Mother-to-child transmission (MTCT) is a major route of hepatitis B virus (HBV) transmission. However, little is known about the clinical features of the key population involved with MTCT. This study aimed to characterize the clinical features and identify predictive factors of high serum HBV DNA levels (HBV DNA >200,000 IU/mL) among reproductive-aged chronic hepatitis B (CHB) women. This was a retrospective study performed in a tertiary hospital in Malaysia. Female, reproductive-aged, CHB patients in hospital care between 2009 to 2018 were identified from the medical records. Electronic medical records of the patients were reviewed to capture information on demographics, clinical features, and liver status. A total of 262 eligible CHB women (median age=37 years, IQR=12) were studied. Of this, 62.5%, (n=160) had high HBV DNA levels >200,000 IU/mL. A total of 202 patients had a recorded liver status of which 16 (7.9%) had advanced fibrosis, 38 (18.8%) had liver cirrhosis and 13 (6.4%) had hepatocellular cirrhosis. Predictors of high HBV DNA levels were HBeAg positive and abnormal ALT. HBeAg positive increased the risk of high HBV DNA levels by 9.99 times (adjusted OR=9.99; 95%CI=5.50, 18.13; p<0.001) compared to HBeAg negative patients. Abnormal ALT levels increased the risk of high HBV DNA levels by 1.87 times than those with normal ALT (adjusted OR=1.87; 95%CI=1.02, 3.45; p=0.015). In conclusion, current findings suggest that HBeAg positive and abnormal ALT levels may act as a guide in determining HBV transmission prevention strategies in female reproductive-aged patients.