepatitis B core antibody, which typically indicate chronic hepatitis B virus infection. Since chronic viral hepatitis B is an infectious disease rather than a genetic disorder, it is not inherited. However, mother-to-child (vertical) transmission is the primary route of spread. If a mother tests positive for hepatitis B virus during pregnancy, she may transmit the virus to her child. If the father is hepatitis B positive, transmission to the child may occur through close contact. Additionally, because infants have relatively weak immune systems, they are more likely to develop chronic hepatitis B infection. Pregnant women who test positive for hepatitis B virus—especially those with "big three positives" or viral loads exceeding 10^6 copies/mL—should, under medical guidance, take antiviral medications between weeks 24 and 28 of pregnancy to prevent vertical transmission. Newborns should receive hepatitis B immunoglobulin within 12 hours after birth and undergo appropriate follow-up testing for hepatitis B.

When breastfeeding, be cautious about any damage or breaks in the nipple or the infant's oral mucosa, to avoid blood-borne transmission.