Nucleoside (acid) analogs inhibit viral replication by affecting protein anabolism and may have potential risks to pregnant patients and fetal development. They should be considered only when the benefits outweigh the risks, after weighing the pros and cons. In general, when nucleoside (acid) analogs are used, the risks are greater in early pregnancy than in mid- to late-pregnancy; the benefits of treatment in the event of a hepatitis episode outweigh the prevention of mother-to-child transmission alone. Currently, common pregnancy safety issues that require clinical management can be summarized as follows: (1) Post-pregnancy treatment: For female patients of childbearing age with normal or slightly elevated ALT/AST, high HBV DNA replication, and expecting to have children in the near future, patients should be encouraged to become pregnant first and consider antiviral therapy later. Because such patients have no indication for antiviral therapy for the time being or the indication is unclear, it is difficult to achieve satisfactory efficacy and even more difficult to reach the treatment endpoint. Long-term treatment may have drug-to-pregnancy risks that make it difficult to meet the patient’s near-term fertility needs. In contrast, the patient’s disease is basically in a stable stage, and the temporary absence of medication will not necessarily affect the next step of treatment. Of course, the patient should be closely monitored during pregnancy and antiviral therapy should be implemented in case of hepatitis flare-ups with markedly elevated ALT/AST, especially after the third month of pregnancy. This is a consideration to minimize the risk and put the benefit to the maximum. (2) Pregnancy after treatment: For female patients of childbearing age with significantly elevated ALT/AST, active HBVDNA replication, and expecting to have children in the near future, patients should be advised to receive antiviral treatment for the problem before considering childbirth. Such patients have indications for antiviral therapy, and without treatment the disease may become further active and progress, and also inevitably affect the safety of pregnancy. Of course, the antiviral treatment should be chosen for a short and definite course of treatment, with a high probability of reaching the discontinuation indication. Pregnancy can be considered after 3-6 months of discontinuation and observation. If the disease is stable during treatment but the indication for discontinuation cannot be reached, treatment with lamivudine or telbivudine can be continued or changed with the patient’s informed consent, while the patient can choose whether to become pregnant or not. (3) Treatment during pregnancy: For patients who have received antiviral therapy and have stable disease, but have not reached the treatment endpoint and are continuing treatment, and who expect to have children in the near future, treatment with lamivudine or telbivudine may be continued or changed with full communication and informed consent from the patient, while allowing the patient to choose whether or not to become pregnant. Patients should be closely observed during pregnancy and treatment should be continued after delivery until indications for discontinuation are met. (4) Treatment in late pregnancy: The main objective is to reduce vertical transmission from mother to child. Full communication with the patient and informed consent should be obtained before treatment.