Vertical transmission of hepatitis B virus (HBV) from infected mothers to their fetuses or new born either in utero or peripartum remain a major source of perpetuating the reservoir of chronically infected individuals globally. The main aim of this study is to determine perinatal transmission of the HBV in the Ghanaian setting. One hundred and sixty one (161) pregnant women who were positive for HBV and their respective neonates were enrolled in the study. Viral loads of the mothers were determined using peripheral blood sample and analyzed by PCR. Cord blood of the neonates was assessed for HBV DNA using PCR. The mothers were categorized as having high or low viral load using 106 copies/ml as the reference point. Socio-demographic and obstetrical data were collected using a pre-tested checklist. The babies were assessed for birth weight, prematurity and any abnormalities. Sixty neonatal cord bloods were positive for HBV DNA, a perinatal transmission of 37.3%. The study revealed a positive association between maternal viral load (p<0.001) and neonatal HBV DNA status. The male sex (P<0.001) is at a higher risk for vertical transmission than the females. Preterm delivery and birth weight were comparable between the two groups. Screening of pregnant women for HBV is necessary for the required intervention to reduce MTCT.