Viral hepatitis in pregnancy constitutes a complex issue, requiring meticulous management due to the potential potent compromise of both mother’s and fetus’ health. Hepatitis B and C are implicated with a high risk for chronicity, whereas hepatitis A and hepatitis E have an acute course. In pre-existing viral disease, pregnancy may lead to exacerbation of the disease’s course due to a plethora of hormonal, immunological and genetic alterations. Vice versa, viral hepatitis, acute or chronic, during pregnancy, can cause gestational complications that may lead to significant maternal and neonatal morbidity and mortality. Mother to child transmission of hepatitis B and C virus, in high prevalence areas, has been recognized as a major cause of chronic viral infection and related complications in children. Due to the physiologic alterations in pregnancy, therapeutic indications may differ from those in the general population and there is an expanding field of research on available drugs and vaccines efficacy and safety during pregnancy. Of utmost importance remains the implementation of a preventive strategy in order to reduce the rates of vertical transmission. Universal screening of pregnant women, assessing the risk of transmission and determining the mode of delivery and the impact of breastfeeding are crucial aspects of this strategy. This review summarizes the impact of viral hepatitis in pregnancy, strategies of prevention of vertical transmission and available treatments.