What Examinations Are Required for Pregnant Women with “Big Three Positive” Hepatitis B?

“HBV ‘Big Three-Positive’” (i.e., positive for HBsAg, HBeAg, and anti-HBc) indicates that the patient is a chronic hepatitis B virus (HBV) carrier. This virus is commonly transmitted from mother to child via vertical transmission. So, what tests should be performed if a woman with “Big Three-Positive” hepatitis B becomes pregnant?

What Tests Are Required for Pregnant Women with “Big Three-Positive” Hepatitis B?

Liver function test: To assess whether the patient’s liver function remains normal. Pregnancy increases the metabolic burden on the liver; thus, any abnormality in liver function must be promptly treated, and pregnancy should only be considered after liver function has fully normalized.
HBV-DNA testing: To evaluate the level of HBV replication and infectivity in the patient, thereby minimizing the risk of mother-to-child transmission. A positive HBV-DNA result indicates active viral replication; in such cases, conception should be deferred until viral load is adequately controlled.
Abdominal ultrasound (liver ultrasound): Since chronic HBV infection may lead to structural liver changes, ultrasound helps detect hepatic lesions or abnormalities.

If no hepatic lesions are found and viral replication is low, pregnancy may be considered.
Complete blood count (CBC): Patients with “Big Three-Positive” hepatitis B are at increased risk of postpartum hemorrhage. Prolonged clotting time poses life-threatening risks; therefore, regular CBC monitoring is essential.

Currently, the most effective strategy to prevent HBV transmission to newborns is timely administration of the hepatitis B vaccine—ideally within 12–24 hours after birth. We hope this information is helpful to you!