ReviewAn Algorithm for Risk Assessment and Intervention of Mother to Child Transmission of Hepatitis B Virus
Section snippets
Hepatitis B e antigen
HBeAg is an 18-kDa secretory protein that is postulated to have immunoregulatory functions in the HBV-infected human host.13 In the clinical setting, HBeAg is used as an index for active viral replication and infectivity. Maternal HBeAg may be filtered through the placenta.14, 15 Although HBeAg is present in up to 70% of neonates at birth, only 10% of these infants are actually infected at birth.16 Without HBV viremia, most infants who are HBeAg positive at birth (representing maternal HBeAg)
Hepatitis B Virus Transmission at the Antepartum Stage
Intrauterine transmission is defined as HBsAg in the neonatal blood 1–30 days after birth or detectable HBV DNA in neonatal peripheral venous blood.36 IUT might occur via infected male germline or maternal oocytes in early embryonic stage.20, 28, 37 IUT is not likely prevented by HBIg and HBV vaccine.22 Other mechanisms for IUT include HBV circulating to the fetus via maternal peripheral blood mononuclear cells,38 “cellular transfer” of HBV from cell to cell in the placenta demonstrated by a
Hepatitis B immunoglobulin Injection
Previous reports showed that HBIg induced >2 log drops in maternal HBV DNA with a modest reduction of MTCT rates when administrated during the antepartum stage.46, 47, 48 However, a recent large randomized controlled trial by Yuan et al49 showed that antepartum HBIg use was not effective in preventing MTCT. In addition, all newborns from mothers who received antepartum HBIg were negative for anti-HBs at birth in this study, further challenging the hypothesis that HBIg transferred to the fetus
Summary and Proposal of an Algorithm for the Prevention of Hepatitis B Virus Mother to Child Transmission
The majority of chronic hepatitis B infections, especially in Asians, are due to perinatal transmissions of HBV. Despite passive-active immunoprophylaxis, maternal HBeAg positivity and HBV DNA levels >200,000 IU (6 log10 copies)/mL are correlated with an increased risk of MTCT.9, 12, 27 The transmission risk increases with higher levels of maternal HBV DNA, or if other factors such as threatened preterm labor, prolonged labor, or a prior child with passive-active immunoprophylaxis failure are
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Risk of mother-to-child transmission after amniocentesis in pregnant women with hepatitis B virus: a retrospective cohort study
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2024, American Journal of Obstetrics and GynecologyMaternal-to-Child Transmission of Hepatitis B Virus and Hepatitis Delta Virus
2023, Clinics in Liver DiseaseEASL Clinical Practice Guidelines on the management of liver diseases in pregnancy
2023, Journal of HepatologyLiver histology of treatment-naïve children with chronic hepatitis B virus infection in Shanghai China
2022, International Journal of Infectious Diseases
Conflicts of interest These authors disclose the following: Dr Pan has the following financial relationships with pharmaceutical companies for the past 5 years: he has received research grants from Gilead, Bristol Myers Squibb, Novartis, Idenix, Roche, and Schering-Plough and also serves as a consultant, advisor, and speakers bureau for Gilead, Bristol Myers Squibb, Novartis, Idenix, Roche, Schering-Plough, Onyx, Three Rivers, Salix, Genentech, Vertex, and Pharmasset. Dr Tong is on the speakers bureau for Bristol Meyers Squibb, Gilead, Genentech, Merck, Vertex, and Onyx. The remaining authors disclose no conflicts.
Funding This manuscript was initially based on the expert consensuses of the First International Symposium on Hepatitis B Infection in Special Population held on April 17–18, 2009 in Beijing, China. The primary writers met again on May 14–15, 2010 in Nan Jing, China, to prepare the final draft with updates. The meetings and manuscript development were supported by the Chinese National Research Grant of the Eleventh Five-Year Plan for the Key Projects in Infectious Diseases (grant no. 2008ZX10002-001).