The grades of evidence (I-III) and levels of recommendation (A-C) are defined at the end of the "Major Recommendations" field.
The following recommendations are based on good and consistent scientific evidence (Level A):
- Routine prenatal screening of all pregnant women by hepatitis B surface antigen (HBsAg) testing is recommended.
- Newborns born to hepatitis B carriers should receive combined immunoprophylaxis consisting of hepatitis B immune globulin (HBIG) and hepatitis B vaccine within 12 hours of birth.
- Hepatitis B infection is a preventable disease, and all at-risk individuals, particularly health care workers, should be vaccinated. All infants should receive the hepatitis B vaccine series as part of the recommended childhood immunization schedule.
- Breastfeeding is not contraindicated in women with hepatitis A virus (HAV) infection with appropriate hygienic precautions, in those chronically infected with hepatitis B if the infant receives HBIG passive prophylaxis and vaccine active prophylaxis, or in women with hepatitis C virus (HCV) infection.
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- Routine prenatal HCV screening is not recommended; however, women with significant risk factors for infection should be offered antibody screening.
- Route of delivery has not been shown to influence the risk of vertical HCV transmission, and cesarean delivery should be reserved for obstetric indications in women with HCV infection.
The following recommendations are based primarily on consensus and expert opinion (Level C):
- The risk of transmission of hepatitis B associated with amniocentesis is low.
- Susceptible pregnant women who are at risk for hepatitis B infections should be specifically targeted for vaccination.
Definitions:
Grades of Evidence
I Evidence obtained from at least one properly designed randomized controlled trial.
II-1 Evidence obtained from well-designed controlled trials without randomization.
II-2 Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
II-3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Levels of Recommendation
Level A — Recommendations are based on good and consistent scientific evidence.
Level B — Recommendations are based on limited or inconsistent scientific evidence.
Level C — Recommendations are based primarily on consensus and expert opinion.