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Screening with HBsAg* should be performed in each pregnancy, regardless of previous HBV* vaccination or previous negative HBsAg test results.

Offer triple panel (HBsAg, anti-HBs, total anti-HBc*) screening to all pregnant persons ≥18 years of age who have not previously been screened with 

a triple panel.

FIRST TRIMESTER

1-13 weeks

SECOND TRIMESTER

14-27 weeks

THIRD TRIMESTER

>28weeks DELIVERY AND POSTPARTUM

SCREENING AND TESTING - Screen all pregnant persons for 

HBsAg at first prenatal visit. Screen 

with triple panel if not previously 

screened. 

-All positive HBsAg results during 

the pregnancy should be 

confirmed with a licensed HBsAg 

neutralizing test according to 

manufacturer labeling.

- If HBsAg positive, check HBV DNA. 

- Screen for HBsAg those not 

previously screened during current 

pregnancy. See first trimester for 

specific details.

- Check/recheck HBV DNA for all

HBsAg positive persons not on 

anti-viral treatment at 26-28 

weeks.

- Screen for HBsAg those not 

previously screened during current 

pregnancy. See first trimester for 

specific details. 

- Check/recheck HBV DNA for all 

HBsAg positive persons not on 

anti-viral treatment at 26-28 

weeks or if DNA not checked 

at/after 26 weeks.

- Screen for HBsAg those not 

previously screened during current 

pregnancy.

-Rescreen for HBsAg pregnant 

persons with clinical hepatitis or 

risk exposures† during pregnancy

at the time of admission to the 

hospital or birthing facility for 

delivery.

MANAGEMENT - After initial HBsAg screen is drawn

for current pregnancy, initiate 

vaccine series with Engerix-B, 

Recombivax-HB or Twinrix§ for 

those who have not previously 

been vaccinated.

- Report HBsAg positives to

Perinatal Hepatitis B Coordinator

and refer to specialty care.

- After initial HBsAg screen is drawn 

for current pregnancy, initiate 

vaccine series if needed. See first 

trimester for specific details.

-Report HBsAg positives to Perinatal 

Hepatitis B Coordinator and refer 

to specialty care.

- After initial HBsAg screen is drawn 

for current pregnancy, initiate 

vaccine series if needed. See first 

trimester for specific details.

- Report HBsAg positives to 

Perinatal Hepatitis B Coordinator 

and refer to specialty care.

- If HBV DNA is ≥ 200,000 IU/mL, 

treat at 28-32 weeks until birth.

- Post-exposure prophylaxis¶ for 

infants born to HBsAg positive 

pregnant people and for infants 

weighing less than 2,000 grams 

born to pregnant people with 

unknown HBsAg status.

-Initiate mother’s vaccine series if 

needed. See first trimester for 

specific details.

- Breastfeeding does not increase 

the risk of HBV transmission to 

infants. 

- Report HBsAg positives to 

Perinatal Hepatitis B Coordinator

and refer to specialty care.

*Abbreviations: HBsAg=hepatitis B (HepB) surface antigen; HBV= HepB virus; anti-HBsAg= antibody to HepB surface antigen; total anti-HBC= total antibody to HepB core antigen

Ϯ Recent or current injection-drug use, more than one sex partner in the previous 6 months, HBsAg-positive sex partner, or evaluated or treated for a sexually transmitted infection

§Heplisav and Prehevbrio are not recommended during pregnancy due to lack of safety data; Twinrix is a combination hepatitis A/hepatitis B vaccine that can be given during pregnancy when 

indicated(https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html) 

¶Post-exposure prophylaxis: administer HepB immunoglobulin and HepB vaccine to the infant within 12 hours of birth and notify infant’s Health Care Provider to f/u for timely vaccination and post 

vaccination serologic testing

Adapted from:

Weng MK, Doshani M, Mohammed AK, et al. Universal Hepatitis B Vaccination in Adults Aged 19–59 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United 

States, 2022. 

Conners EE, Panagiotakopoulos L, Hofmeister MG, et al. Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations — United States, 2023. 

Terrault NA, Bzowej NH, Chang K-M, et al. AASLD guidelines for treatment of chronic hepatitis B. Hepatology 2016;63(1):261-83. 

Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. 

Obstetrical Tip Sheet for Hepatitis B Screening, Testing, and Management of Pregnant Persons