A 29-year-old pregnant woman at 34 weeks gestation is referred for management of chronic hepatitis B infection identified during prenatal screening. She is positive for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg), with an HBV DNA level of 250,000 IU/mL. She has no symptoms of liver disease, and her ALT levels are mildly elevated. The healthcare team evaluates her risk for perinatal transmission to determine the appropriate interventions. Which maternal factor is the strongest predictor of perinatal transmission of hepatitis B?
