Pregnancy Vaccine Receipt Linked to Greater Odds of Neonatal HBV Vaccination

Stephanie Lambert, MD, MPH

Credit: Penn State Health

New research is shedding light on a significant association between maternal vaccination during pregnancy and neonatal vaccination against hepatitis B virus (HBV) before hospital discharge.¹

Study findings highlight an 8-fold increase in the odds of newborn receipt of the HepB vaccine among participants who received the tetanus, diphtheria, and pertussis (Tdap) vaccine or seasonal influenza vaccine during pregnancy compared with participants who declined both pregnancy vaccinations.¹

According to the World Health Organization, an estimated 254 million people were living with chronic hepatitis B infection in 2022, with 1.2 million new infections occurring each year. In highly endemic areas, hepatitis B is most commonly spread from mother to child at birth via perinatal transmission, leading to chronic hepatitis in as many as 95% of cases.²

Accordingly, the World Health Organization recommends all infants receive the hepatitis B vaccine as soon as possible after birth, within 24 hours, followed by 2 or 3 doses of hepatitis B vaccine at least 4 weeks apart.²

“Increasing the rate of HepB vaccination at birth is an important strategy in preventing HBV infection,” Stephanie Lambert, MD, MPH, an assistant professor in the department of obstetrics and gynecology at Penn State Health, and colleagues wrote.¹ “Although studies have investigated some of the factors influencing vaccine decisions during the prenatal period and childhood, studies exploring correlations between maternal vaccination during gestation and neonatal HepB vaccination are few.”

To address this gap in research, investigators conducted a retrospective cohort study of patients who received prenatal care and delivered at an academic tertiary care hospital in central Pennsylvania between January 2015 and January 2020. Investigators focused solely on the months January, April, July, and October of each year to evaluate whether seasonality impacted influenza vaccine uptake.¹

Vaccination status for influenza and Tdap vaccination during pregnancy was abstracted from patient prenatal charts and documented as either administered, declined, or absent for charts that did not document either administration or declination.¹

In total, the study included 2947 patients with a mean age of 29 (standard deviation [SD], 5.5) years at delivery. The average gestational age was 38.8 weeks (SD, 1.9), and the majority of the cohort was non-Hispanic (87.3%) and White (69.9%).¹

Investigators noted it was the first birth for 1177 (39.9%) patients in the study. Among this cohort, 2645 (89.8%) mothers received ≥ 1 of the 2 recommended vaccinations, influenza or Tdap, during pregnancy, and 2843 neonates (96.5%) received the HepB vaccine in the hospital before discharge.¹

Vaccine receipt during pregnancy was found to be the strongest predictor of HepB vaccine uptake. After adjusting for the other factors of interest, investigators pointed out participants who had ≥ 1 of the vaccinations during pregnancy had 8 times greater odds of vaccinating their neonate against HBV than those who declined both pregnancy vaccinations (adjusted odds ratio [AOR], 8.37; 95% CI, 5.33-13.15; P <.001).¹

Investigators noted first birth was associated with HepB vaccine receipt in the unadjusted model but called attention to a loss of statistical significance after adjusting for the other factors in the model (AOR, 1.49; 95% CI, 0.94-2.35; P = .09). They additionally noted race, ethnicity, age, and NICU disposition were not associated with HepB vaccine receipt in both the unadjusted or adjusted models.¹

“Receipt of the Tdap or seasonal influenza vaccine during pregnancy was associated with newborn receipt of the HepB vaccine in-hospital,” investigators concluded.¹ “Prenatal care presents an opportunity for productive patient engagement to increase HepB vaccination rates for infants.”

References

1. Young Graf Z, Kolagani R, Stetter C, et al. Association of Vaccination in Pregnancy With Newborn Hepatitis B Vaccine Receipt. Perm J. doi:10.7812/TPP/24.061

2. World Health Organization. Hepatitis B. April 9, 2024. Accessed March 5, 2025. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b