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Background: Perinatal transmission of hepatitis B virus (HBV) occurs in approximately 10-15% of children from mothers with high viral load despite active-passive immunoprophylaxis. Data is limited for the optimal target population and starting point for antiviral therapy in this setting. Methods: A total of 221 singleton pregnant women with detectable HBV-DNA levels (≥ 10^3 copies/mL) were enrolled during January 2011 to June 2015. Forty-three high viraemic patients (≥ 10^6 copies/mL) received telbivudine in the 2nd or 3rd trimester according to their intention, while 89 high viraemic and 79 low viraemic (≥10^3 and <10^6 copies/mL) patients were the control cohorts. Primary endpoint was the pregnancy outcomes and secondary endpoint the perinatal transmission including intrauterine infection, immunoprophylaxis failure and occult infection. Results: In all, 209 patients completed pregnancy with 209 infants, while 2 in telbivudine-treated cohort had unexplained late stillbirths. Twenty-nine (70.7%) of telbivudine-treated patients and 3 (3.4%) of untreated high viraemic controls achieved undetectable HBV-DNA levels prior delivery. At 7 months postpartum, immunoprophylaxis failure was significantly lower (2.4%) in telbivudinetreated cohort, compared with 16.9% and 10.1% in untreated high and low viraemic cohorts respectively. Conclusions: Low viraemic patients may also need antiviral therapy since they bear moderate risk for perinatal transmission of HBV. However, more multicenter, large-scale studies are required before antepartum antiviral therapy is routinely recommended in patients with detectable viral loads. [ABSTRACT FROM AUTHOR]