Chronic hepatitis B virus (HBV) infection has become a global health problem. Currently, more than 400 million people are affected worldwide, with 75% of those infected in Asia, the western Pacific and sub-Saharan Africa. There are about 93 million people with chronic HBV infection in China, including about 20 million cases of chronic hepatitis B. Mother-to-child transmission is an important route of HBV infection, and since HBV infection during infancy is often prone to chronic infection, proper prevention and management of HBV infection in women during pregnancy is crucial to interrupting mother-to-child transmission and reducing the rate of chronic infection. However, there are still many problems in the management of hepatitis B in pregnancy, such as the lack of a uniform guideline strategy for the management of mother-to-child hepatitis B, the risk of exacerbation of HBV infection in the postpartum period, and the lack of data from randomized clinical trials to assess the safety and efficacy of antiviral therapy in pregnancy. In this regard, Visvanathan, Associate Professor of Infectious Diseases at St. Vincent’s Hospital, University of Melbourne, together with experts from Australia, the United Kingdom and New Zealand, have reviewed these issues based on the available clinical evidence and data, with the aim of providing guidance for women with HBV infection before pregnancy, during all stages of pregnancy, and for postpartum maternal and infant follow-up. The article was recently published online in the journal Gut. The following is an overview of the main points of focus in this field, to provide reference for the medical practice of the relevant departments: 1. Evidence and recommendations for prenatal HBV screening and referral pathways (1) HBV prenatal screening and infant vaccination have gradually shifted from selective to universal implementation. The United States Preventive Medicine Task Force (USPSTF) strongly recommends that pregnant women receive prenatal HBV screening during their first maternity visit. The Obstetrics and Gynecology Section of the Chinese Medical Association developed the 1st edition of the Clinical Guidelines for the Prevention of Mother-to-child Transmission of Hepatitis B Virus in 2013. The guidelines clearly state that all pregnant women need to be prenatally screened for hepatitis B serological markers (commonly known as hepatitis B two-and-a-half), and if they are positive for HBsAg, their newborns are at high risk for HBV infection and must be given hepatitis B immunoglobulin within 12h after birth, in addition to hepatitis B vaccination. (2) The ideal referral pathway for antenatal screening for HBV infection is: Antenatal assessment of the condition of pregnant women with HBV infection detected by general screening should be performed, including disease staging and serological assessment and assessment of the risk of transmission (HBeAg, HBVDNA load and understanding of previous history of mother-to-child transmission), and the application of the non-invasive test FibroScan is not recommended during pregnancy. Antenatal education should also be provided to pregnant women on Education about hepatitis B should include disease staging, natural history, explanation of serologic markers, risk of transmission of infection and exacerbation of the disease. In addition, the physician should explain the possibility of antiviral therapy in early and late pregnancy, drug selection, preventive measures, and the advantages and disadvantages of breastfeeding, and discuss with the pregnant woman a reasonable method of delivery. During the perinatal period, the mother’s treatment follow-up schedule and the infant’s vaccination schedule should be precisely implemented. In the postpartum period, the issues of continued postpartum treatment and recurrence of the disease and monitoring of the infant’s infection should be addressed. Patients in this phase can be referred to an infection specialist or managed by a general practitioner for postpartum continuation of treatment. Our guidelines state that before a woman with chronic HBV infection plans to become pregnant, it is best to have her liver function evaluated by a specialist in infection or hepatology: an infected person with consistently normal liver function can have a normal pregnancy; an abnormal liver function can have a pregnancy if it returns to normal after treatment and is rechecked normal more than 6 months after stopping medication. Pregnancy during antiviral therapy must be done with caution. If pregnancy occurs during the use of any antiviral drug, the patient must be informed of the various risks of the drug used and the relevant physician must be consulted to decide whether to interrupt the pregnancy or whether to continue antiviral therapy. If the ALT level rises more than two times the normal value (>80U/L) or the bilirubin level rises during pregnancy follow-up, a consultation with a relevant physician is required, and if necessary, hospitalization is required, and in serious cases, pregnancy should be terminated. (1) Clinicians need to fully evaluate and consider the following aspects: the impact of HBV on pregnancy, the impact of pregnancy itself on the course of HBV infection, what treatment options to choose for HBV infection during pregnancy, and how to interrupt mother-to-child transmission of the virus. Impact of HBV on pregnancy: HBV positivity is a risk factor for adverse perinatal outcomes in pregnant women, including preterm delivery, premature rupture of membranes, placental abruption, increased induction of labor, increased cesarean section rates, increased perinatal mortality, congenital malformations, and low birth weight babies. Effect of pregnancy on HBV: For most pregnant women with HBV infection, their liver disease and liver enzyme levels do not progress significantly during pregnancy. However, cases of worsening liver disease or fulminant liver failure in pregnant women with HBV infection have been reported. HBV-infected women of childbearing age are usually in the “immune tolerance phase” of hepatitis B treatment (a period when the body’s immunity does not recognize HBV and does not effectively clear HBV but liver function is normal), and as more and more women join the late marriage and late childbearing group, more and more infected women are in the “immune clearance phase” of hepatitis B treatment (a period when the body’s immunity actively clears the virus but is prone to (during this period the body is immunologically active in clearing the virus but is prone to recurrent abnormalities in liver function). Given the relatively limited availability of hepatitis B medications for pregnant women, treatment of chronic hepatitis B infection during pregnancy should be carefully weighed against the health of the mother and the safety of the fetus. Treatment should generally be started after delayed childbirth in mild disease, but it may be wiser to delay treatment if pregnancy is contemplated in the near future. Because pegylated interferon is contraindicated in pregnant women, it is also the only drug currently available that provides a sustained virologic response with limited maintenance therapy. Patients without contraindications to pegylated interferon therapy may be considered for use and should be advised to use contraception during treatment. If nucleotide analogs must be used, the most effective drugs recommended are entecavir and tenofovir, with tenofovir being the preferred choice based on available safety data. (2) Is it safe to use anti-HBV drugs during pregnancy? Should the original treatment regimen be changed if pregnancy occurs during treatment.