Objective：To compare the efficacy and safety of telbivudine (LdT), tenofovir alafenamide fumarate (TAF) and tenofovir disoproxil fumarate (TDF) for preventing Hepatitis B transmission in immune-tolerant pregnant women with HBV infection. Methods: We conducted a retrospective cohort study involving women who had HBV DNA 2 × 105 IU / ml and initiated LdT, TDF or TAF to prevent mother-to-child transmission (MTCT). The primary endpoint was the safety of mothers and infants. The secondary endpoints were maternal hepatitis B virus DNA reduction at delivery and mother-to-child transmission rate. Results: A total of 96 patients were enrolled in the study ( LdT group, n=36; TDF group, n=35; TAF group, n=25). All infants received hepatitis B virus immunoprophylaxis. The mother-to-child transmission rate was 0%( [0 of 25] vs. [0 of 35] vs [0 of 36], P＞0.05). No severe liver function damage occurred in any of the mothers. Babies delivered in all groups had prenatal ultrasound screening abnormalities, but abnormality rates were not statistically significant between groups. Conclusion: The application of TDF, TAF, or LdT to immune-tolerant HBV-infected pregnant women in middle-late pregnancy, can successfully interrupt mother-to-child transmission of the HBV virus. However, for all three groups of pregnant women who delivered babies with abnormal prenatal ultrasound screening, an expanded sample size may be needed for further observation.