This study evaluated HBV screening rates and predictors in pregnancy before and after implementation of the updated 2023 CDC and ACOG hepatitis B screening guidelines which recommend a triple panel of HBsAg, HBcAb, and HBsAb.  Authors retrospectively reviewed the charts of 19,499 adult women who had at least one documented pregnancy encounter and HBV test result across two hospital-based obstetric practices affiliated with a large urban academic center between August 2021 and March 2024.  Overall, 1,566 individuals (8%) had complete triple panel testing: rates varied by race/ethnicity and Medicaid status (a higher rate of complete testing was observed among individuals with Medicaid coverage compared to other insurance types, 11% vs. 7%,).  Of 1,638 individuals who underwent HBsAg testing after the two practices’ implementation of updated guidelines in February 2024, 332 (20%) received triple screening compared to 1245/17,861 (7%) of women tested prior to implementation, a significant increase.  Out of 5,038 women tested for HBsAb, 1,430 (28%) had non-reactive results: of this group, 394 (28%) were negative for all three tests suggesting possible non-immunity and thus vaccine eligibility.  19,495 individuals were tested for HBsAg, 80 (0.4%) of whom had reactive results.  Of 1,779 individuals tested for HBcAb, 95 (5%) had reactive results.