1
|
Yuan X, Ma X, Zhu J, Yang Y, Wang Y, Xu J, Dai L, Li H, Liu Z, Dong J, Wang K, Li X, He Y. Maternal infection with hepatitis B virus before pregnancy and risk of congenital malformations in offspring: a record-linkage study of a large national sample from China. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101121. [PMID: 39040040 PMCID: PMC11262192 DOI: 10.1016/j.lanwpc.2024.101121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 07/24/2024]
Abstract
Background Whether hepatitis B virus (HBV) infection of women prior to pregnancy can influence risk of congenital malformations in offspring remains controversial. We assessed the association between them by considering congenital malformations in the aggregate as well as risk of organs systems using a large national sample of Chinese women. Methods We performed a record-linkage cohort study of women who participated in National Free Preconception Health Examination Project, between January 1, 2010, and December 31, 2019 for whom data on congenital malformations in their offspring were available from the National Population-Based Birth Defects Surveillance Network. A total of 498,968 linked records were obtained, of which 127,371 were excluded because HBV status before pregnancy was unknown, the records involved multiple pregnancies, or pre-pregnancy examinations were conducted after conception. Based on pre-pregnancy status, mothers were assigned to two categories of HBsAg- or HBsAg+ and, in certain analyses, to three categories of HBsAg-, HBsAg+/HBeAg- or HBsAg+/HBeAg+. Potential associations of serological status with risk of congenital malformations, considered separately or in aggregate, were explored using multilevel logistic regression. Factors that might influence such associations were also explored. Findings Among the 371,597 women analyzed, 21,482 (5.78%) were HBsAg+ before pregnancy, and 8333 (2.24%) had a fetus or child diagnosed with congenital malformations, composed of 7744 HBsAg- women and 589 HBsAg+ women. HBsAg+ status was associated with increased risk of congenital malformations in the aggregate (OR 1.14, 95% CI 1.03-1.25) and of cardiovascular malformations specifically (OR 1.18, 95% CI 1.03-1.35). HBsAg+/HBeAg- status was associated with significantly higher risk of cardiovascular malformations (OR 1.19, 95% CI 1.01-1.39) as well as reproductive malformations (OR 1.51, 95% CI 1.02-2.23). Associations between HBsAg+ status before pregnancy and risk of congenital malformations was modified by alanine aminotransferase activity (P interaction < 0.05). Interpretation Prepregnancy HBV infection might be associated with fetal malformations. This association needs further investigation to confirm whether it is a causal association, and assess whether antiviral therapy of women with HBsAg+ planning to conceive might reduce the risk of fetal malformations. Funding The National Health Commission of the People's Republic of China, China; Science and Technology Department of Sichuan Province, China; and the Ministry of Science and Technology of the People's Republic of China.
Collapse
Affiliation(s)
- Xuelian Yuan
- National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, 610041, China
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, 100081, China
- National Human Genetic Resources Center, Beijing, 101199, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Jun Zhu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, 610041, China
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, 100081, China
- National Human Genetic Resources Center, Beijing, 101199, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yanping Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, 610041, China
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jihong Xu
- National Research Institute for Family Planning, Beijing, 100081, China
- National Human Genetic Resources Center, Beijing, 101199, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Li Dai
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, 610041, China
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Huimin Li
- National Research Institute for Family Planning, Beijing, 100081, China
- National Human Genetic Resources Center, Beijing, 101199, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Zhen Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, 610041, China
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jing Dong
- National Research Institute for Family Planning, Beijing, 100081, China
- National Human Genetic Resources Center, Beijing, 101199, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Ke Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, 610041, China
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaohong Li
- National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, 610041, China
- Sichuan Birth Defects Clinical Research Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yuan He
- National Research Institute for Family Planning, Beijing, 100081, China
- National Human Genetic Resources Center, Beijing, 101199, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| |
Collapse
|
2
|
Meng X, Dai X, Huang J, Han T, Liao X, Cheng K, Sun X, Xie Q, Sun P, Zhou X. The influence of male HBV infection on sperm quality, embryonic development, and assisted reproductive outcomes. Hum Reprod 2024; 39:43-52. [PMID: 37994690 DOI: 10.1093/humrep/dead235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/12/2023] [Indexed: 11/24/2023] Open
Abstract
STUDY QUESTION What is the impact of male hepatitis B virus (HBV) infection on sperm quality, embryonic development, and assisted reproductive outcomes? SUMMARY ANSWER Male HBV infection did not affect assisted reproductive outcomes, but HBV is capable of impairing human sperm and embryo formation in the early stages following fertilization. WHAT IS KNOWN ALREADY HBV is found in germ cells and early embryos of patients with HBV. HBV may impair human sperm function via increasing reactive oxygen species. STUDY DESIGN, SIZE, DURATION We conducted a retrospective cohort study of 1581 infertile couples, including 496 male patients clinically confirmed to have hepatitis B infection, and a laboratory study of effects of HBV proteins on early embryos, using human embryonic stem cells (hESCs), human sperm, and golden hamster oocytes. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 1581 infertile couples (24-40 years of age) who were admitted to a reproductive medicine center to undergo ART for the first time from January 2019 to November 2021 were selected as the study subjects. The case group was composed of 469 couples with hepatitis B surface antigen (HBsAg)-seropositive men and seronegative women (368 for IVF and 101 for ICSI treatment). The negative control group was composed of 1112 couples where both men and women were seronegative for hepatitis B antigen. We divided these couples into three comparison groups (IVF/ICSI, IVF, and ICSI). IVF of human sperm and hamster oocytes was used to evaluate the influence of the HBV HBs protein on formation of 2-cell embryos. Mitochondrial membrane potential (MMP) of hESCs was assayed via a fluorescence intensity system. Immunofluorescence staining of the phosphorylated histone H2A.X was applied to identify DNA damage to hESCs caused by the HBV X (HBx) protein. MAIN RESULTS AND THE ROLE OF CHANCE Sperm concentration, total sperm number, and sperm with normal morphology were decreased in the couples with HBV-infected males in couples who were undergoing IVF/ICSI (male HBV(+) vs control: 469 vs 1112 individuals; sperm number, P < 0.01; normal sperm morphology, P < 0.01), IVF (368 vs 792; sperm number, P < 0.01; normal sperm morphology, P ≤ 0.05), and ICSI (101 vs 306; sperm number, P < 0.01; normal sperm morphology, P < 0.001). There was no significant difference in the number of embryo cleavages, blastocyst formation, biochemical pregnancy rate, clinical pregnancy rate, and live-birth rate between case and control groups. The 2PN fertilization rate in IVF/ICSI (P < 0.01) and ICSI (P < 0.05) couples, and the number of 2PN-fertilized oocytes in IVF (P < 0.001) couples were lower in couples with male HBV infection compared to control couples. HBV HBs protein reduced the MMP of human sperm and decreased 2-cell embryo formation in IVF of human sperm and zona-free-hamster oocyte. A reduction in fluorescence intensity and immunofluorescence staining of phosphorylated histone H2A.X indicated that HBx caused MMP impairment and DNA damage in human early embryonic cells, respectively. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION HBV can be examined in samples of sperm or discarded IVF early embryos from HBsAg-seropositive men and seronegative women. The hESC model in vitro may not fully mimic the natural embryos in vivo. WIDER IMPLICATIONS OF THE FINDINGS This study furthers our understanding of the influence of male HBV infection on embryonic development. Our results suggest that a semen-washing process may be necessary for male patients with HBV undergoing ART to minimize the potential negative effects of HBV infection on the early embryo. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by grants from the National Natural Science Foundation of China, grant numbers 81870432 and 81570567 to X.Z., 81571994 to P.S., and 81950410640, the Natural Science Foundation of Guangdong Province, China (No. 2023A1515010660 to X.Z.), and the Li Ka Shing Shantou University Foundation (Grant No. L11112008). The authors have no conflicts of interest.
Collapse
Affiliation(s)
- Xiangqian Meng
- Chengdu Xinan Gynecology Hospital; Sichuan Jinxin Xinan Women's & Children's Hospital (Bisheng), Chengdu, China
| | - Ximing Dai
- Stem Cell Research Center, Shantou University Medical College, Shantou, China
- Research Center for Reproductive Medicine, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
| | - Jihua Huang
- Chengdu Xinan Gynecology Hospital; Sichuan Jinxin Xinan Women's & Children's Hospital (Bisheng), Chengdu, China
| | - Tingting Han
- Chengdu Xinan Gynecology Hospital; Sichuan Jinxin Xinan Women's & Children's Hospital (Bisheng), Chengdu, China
| | - Xue Liao
- Chengdu Xinan Gynecology Hospital; Sichuan Jinxin Xinan Women's & Children's Hospital (Bisheng), Chengdu, China
| | - Ke Cheng
- Stem Cell Research Center, Shantou University Medical College, Shantou, China
- Research Center for Reproductive Medicine, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
| | - Xiaoyue Sun
- Stem Cell Research Center, Shantou University Medical College, Shantou, China
- Research Center for Reproductive Medicine, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
| | - Qingdong Xie
- Stem Cell Research Center, Shantou University Medical College, Shantou, China
- Research Center for Reproductive Medicine, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
| | - Pingnan Sun
- Stem Cell Research Center, Shantou University Medical College, Shantou, China
- Research Center for Reproductive Medicine, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
| | - Xiaoling Zhou
- Stem Cell Research Center, Shantou University Medical College, Shantou, China
- Research Center for Reproductive Medicine, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
| |
Collapse
|
3
|
Amorim de Almeida Pondé R. Vertical transmission of hepatitis B virus from father to child: what can be concluded about this possibility? Arch Virol 2023; 168:168. [PMID: 37227513 DOI: 10.1007/s00705-023-05796-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/12/2023] [Indexed: 05/26/2023]
Abstract
Vertical hepatitis B virus (HBV) transmission is defined as transmission that occurs during pregnancy or postpartum from an HBV-infected mother to her fetus or child. It is an efficient route for the spread of HBV and is responsible for most of the cases of chronic HBV infection in adults. During pregnancy, vertical transmission can occur in the intrauterine phase, by placental infection via peripheral blood mononuclear cells, by placental leakage, or through female germ cells.The detection of HBV DNA in semen and spermatids from HBV-infected men has provided strong evidence that the male genital tract may act as a reservoir of the virus in HBV-infected men, supporting the possibility that vertical HBV transmission from an HBV-infected father to his child may also occur via the germ line at the time of fertilization, as occurs in HBV transmission from mother to child. Furthermore, it has been shown that integration of the HBV genome into the sperm cell genome can compromise sperm morphology and function and even cause hereditary or congenital biological effects in the offspring when an HBV-infected sperm fuses with an ovum.Since vertical HBV transmission from father to child can be a topic of interest and of global importance for controlling the spread of HBV, this article addresses the evidence supporting its occurrence via germ cells, the biological impact of integration of the HBV genome into the male germ cell genome, and the role of maternal immunoprophylaxis in vertical HBV transmission from father to child.
Collapse
Affiliation(s)
- Robério Amorim de Almeida Pondé
- Secretaria de Estado da Saúde -SES/Superintendência de Vigilância em Saúde-SUVISA/GO, Gerência de Vigilância Epidemiológica de Doenças Transmissíveis-GVEDT/Coordenação de Análises e Pesquisas-CAP, Rua 136 Qd F44 Lt 22/24 Ed. César Sebba- Setor Sul, 74-093-250, Goiânia, Goiás, Brazil.
- Laboratory of Human Virology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil.
| |
Collapse
|
4
|
Wu H, Yang Y, Jia J, Guo T, Lei J, Deng Y, He Y, Wang Y, Peng Z, Zhang Y, Zhang H, Wang Q, Shen H, Zhang Y, Yan D, Ma X. Maternal Preconception Hepatitis B Virus Infection and Risk of Congenital Heart Diseases in Offspring Among Chinese Women Aged 20 to 49 Years. JAMA Pediatr 2023; 177:498-505. [PMID: 36912830 PMCID: PMC10012042 DOI: 10.1001/jamapediatrics.2023.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/12/2023] [Indexed: 03/14/2023]
Abstract
Importance Maternal hepatitis B virus (HBV) infection during early pregnancy has been related to congenital heart diseases (CHDs) in offspring. However, no study to date has evaluated the association of maternal preconception HBV infection with CHDs in offspring. Objective To explore the association of maternal preconception HBV infection with CHDs in offspring. Design, Setting, and Participants This retrospective cohort study used nearest-neighbor (1:4) propensity score matching of 2013 to 2019 data from the National Free Preconception Checkup Project (NFPCP), a national free health service for childbearing-aged women who plan to conceive throughout mainland China. Women aged 20 to 49 years who got pregnant within 1 year after preconception examination were included, and those with multiple births were excluded. Data were analyzed from September to December 2022. Exposures Maternal preconception HBV infection statuses, including uninfected, previous, and new infection. Main Outcomes and Measures The main outcome was CHDs, which were prospectively collected from the birth defect registration card of the NFPCP. Logistic regression with robust error variances was used to estimate the association between maternal preconception HBV infection status and CHD risk in offspring, after adjusting for confounding variables. Results After matching with a 1:4 ratio, there were 3 690 427 participants included in the final analysis, where 738 945 women were infected with HBV, including 393 332 women with previous infection and 345 613 women with new infection. Approximately 0.03% (800 of 2 951 482) of women uninfected with HBV preconception and women newly infected with HBV carried an infant with CHDs, whereas 0.04% (141 of 393 332) of women with HBV infection prior to pregnancy carried an infant with CHDs. After multivariable adjustment, women with HBV infection prior to pregnancy had a higher risk of CHDs in offspring compared with women who were uninfected (adjusted relative risk ratio [aRR], 1.23; 95% CI, 1.02-1.49). Moreover, compared with couples who were uninfected with HBV prior to pregnancy (680 of 2 610 968 [0.026%]), previously infected women with uninfected men (93 of 252 919 [0.037%]) or previously infected men with uninfected women (43 of 95 735 [0.045%]) had a higher incidence of CHDs in offspring and were significantly associated with a higher risk of CHDs in offspring (previously infected women with uninfected men: aRR, 1.36; 95% CI, 1.09-1.69; previously infected men with uninfected women: aRR, 1.51; 95% CI, 1.09-2.09) with multivariable adjustment, while no significant association was observed between maternal new HBV infection and CHDs in offspring. Conclusions and Relevance In this matched retrospective cohort study, maternal preconception previous HBV infection was significantly associated with CHDs in offspring. Moreover, among women with HBV-uninfected husbands, significantly increased risk of CHDs was also observed in previously infected women prior to pregnancy. Consequently, HBV screening and getting HBV vaccination-induced immunity for couples prior to pregnancy are indispensable, and those with previous HBV infection prior to pregnancy should also be taken seriously to decrease the CHDs risk in offspring.
Collapse
Affiliation(s)
- Hanbin Wu
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Jiajing Jia
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, China
| | - Tonglei Guo
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jueming Lei
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
| | - YuZhi Deng
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Yuan He
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
| | - Ya Zhang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| |
Collapse
|
5
|
di Filippo Villa D, Navas MC. Vertical Transmission of Hepatitis B Virus-An Update. Microorganisms 2023; 11:1140. [PMID: 37317114 DOI: 10.3390/microorganisms11051140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 06/16/2023] Open
Abstract
Hepatitis B virus (HBV) infection is a major public health problem in the world. Approximately 296 million people are chronically infected. In endemic areas, vertical transmission is a common route of transmission. There are several strategies for the prevention of HBV vertical transmission, such as antiviral treatment during the third trimester of pregnancy and immunoprophylaxis to newborns that includes the administration of hepatitis B immune globulin (HBIG) and an HBV vaccine. Despite this, immunoprophylaxis failure can occur in up to 30% of infants born to HBeAg-positive mothers and/or with high viral load. Therefore, management and prevention of HBV vertical transmission is of paramount significance. In this article, we provided a review of the epidemiology, mechanisms of pathogenesis and risk factors of vertical transmission, as well as the strategies implemented to prevent the infection.
Collapse
Affiliation(s)
- Diana di Filippo Villa
- Gastrohepatology Group, Faculty of Medicine, Universidad de Antioquia (UdeA), Calle 70 No. 52-21, Medellin 050010, Colombia
| | - Maria-Cristina Navas
- Gastrohepatology Group, Faculty of Medicine, Universidad de Antioquia (UdeA), Calle 70 No. 52-21, Medellin 050010, Colombia
| |
Collapse
|
6
|
Yi W, Li M, Sun F, Lu H, Zeng Z, Bi X, Yang L, Lin Y, Cao X, Hu Y, Zhou M, Zhang L, Lu Y, Wan G, Xie Y. Impact of in vitro fertilization-embryo transfer on mother-to-infant transmission in women with chronic HBV infection. Liver Int 2022; 42:2167-2174. [PMID: 35758891 DOI: 10.1111/liv.15349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 04/15/2022] [Accepted: 06/24/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS In vitro fertilization-embryo transfer (IVF-ET) may increase the risk of mother-to-child transmission (MTCT) of hepatitis B virus (HBV). The purpose of this study was to investigate the impact and safety of IVF-ET on MTCT in women with chronic HBV infection (CHB). METHODS The data of 298 women who got pregnant by IVF-ET and their 375 children were collected retrospectively. Mothers were divided into the CHB group (n = 224) and the control group (HBsAg negative, n = 74). After birth, newborns were routinely vaccinated with the hepatitis B vaccine, and infants in the CHB group were injected with hepatitis B immunoglobulin within 2 h after birth. Demographic information, clinical data and laboratory test results were collected. The primary outcome measures were the MTCT rate of HBV, and the secondary outcome measures were the safety of the mother and infant. RESULTS There was no case of HBV MTCT in all 282 newborns born in the CHB group and 93 neonates born in the control group. Of the two groups, the birth weight (3056.74 ± 601.65 vs. 2926.24 ± 704.86, P = .083), length (49.22 ± 1.97 vs. 48.74 ± 3.09, P = .167), 5-min Apgar score (9.97 ± 0.21 vs. 9.90 ± 0.51, P = .212), days of pregnancy (265.70 ± 12.73 vs. 262.02 ± 17.50, P = .064) and neonatal malformation rate (0.71% vs. 0, P = 1.000) were similar. Two cases of neonatal malformation occurred in the CHB group. The incidences of pregnancy and childbirth complications were similar between the two groups. CONCLUSION IVF-ET does not increase the risk of MTCT in women with chronic HBV infection, and it is safe for mothers and infants.
Collapse
Affiliation(s)
- Wei Yi
- Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Minghui Li
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China.,Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Fangfang Sun
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Huihui Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhan Zeng
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Xiaoyue Bi
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Liu Yang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yanjie Lin
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Xiuzhen Cao
- Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuhong Hu
- Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Mingfang Zhou
- Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Lu Zhang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yao Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Gang Wan
- Department of Medical and Biological Statistics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yao Xie
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China.,Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| |
Collapse
|
7
|
Xiong Y, Liu C, Wei W, Huang S, Wang J, Qi Y, Zou K, Tan J, Sun X. The impact of biparental hepatitis B virus infection on pregnancy outcomes in patients undergoing assisted reproductive technology treatment: a systematic review and meta-analysis. Arch Gynecol Obstet 2022; 306:1253-1266. [PMID: 35551455 DOI: 10.1007/s00404-022-06586-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 04/15/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the association between biparental hepatitis B virus (HBV) infection (hepatitis B surface antigen [HBsAg] seropositivity) and pregnancy outcomes in patients undergoing assisted reproductive technology (ART) treatment, including clinical pregnancy rate (CPR) and live birth rate (LBR). METHODS We searched various literature databases from the earliest date available until May 20, 2021, including PubMed, Embase, Medline, Web of Science, Scopus, CNKI, and Wangfang. Four patterns of biparental HBV infection for pregnancy outcomes following ART were synthesized separately by using random-effects model. We also performed subgroup analyses (matched or unmatched) and two forms of sensitivity analysis. RESULTS A total of 25 retrospective cohort studies, involving more than 19,269 couples, were included. Maternal and paternal HBV co-infection (crude relative risk [cRR]: 0.58, 95% confidence interval: 0.28-1.23), either maternal or paternal infection (cRR: 1.05, 0.88-1.24), maternal HBV infection alone (cRR: 0.96, 0.79-1.16), or paternal HBV infection alone (cRR: 1.02, 0.91-1.13) were not associated with significant reductions in CPR at per woman level. These patterns of infection were also not significantly associated with decreased LBR at per woman level. However, paternal HBV infection alone reduced CPR (adjusted odds ratio: 0.54, 0.33-0.86) and LBR (cRR: 0.52, 0.28-0.99) at per cycle level. Subgroup analyses and sensitivity analyses were mostly consistent with the primary results. CONCLUSIONS Paternal HBV infection alone probably decrease CPR after ART at per cycle level. However, maternal HBV infection was not associated with reductions in CPR and LBR in women undergoing ART at per woman level.
Collapse
Affiliation(s)
- Yiquan Xiong
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
| | - Chunrong Liu
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
| | - Wei Wei
- Department of First Convalescent, Dujiangyan Special Crew Sanatorium of PLA Air Force, Dujiangyan, 611830, China
| | - Shiyao Huang
- Sichuan Evidence-Based Medicine Center of Traditional Chinese Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Jing Wang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
| | - Yana Qi
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
| | - Kang Zou
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
| | - Jing Tan
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China. .,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China.
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China. .,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China.
| |
Collapse
|
8
|
Dionne-Odom J, Cozzi GD, Franco RA, Njei B, Tita AT. Treatment and prevention of viral hepatitis in pregnancy. Am J Obstet Gynecol 2022; 226:335-346. [PMID: 34516961 PMCID: PMC8907340 DOI: 10.1016/j.ajog.2021.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023]
Abstract
Viral hepatitis in pregnancy may be caused by many types of viruses that cause systemic infection or target hepatocytes in their pathogenesis. Because viral hepatitis during pregnancy may represent acute or chronic infection or the reactivation of a prior infection, a high clinical suspicion, medical history review, and awareness of risk factors for the acquisition of infection are important management principles. The route of infection varies widely and ranges from fecal-oral transmission for the hepatitis A and E viruses to vertical transmission for hepatitis B, blood-borne transmission for hepatitis C, and sexual transmission for the herpes simplex virus. For this reason, the exposure details about travel, food preferences, drug use, and sexual contacts are important to elicit. Although routine prenatal screening is recommended for chronic viral hepatitis caused by hepatitis B and C, most other causes of viral hepatitis in pregnancy are detected in the setting of compatible signs and symptoms (fatigue, abdominal discomfort, jaundice, scleral icterus) or incidentally noted transaminitis on routine labs. Serologic testing is helpful for diagnosis with molecular testing as indicated to guide the management of hepatitis B and C. Preventive vaccines for hepatitis A and B with established safety of use in pregnancy are recommended for women who are at risk of acquisition. Postexposure prophylaxis for hepatitis A is a single dose of immunoglobulin and vaccination can be used if immunoglobulin G is not available. Antiviral therapy with tenofovir disoproxil fumarate is recommended as prophylaxis in pregnant women with active hepatitis B and an elevated viral load (>200,000 IU/mL) during the third trimester to prevent vertical transmission. The neonate exposed to hepatitis B at birth should receive immunoglobulin G and a monovalent birth dose vaccine within 12 hours, followed by completion of the 3-dosage vaccine series. The prevalence of hepatitis C in women of reproductive age has increased in the United States, and the role of antiviral therapy during pregnancy is of great interest. Cesarean delivery is not currently recommended for the sole purpose of reducing vertical transmission risk in pregnant women with viral hepatitis. Breastfeeding is recommended in women with hepatitis A, B, and C. New and promising prevention and treatment options for hepatitis B and C are under investigation. Investigators and regulatory authorities should ensure that these clinical trials for promising antivirals and vaccines are designed to include pregnant and lactating women.
Collapse
Affiliation(s)
- Jodie Dionne-Odom
- Division of Infectious Diseases, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL; Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL.
| | - Gabriella D. Cozzi
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ricardo A. Franco
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Basile Njei
- Yale Center for Clinical Investigation, Yale School of Medicine, New Haven, Connecticut
| | - Alan T.N. Tita
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama,Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
9
|
Kumar M, Abbas Z, Azami M, Belopolskaya M, Dokmeci AK, Ghazinyan H, Jia J, Jindal A, Lee HC, Lei W, Lim SG, Liu CJ, Li Q, Al Mahtab M, Muljono DH, Niriella MA, Omata M, Payawal DA, Sarin SK, Ségéral O, Tanwandee T, Trehanpati N, Visvanathan K, Yang JM, Yuen MF, Zheng Y, Zhou YH. Asian Pacific association for the study of liver (APASL) guidelines: hepatitis B virus in pregnancy. Hepatol Int 2022; 16:211-253. [PMID: 35113359 DOI: 10.1007/s12072-021-10285-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/06/2021] [Indexed: 12/11/2022]
Abstract
Hepatitis B virus (HBV) infection still remains a major public health issue in the Asia-Pacific region. Most of the burden of HBV-related disease results from infections acquired in infancy through perinatal or early childhood exposure to HBV in Asia-Pacific. Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These APASL guidelines provide a comprehensive review and recommendations based on available evidence in the literature, for the management of females with HBV infection through every stage of pregnancy and postpartum. These also address the concerns, management challenges, and required follow-up of children born to hepatitis B-positive mothers.
Collapse
Affiliation(s)
- Manoj Kumar
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India.
| | - Zaigham Abbas
- Department of Medicine, Ziauddin University Hospital, Karachi, Pakistan
| | - Milad Azami
- Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | | | - A K Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Hasmik Ghazinyan
- Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, China
| | - Ankur Jindal
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
| | - Han Chu Lee
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Wei Lei
- Hepatopancreatobiliary Center, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Seng Gee Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chun-Jen Liu
- Department of Internal Medicine and Hepatitis Research Center, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Qiang Li
- Division of Liver Diseases Jinan Infectious Disease Hospital, Shandong University, Jinan, China
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Madunil Anuk Niriella
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Colombo, Sri Lanka
| | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan
- University of Tokyo, Tokyo, Japan
| | - Diana A Payawal
- Fatima University Medical Center Manila, Manila, Philippines
| | - Shiv K Sarin
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India.
| | - Olivier Ségéral
- French Agency for Research on AIDS and Viral Hepatitis, University of Health Science, Phnom Penh, Cambodia
| | - Tawesak Tanwandee
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nirupma Trehanpati
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Kumar Visvanathan
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Jin Mo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Man-Fung Yuen
- Li Shu Fan Medical Foundation Professor in Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yingjie Zheng
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Y H Zhou
- Department of Laboratory Medicine, Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| |
Collapse
|
10
|
Carbone L, Conforti A, La Marca A, Cariati F, Vallone R, Raffone A, Buonfantino C, Palese M, Mascia M, DI Girolamo R, Capuzzo M, Esteves SC, Alviggi C. The negative impact of most relevant infections on fertility and assisted reproduction technology. Minerva Obstet Gynecol 2022; 74:83-106. [PMID: 34137567 DOI: 10.23736/s2724-606x.21.04870-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Infections may act with variable impact on the physiopathology of the reproductive organs, determining infertility or reducing the outcomes of assisted reproduction technology. The aim of this narrative review is to describe the existing evidence regarding the pathogens with a supposed or recognized role in reproductive medicine. Viral hepatitis, as well as HIV, can reduce sperm quality. Syphilis carries a risk of erectile dysfunction and increased endometrial thickness. Chlamydia is the main cause of pelvic inflammatory disease. In relation to Mycoplasma and Ureaplasma spp., only few species seem to show a correlation with infertility and poor in-vitro fertilization outcomes. There is evidence of a role for bacterial vaginosis in early pregnancy loss. HPV infection in males seems to determine infertility. Herpesviruses are more a risk for fetuses than for fertility itself. Zika virus is responsible for altered early embryo development and waiting to conceive is recommended in suspected or confirmed cases. The impact of SARS-CoV-2 is yet to be elucidated. Rubella and toxoplasmosis can provoke important congenital defects and therefore screening is mandatory before conception; a vaccine for Rubella is recommended. Further and well-designed studies are still needed to better elucidate the role of some infectious agents, to improve fertility and its treatments.
Collapse
Affiliation(s)
- Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy -
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Roberta Vallone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Cira Buonfantino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Michela Palese
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Marika Mascia
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Raffaella DI Girolamo
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Martina Capuzzo
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Sandro C Esteves
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
- ANDROFERT - Andrology and Human Reproduction Clinic, Campinas, Brazil
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| |
Collapse
|
11
|
Wang Z, Liu W, Zhang M, Wang M, Wu H, Lu M. Effect of Hepatitis B Virus Infection on Sperm Quality and Outcomes of Assisted Reproductive Techniques in Infertile Males. Front Med (Lausanne) 2021; 8:744350. [PMID: 34796185 PMCID: PMC8592897 DOI: 10.3389/fmed.2021.744350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/11/2021] [Indexed: 01/21/2023] Open
Abstract
Background: Hepatitis B virus (HBV) infection is one of the health problems and has adverse effects on public health. However, the consequences of male HBV carriers for assisted reproductive techniques (ART) remain unclear. Objective: To examine whether men with HBV would impact sperm quality and the intrauterine insemination (IUI)/ in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) outcomes. Methods: We retrospectively analyzed data from 681 infertile couples for IUI/IVF/ICSI fresh cycle outcomes. Case group was 176 infertile couples with male HBV infection undergoing embryo transfer in our center (99 for IVF and 77 for ICSI) and 51 infertile couples for IUI. Negative control was 454 non-infected infertility couples, matched for female age, BMI and infertility duration (102 for IUI and 198 for IVF and 154 for ICSI). Results: Sperm viability among infertile men with HBV infection was significantly lower than control group (74.1 ± 13.7 vs. 77.0 ± 12.8, P < 0.01). Sperm motility was significantly decreased in HBV positive men in comparison to the control group (32.5 ± 14.6 vs. 35.5 ± 12.9, P < 0.05). In IVF/ICSI cycles, two groups had similar results in two pronuclear (2PN) fertilization rate, implantation rate, clinical pregnant rate and abortion rate (P > 0.05). There was also no difference in the clinical pregnant rate and abortion rate in IUI cycles (P > 0.05). Conclusion: Men with HBV infection will affect their sperm quality, but not affect the outcomes of ART.
Collapse
Affiliation(s)
- Zichun Wang
- Department of Reproductive, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wanpeng Liu
- Department of Reproductive, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Mingming Zhang
- Department of Reproductive, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Minglei Wang
- Department of Reproductive, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huaying Wu
- Department of Reproductive, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Meisong Lu
- Department of Reproductive, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| |
Collapse
|
12
|
Reply to 'Evidence against in utero transmission of hepatitis B virus'. Nat Rev Gastroenterol Hepatol 2021; 18:445-446. [PMID: 33888888 DOI: 10.1038/s41575-021-00456-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
13
|
Terrault NA, Levy MT, Cheung KW, Jourdain G. Viral hepatitis and pregnancy. Nat Rev Gastroenterol Hepatol 2021; 18:117-130. [PMID: 33046891 DOI: 10.1038/s41575-020-00361-w] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 02/06/2023]
Abstract
The management of viral hepatitis in the setting of pregnancy requires special consideration. There are five liver-specific viruses (hepatitis A, B, C, D, E), each with unique epidemiology, tendency to chronicity, risk of liver complications and response to antiviral therapies. In the setting of pregnancy, the liver health of the mother, the influence of pregnancy on the clinical course of the viral infection and the effect of the virus or liver disease on the developing infant must be considered. Although all hepatitis viruses can harm the mother and the child, the greatest risk to maternal health and subsequently the fetus is seen with acute hepatitis A virus or hepatitis E virus infection during pregnancy. By contrast, the primary risks for hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus are related to the severity of the underlying liver disease in the mother and the risk of mother-to-child transmission (MTCT) for HBV and HCV. The prevention of MTCT is key to reducing the global burden of chronic viral hepatitis, and prevention strategies must take into consideration local health-care and socioeconomic challenges. This Review presents the epidemiology of acute and chronic viral hepatitis infection in pregnancy, the effect of pregnancy on the course of viral infection and, conversely, the influence of the viral infection on maternal and infant outcomes, including MTCT.
Collapse
Affiliation(s)
- Norah A Terrault
- Keck School of Medicine, University of Southern California, Los Angeles, USA.
| | - Miriam T Levy
- Department of Gastroenterology and Liver, Liverpool Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Ka Wang Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong
| | - Gonzague Jourdain
- French National Research Institute for Sustainable Development (IRD), Marseille, France.,Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
14
|
Cantalloube A, Ferraretto X, Lepage J, Gervais A, Llabador MA, Epelboin S. [Outcomes of cumulative transfers of fresh and frozen embryos in in vitro fertilization in women infected by hepatitis B virus]. ACTA ACUST UNITED AC 2021; 49:529-537. [PMID: 33434753 DOI: 10.1016/j.gofs.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the impact of hepatitis B virus (HBV) infection in women on in vitro fertilization (IVF) outcomes. METHODS An observational monocentric case-control cohort study conducted between 2012 and 2019 compared the outcomes of the first cycle of IVF between 64 woman infected with HBV and 128 seronegative controls. Frozen embryos transfers made within 18 months of the puncture were included. The exclusion criteria were severe infections, viral co-infection in women, any viral infection in their spouse, or lack of fresh embryo transfer. The matching was performed according to age, primary infertility or secondary, conventional or intracytoplasmic injection IVF technique and date of attempt. The main analysis focused on cumulative live births rates (LBR). RESULTS The clinical and ovarian stimulation characteristics were comparable except for a longer period of infertility in the HBV group. The LBR in the HBV group, when compared to controls, was not different after transfer of fresh (14.06 vs. 25.00% P=0.08) or frozen embryos (4.17 vs. 18.92% P=0.08), but significantly decreased in cumulative analysis (15.63 vs. 35.94% P=0.003). HBV infection was negatively associated with LBR in multivariate analysis OR=0.38 (95% CI 0.14-0.92) P<0.05. The implantation rate was lower in the HBV group versus controls, in fresh (14.89 vs. 27.72% P=0.02) and frozen (3.03 vs. 21.65% P=0.01) embryo transfers. CONCLUSION This study suggests a negative impact of HBV infection in women on the cumulative LBR after IVF.
Collapse
Affiliation(s)
- A Cantalloube
- Unité de médecine de la reproduction, service de gynécologie-obstétrique, hôpital Bichat-Claude-Bernard, Nord-université de Paris, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - X Ferraretto
- Service de biologie de la reproduction, Nord-université de Paris, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - J Lepage
- Unité de médecine de la reproduction, service de gynécologie-obstétrique, hôpital Bichat-Claude-Bernard, Nord-université de Paris, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Gervais
- Service hépato gastro-entérologie, hôpital Bichat-Claude-Bernard, Nord-université de Paris, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - M-A Llabador
- Service de biologie de la reproduction, Nord-université de Paris, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - S Epelboin
- Unité de médecine de la reproduction, service de gynécologie-obstétrique, hôpital Bichat-Claude-Bernard, Nord-université de Paris, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| |
Collapse
|
15
|
Virant-Klun I, Strle F. Human Oocytes Express Both ACE2 and BSG Genes and Corresponding Proteins: Is SARS-CoV-2 Infection Possible? Stem Cell Rev Rep 2021; 17:278-284. [PMID: 33403489 PMCID: PMC7785127 DOI: 10.1007/s12015-020-10101-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 12/14/2022]
Abstract
In addition to a number of scientific and medical questions about SARS-CoV-2 infection that still need to be answered, there is also the question of how this highly virulent virus and COVID-19 disease affect gametogenesis in humans. Even more important is the question of whether the virus can also enter and infect oocytes and possibly alter them in an unknown way, which could also affect the development and status of the human embryo. The answers to these questions are still poorly known, so we reviewed the human oocyte transcriptome and proteome obtained in our previous studies and found that human oocytes from the in vitro fertilization program expressed both the ACE2 and BSG genes and the corresponding ACE2 and BSG proteins. This means that human oocytes possess the molecular ‘machinery’ to facilitate SARS-CoV-2 entrance and infection. According to various studies, especially in animal models, different viruses can infect oocytes, so infection of the oocyte with SARS-Cov-2 cannot be completely ruled out. A hypothetical model of human oocyte infection with this virus has been proposed.
Collapse
Affiliation(s)
- Irma Virant-Klun
- Clinical Research Center, University Medical Center Ljubljana, Vrazov trg 1, Ljubljana, Slovenia.
| | - Franc Strle
- Clinical Research Center, University Medical Center Ljubljana, Vrazov trg 1, Ljubljana, Slovenia
| |
Collapse
|
16
|
van der Kuyl AC, Berkhout B. Viruses in the reproductive tract: On their way to the germ line? Virus Res 2020; 286:198101. [PMID: 32710926 DOI: 10.1016/j.virusres.2020.198101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 01/13/2023]
Abstract
Studies of vertebrate genomes have indicated that all species contain in their chromosomes stretches of DNA with sequence similarity to viral genomes. How such 'endogenous' viral elements (EVEs) ended up in host genomes is usually explained in general terms such as 'they entered the germ line at some point during evolution'. This seems a correct statement, but is also rather imprecise. The vast number of endogenous viral sequences suggest that common routes to the 'germ line' may exist, as relying on chance alone may not easily explain the abundance of EVEs in modern mammalian genomes. An increasing number of virus types have been detected in human semen and a growing number of studies have reported on viral infections that cause male infertility or subfertility and on viral infections that threaten in vitro fertilisation practices. Thus, it is timely to survey the pathway(s) that viruses can use to gain access to the human germ line. Embryo transfer and semen quality studies in livestock form another source of relevant information because virus infection during reproduction is clearly unwanted, as is the case for the human situation. In this review, studies on viruses in the male and female reproductive tract and in the early embryo will be discussed to propose a plausible viral route to the mammalian germ line.
Collapse
Affiliation(s)
- Antoinette Cornelia van der Kuyl
- Laboratory of Experimental Virology, Department of Medical Microbiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
| | - Ben Berkhout
- Laboratory of Experimental Virology, Department of Medical Microbiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| |
Collapse
|
17
|
Condijts T, Bourdeaud'huy L, Tilleman K, Lierman S, Dewinter C, Padalko E. Swim-up as a strategy for isolation of spermatozoa without viral incorporation in men with chronic hepatitis B: A pilot study. Andrologia 2020; 52:e13732. [PMID: 32658358 DOI: 10.1111/and.13732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/07/2020] [Accepted: 05/28/2020] [Indexed: 11/27/2022] Open
Abstract
Hepatitis B virus (HBV) incorporates into spermatozoa which raises safety concerns about paternofetal transmission performing intracytoplasmatic sperm injection (ICSI) in men with chronic hepatitis B (cHB). HBV reduces sperm cell motility, assuming spermatozoa with highest motility are least HBV-incorporated. This study investigates an ICSI preparation technique (swim-up) to isolate most motile spermatozoa in order to select HBV-free spermatozoa. Semen and blood samples were collected from four patients with cHB. Spermatozoa were incubated in trajectories of gamete medium to create non-motile, motile/non-progressive and motile/progressive fractions. After DNA-extraction, HBV DNA loads were determined in every fraction. Participants (mean age 31) were HBsAg+(4/4), anti-HBc+(4/4) and HBV DNA+(2/4). They were treated (3/4) with entecavir(1/4) or tenofovir (2/4) and had no adverse sperm parameters(3/4). CRP-gene was detected in 95/96 sample fractions, proving successful DNA-extraction. HBV DNA was detected in none of the sample fractions, except for the motile, non-progressive fraction of one patient (HBeAg+, HBV DNA+). Since no HBV DNA was detected in progressive fractions, this study suggests swim-up a successful strategy to select HBV-free spermatozoa. Since all but one fraction was HBV DNA-negative, this study also suggests that patients with well-controlled disease have no HBV-contaminated sample fractions. This study encourages evaluation of guidelines restricting reproductive possibilities in men with cHB.
Collapse
Affiliation(s)
- Thomas Condijts
- Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Liesl Bourdeaud'huy
- Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Kelly Tilleman
- Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Sylvie Lierman
- Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Chantal Dewinter
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Elizaveta Padalko
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
18
|
Managing and preventing blood-borne viral infection transmission in assisted reproduction: a Canadian Fertility and Andrology Society clinical practice guideline. Reprod Biomed Online 2020; 41:203-216. [PMID: 32546334 DOI: 10.1016/j.rbmo.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/07/2020] [Indexed: 12/30/2022]
Abstract
Fertility care providers have an obligation to provide safe and effective care to patients. When a user of assisted reproductive technology (ART) is living with a blood-borne viral infection (BBVI: HIV, hepatitis C or hepatitis B), physicians and ART laboratory personnel need to know the requirements for providing quality care. Recent developments in the treatment of BBVI and understanding of transmission have changed these requirements. This guideline from the Canadian Fertility and Andrology Society (CFAS) provides comprehensive, evidence-based guidelines for reducing horizontal transmission and cross-contamination in the ART setting.
Collapse
|
19
|
Hepatitis B - Vertical transmission and the prevention of mother-to-child transmission. Best Pract Res Clin Obstet Gynaecol 2020; 68:78-88. [PMID: 32249130 DOI: 10.1016/j.bpobgyn.2020.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 12/20/2022]
Abstract
Hepatitis B virus (HBV) infection is the commonest cause of chronic hepatitis, with an estimated global prevalence of 3.5%, and which leads to significant morbidity and mortality. Mother-to-child transmission (MTCT) during pregnancy is the leading form of transmission in endemic populations, and its interruption is thus crucial as the initial step in the elimination of HBV infection, notwithstanding the availability of potent antiviral medications. The risk of MTCT is dramatically reduced by timely neonatal HBV vaccination and the administration of hepatitis B immunoglobulin after birth in high-risk infants. Maternal HBV DNA quantification during pregnancy allows the assessment of the risk of newborn immunoprophylaxis failure (IF). Maternal antiviral treatment in highly viremic women can reduce the risk of IF. However, the optimal HBV DNA cutoff level for the initiation of antiviral treatment remains to be determined.
Collapse
|
20
|
Mak JSM, Lao TT. Assisted reproduction in hepatitis carrier couples. Best Pract Res Clin Obstet Gynaecol 2020; 68:103-108. [PMID: 32278628 DOI: 10.1016/j.bpobgyn.2020.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 01/04/2023]
Abstract
Chronic Hepatitis B virus (HBV) infection is endemic worldwide, and the prevalence is especially high in the Asia-Pacific regions. Despite its high prevalence, the literature regarding the impact of HBV infection on subfertility and fertility treatment remains limited and conflicting. Latest studies do not suggest any detrimental effect of HBV infection on the outcome of IVF/ICSI treatment in women having chronic HBV infection. There is evidence that HBV exists in ovarian tissue including oocyte and follicular fluid, and therefore has the potential risk of transmission to the embryo, which can explain the finding of vertical transmission despite immunoprophylaxis. Most recently, we have observed the evidence of HBV viral replication in female HBV carriers undergoing IVF/ICSI treatment. This raises the question of whether antiviral medication should be administered during ovarian stimulation in IVF/ICSI treatment cycles for women with chronic HBV infection to help reduce the chance of vertical transmission.
Collapse
Affiliation(s)
- Jennifer S M Mak
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Terence T Lao
- Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
| |
Collapse
|
21
|
Mak JSM, Lao TT, Leung MBW, Chung CHS, Chung JPW, Cheung LP, Li TC. Ovarian HBV replication following ovulation induction in female hepatitis B carriers undergoing IVF treatment: A prospective observational study. J Viral Hepat 2020; 27:110-117. [PMID: 31519044 DOI: 10.1111/jvh.13210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 01/15/2023]
Abstract
Hepatitis B virus (HBV) can be found in ovarian tissues. This study compared HBV DNA levels in follicular fluid collected during oocyte retrieval with paired serum samples in HBV carriers after ovarian stimulation during IVF treatment for infertility. Sixty-four HBV carrier women referred to the Assisted Reproductive Units of two Hong Kong hospitals were recruited. At oocyte retrieval, the follicular fluid aspirated from the first follicle was collected for study. In 22 women, the first follicular fluid sample from both ovaries was similarly collected and studied. These women were also tested for liver function test and HBeAg. In 28 (43.8%) women, HBV DNA was detected in follicular fluid and the level correlated with serum levels (Spearman's correlation P < .001). There was concordant detection of HBV DNA in both ovaries, and the levels were significantly correlated (Spearman's correlation P = .029). In 40% of women with FF HBV DNA, the follicular fluid:serum ratio was >1.0, suggesting stimulation of HBV replication. These women also had significantly different liver function test results. Increased HBV replication exists in 40% of women with HBV DNA detected in follicular undergoing ovarian stimulation during IVF treatment.
Collapse
Affiliation(s)
- Jennifer Sze Man Mak
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Terence T Lao
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Maran Bo Wah Leung
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cathy Hoi Sze Chung
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jacqueline Pui Wah Chung
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lai Ping Cheung
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tin-Chiu Li
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
22
|
Joshi SS, Coffin CS. Hepatitis B and Pregnancy: Virologic and Immunologic Characteristics. Hepatol Commun 2020; 4:157-171. [PMID: 32025602 PMCID: PMC6996345 DOI: 10.1002/hep4.1460] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/23/2019] [Indexed: 12/18/2022] Open
Abstract
The hepatitis B virus (HBV) is an important human pathogen. Unvaccinated infants infected through mother-to-child transmission (MTCT) are at >95% risk of developing serum hepatitis B surface antigen-positive chronic hepatitis B (CHB). Despite complete passive-active HBV immunoprophylaxis, approximately 10% of infants born to mothers who are highly viremic develop CHB, and thus maternal treatment with nucleos(t)ide analogs (tenofovir disoproxil fumarate, lamivudine, or telbivudine) is recommended in the third trimester of pregnancy to reduce MTCT risk. Viral rebound usually occurs after stopping treatment and, in the context of maternal immunologic reconstitution postpartum, can also precipitate host immune-mediated hepatic (biochemical) flares. In this article, we review the epidemiology of HBV MTCT, discuss management and potential mechanisms of HBV vertical transmission, and highlight recent studies on virologic and immunologic aspects of hepatitis B in pregnancy and postpartum.
Collapse
Affiliation(s)
- Shivali S. Joshi
- Liver UnitDivision of Gastroenterology and HepatologyDepartment of MedicineUniversity of CalgaryCalgaryCanada
- Department of Microbiology, Immunology and Infectious DiseasesCumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Carla S. Coffin
- Liver UnitDivision of Gastroenterology and HepatologyDepartment of MedicineUniversity of CalgaryCalgaryCanada
- Department of Microbiology, Immunology and Infectious DiseasesCumming School of MedicineUniversity of CalgaryCalgaryCanada
| |
Collapse
|
23
|
Tenofovir and telbivudine combination therapy rapidly decreases viral loads in immune-tolerant chronic hepatitis B patients awaiting assisted reproduction: an open-label, randomized, controlled study. Eur J Gastroenterol Hepatol 2019; 31:832-835. [PMID: 30601336 DOI: 10.1097/meg.0000000000001345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Immune-tolerant chronic hepatitis B (CHB) patients awaiting assisted reproduction (AR) are required to initiate antiviral therapy because of laboratory safety concerns. The antiviral therapy in this group has not been well assessed. We sought to explore the efficacy and safety of the combination therapy (COM) of tenofovir (TDF) and telbivudine (LdT). PATIENTS AND METHODS In this open-label, randomized, controlled study, we enrolled and randomized hepatitis B virus e-antigen (HBeAg)-positive CHB patients awaiting AR into the study COM group and the control (TDF) group. The COM group received combination therapy of TDF and LdT, and the TDF group received a single treatment of TDF. The patients were followed up for at least 48 weeks. The primary endpoint was the proportion of patients with undetectable HBV DNA level at week 12. RESULTS A total of 121 patients were recruited into the COM group (n=60) and the TDF group (n=61). The percentages of patients with undetectable HBV DNA levels were 90.0% (54/60) in the COM group and 67.2% (41/61) (P=0.002) in the TDF group at week 12; the percentages were 96.6% (58/60) in the COM group and 85.2% (52/61) in the TDF group at week 48 (P=0.028), respectively. HBeAg seroconversion occurred in 5/60 (8.3%) patients in the COM group and 2/61 (3.3%) patients in the TDF group at week 48 (P=0.233). CONCLUSION TDF and LdT combination therapy shows a rapid antivirological response in immune-tolerant CHB patients awaiting AR, which provide an alternative for this group at AR centers. However, the HBeAg seroconversion rate is unsatisfactory in the short term.
Collapse
|
24
|
Nie R, Wang M, Liao T, Qian K, Zhu G, Jin L. Assisted conception does not increase the risk for mother-to-child transmission of hepatitis B virus, compared with natural conception: a prospective cohort study. Fertil Steril 2019; 111:348-356. [PMID: 30691633 DOI: 10.1016/j.fertnstert.2018.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/20/2018] [Accepted: 10/22/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine whether assisted conception increases the risk for mother-to-child transmission of hepatitis B virus (HBV) infection compared with natural conception. DESIGN Prospective cohort study. SETTING Research laboratory. PATIENT(S) A total of 305 children, 176 born with assisted conception and 129 born with natural conception, were born to a total of 251 hepatitis B surface antigen- (HBsAg-) positive women. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The seropositive rates of HBsAg in children at birth and HBV infection rates at 9-15 months of age. RESULT(S) Overall, 7.5% (23/305) of children were HBsAg-positive at birth. The rate of HBsAg-positive children at birth did not significantly differ between children in the assisted conception group compared with those in the natural conception group (6.3% [11/176] vs. 9.3% [12/129]). Multivariate logistic regression analysis showed that conception method is not related to the rate of HBsAg-positive children at birth. All children who were positive for HBsAg at birth and were followed up for 9-15 months became negative for HBsAg after hepatitis B immunization. CONCLUSION(S) Assisted conception does not increase the risk for mother-to-child transmission of HBV compared with natural conception.
Collapse
Affiliation(s)
- Rui Nie
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Mingyue Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Tantan Liao
- Reproductive Medicine Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, People's Republic of China
| | - Kun Qian
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Guijin Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
| |
Collapse
|
25
|
Wang L, Li L, Huang C, Diao L, Lian R, Li Y, Xiao S, Hu X, Mo M, Zeng Y. Maternal chronic hepatitis B virus infection does not affect pregnancy outcomes in infertile patients receiving first in vitro fertilization treatment. Fertil Steril 2019; 112:250-257.e1. [PMID: 31103286 DOI: 10.1016/j.fertnstert.2019.03.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/14/2019] [Accepted: 03/28/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate whether maternal chronic hepatitis B virus (HBV) infection affects pregnancy outcomes in infertile patients undergoing their first in vitro fertilization (IVF) treatment. DESIGN A retrospective case control study. SETTING Fertility center. PATIENT(S) Female patients, comprising 8,550 infertile women including 180 HBsAg+HBeAg+, 714 HBsAg+HBeAg-, and 7,656 HBsAg seronegative controls undergoing their first IVF treatments. INTERVENTION(S) Clinical characteristics, pregnancy and neonatal outcomes were analyzed by Kruskal-Wallis test, analysis of variance, or chi-square test. Logistic regression was employed to verify the contribution of maternal HBV to clinical pregnancy, live birth, and miscarriage. MAIN OUTCOME MEASURE(S) Primary outcome: live-birth rate; secondary outcomes: implantation, clinical pregnancy, and miscarriage rates. RESULT(S) An increased duration of infertility and more secondary infertility and ovulatory disorders were observed in the HBV patients. The implantation rate was statistically significantly lower in the HBsAg+HBeAg- group compared with the controls. However, the clinical pregnancy rate, miscarriage rate, live-birth rate, neonatal outcomes, and pregnancy complications showed no statistically significant differences among the groups. The logistic regression analysis showed that HBV infection status did not affect the clinical pregnancy, miscarriage, or live-birth rates, unlike maternal age, endometrial thickness, and use of high-quality embryos. CONCLUSION(S) Hepatitis B virus infection is not an independent contributor to pregnancy outcomes, although it is associated with prolonged infertility duration, a high frequency of secondary infertility and ovulatory disorders, and a reduced implantation rate.
Collapse
Affiliation(s)
- Linlin Wang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Longfei Li
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, People's Republic of China; Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, People's Republic of China
| | - Chunyu Huang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Lianghui Diao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Ruochun Lian
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Yuye Li
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Shan Xiao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xiuyu Hu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Meilan Mo
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Yong Zeng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, People's Republic of China.
| |
Collapse
|
26
|
Wang M, Bian Q, Zhu Y, Pang Q, Chang L, Li R, Tiongson BC, Zhang H, Pan CQ. Real-world study of tenofovir disoproxil fumarate to prevent hepatitis B transmission in mothers with high viral load. Aliment Pharmacol Ther 2019; 49:211-217. [PMID: 30506691 DOI: 10.1111/apt.15064] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/05/2018] [Accepted: 10/27/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Data on tenofovir disoproxil fumarate (TDF) therapy for preventing vertical transmission of hepatitis B virus (HBV) in the real-world setting are limited. AIM To investigate TDF for preventing vertical transmission of HBV in real-world practice. METHODS Hepatitis B e-antigen (HBeAg)-positive mothers with HBV-DNA >6 log10 IU/mL to receive TDF between gestational weeks 24-33 and delivery were prospectively enrolled and followed until post-partum week 28. All infants received immunoprophylaxis. Primary endpoints were safety of TDF use and mother-to-child transmission rates. Secondary outcomes were maternal HBV-DNA level suppression (<200 000 IU/mL) at delivery and HBeAg and hepatitis B surface antigen (HBsAg) serologic changes during the study. RESULTS Among 147 mothers enrolled, 143 started TDF and 143/144 infants completed the study. At delivery, 93.7% (134/143) of the mothers achieved HBV-DNA<200 000 IU/L. On-treatment, alanine aminotransferase (ALT) flares were observed in 8.4% (12/143) of mothers. After TDF cessation, ALT increased in 7.7% (11/143) of the mothers and 2.8% (4/143) achieved HBeAg negativity, but none had HBsAg loss. At birth, HBsAg was detected in 13.9% (20/144) of newborns and none at post-partum week 28. Vertical transmission rates among infants were 0.7% (1/144, intention-to-treat) and 0% (per-protocol). No infants had birth defects. No serious adverse effects were reported in either mothers or infants. Breastfeeding did not increase the HBV infection rate among infants although mothers had viral rebound after TDF cessation. CONCLUSIONS TDF for highly viraemic mothers was well tolerated and reduced vertical transmission of HBV in a real-world setting. There were no safety concerns during the postpartum 28-week follow-up. Registry number: Chinese Clinical Trial Registration No. ChiCTR-OIC-17010869.
Collapse
Affiliation(s)
- Ming Wang
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Qian Bian
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yunxia Zhu
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Qiumei Pang
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Lingzhi Chang
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ran Li
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | | | - Hua Zhang
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Calvin Q Pan
- Division of Gastroenterology, Department of Medicine, NYU Langone Health, NYU School of Medicine, New York City, NY
| |
Collapse
|
27
|
Bhamidimarri KR, Pan CQ. Update in the Management of Chronic Hepatitis B in Pregnancy. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s11901-018-0437-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
28
|
Park JS, Pan CQ. Viral factors for HBV mother-to-child transmission. Hepatol Int 2017; 11:476-480. [DOI: 10.1007/s12072-017-9825-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
|
29
|
Albadran A, Hibshi A, Saeed B, Coskun S, Awartani KA. Hepatitis B and C virus prevalence in couples attending an in vitro fertilization clinic in a tertiary care hospital in Saudi Arabia: comparison with ten years earlier. Ann Saudi Med 2017; 37:272-275. [PMID: 28761024 PMCID: PMC6150590 DOI: 10.5144/0256-4947.2017.272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Viral hepatitis B (HBV) and C (HCV) are a major public health problem in Saudi Arabia. Recent data has indicated a major reduction in viral hepatitis prevalence in Saudi population. However, there is limited data for infertile Saudi couples. OBJECTIVES To determine the prevalence of HCV and HBV attending an in vitro fertilization (IVF) clinic in Saudi Arabia between 2012 and 2015 to compare with the prevalence 10 years earlier in the same center. DESIGN Retrospective prevalence study. SETTING Tertiary care center in Riyadh. PATIENTS AND METHODS Data on the prevalence of HBV and HCV was collected on all couples seen at the IVF unit between 2002-2005 and 2012-2015. MAIN OUTCOME MEASURE(S) Prevalence of HBV and HCV. RESULTS In 4442 patients during 2002-2005 and 5747 patients during 2012-2015, the prevalence of HBV was significantly less in 2012-2015 compared with 2002-2005 (1.67% [97 patients] vs 4.7% [210 patients], P < .0001), respectively, but HCV prevalence was similar for the two periods (0.7% for both periods) (P=.887). The hepatitis B seroprevalence rate was higher in males compared to females during 2002-2005 (6.3% vs 3.1%) (P < .0001) and 2012-2015 (2.4% vs 1.1% ) (P < .0001), respectively. CONCLUSION The significant drop in HBV prevalence was most likely due to the introduction of the vaccination program in 1989, while reasons for HCV prevalence remaining unchanged are unclear. LIMITATION No data on confounding factors that may have affected the prevalence.
Collapse
Affiliation(s)
- Asma Albadran
- Dr. Asma Albadran, Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211,, Saudi Arabia, T: +966-11-442-7392, F: +966-11-442-7393, , ORCID: http://orcid.org/0000-0003-4160-409X
| | | | | | | | | |
Collapse
|
30
|
Jindal SK, Rawlins RG, Muller CH, Drobnis EZ. Guidelines for risk reduction when handling gametes from infectious patients seeking assisted reproductive technologies. Reprod Biomed Online 2016; 33:121-30. [PMID: 27235103 DOI: 10.1016/j.rbmo.2016.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/22/2016] [Accepted: 04/26/2016] [Indexed: 02/07/2023]
Abstract
According to the Americans with Disabilities Act (1990), couples with blood-borne viruses that lead to infectious disease cannot be denied fertility treatment as long as the direct threat to the health and safety of others can be reduced or eliminated by a modification of policies or procedures. Three types of infectious patients are commonly discussed in the context of fertility treatment: those with human immunodeficiency virus (HIV), hepatitis C or hepatitis B. Seventy-five per cent of hepatitis C or HIV positive men and women are in their reproductive years, and these couples look to assisted reproductive techniques for risk reduction in conceiving a pregnancy. In many cases, only one partner is infected. Legal and ethical questions about treatment of infectious patients aside, the question most asked by clinical embryologists and andrologists is: "What are the laboratory protocols for working with gametes and embryos from patients with infectious disease?" The serostatus of each patient is the key that informs appropriate treatments. This guidance document describes protocols for handling gametes from seroconcordant and serodiscordant couples with infectious disease. With minor modifications, infectious patients with stable disease status and undetectable or low viral load can be accommodated in the IVF laboratory.
Collapse
Affiliation(s)
- Sangita K Jindal
- Department Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore's Institute for Reproductive Medicine and Health, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
| | - Richard G Rawlins
- Department Obstetrics and Gynecology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612
| | - Charles H Muller
- Male Fertility Lab, Department Urology, University of Washington, 4245 Roosevelt Way NE, Seattle, WA 98105
| | - Erma Z Drobnis
- Reproductive Medicine and Fertility, Department Obstetrics, Gynecology and Women's Health, University of Missouri, 500 N. Keene St, Suite 203, Columbia, MO 65201
| |
Collapse
|
31
|
Liu Y, Wang M, Yao S, Yuan J, Lu J, Li H, Zeng W, Deng Y, Zou R, Li J, Xiao J. Efficacy and safety of telbivudine in different trimesters of pregnancy with high viremia for interrupting perinatal transmission of hepatitis B virus. Hepatol Res 2016; 46:E181-8. [PMID: 25869545 DOI: 10.1111/hepr.12525] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 04/03/2015] [Accepted: 04/08/2015] [Indexed: 01/05/2023]
Abstract
AIM We aimed to investigate the efficacy and safety of telbivudine (LdT) on the intervention of mother-to-child transmission (MTCT) in different trimesters of pregnant women with high viral loads. METHODS In this prospective cohort study, 160 cases of mothers with high viral loads were included. Eighty-two subjects received 600 mg/day LdT therapy. Fifty of them started LdT therapy before the third trimester of gestation, including 17 cases before pregnancy, nine and 24 cases in the first and second trimesters of pregnancy, respectively. The other 32 cases started LdT in the third trimester of gestation. Control pregnant women (78 cases) did not take LdT therapy. MTCT rate was determined by hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) DNA data of infants at the 51st week post-partum. Adverse events were also evaluated throughout the study. RESULTS One hundred and sixty infants were born from 160 pregnant women. Both LdT-treated groups displayed a marked decline in HBV DNA levels from the beginning to delivery. Positive rate of serum HBsAg in infants born from the above two groups of mothers were 0% and 3.1%, respectively, which was significantly lower than that in the untreated controls (24.4%). The incidence of detectable HBV DNA levels was significantly lower in infants born to LdT-treated mothers than in the controls (16.7%) at the 51st week post-partum. No infant had birth defects. No severe adverse event or complication were observed in LdT-treated mothers or infants followed until the 51st week post-partum. CONCLUSION The earlier application of LdT during pregnancy, the better preventive effects it offered on MTCT.
Collapse
Affiliation(s)
- Yingxia Liu
- State Key Discipline of Infectious Diseases, Department of Infectious Diseases, Shenzhen, China
| | - Miao Wang
- Department of Obstetrics and Gynecology, Shenzhen Third People's Hospital, Shenzhen, China
| | - Simin Yao
- State Key Discipline of Infectious Diseases, Department of Infectious Diseases, Shenzhen, China
| | - Jing Yuan
- State Key Discipline of Infectious Diseases, Department of Infectious Diseases, Shenzhen, China
| | - Jian Lu
- State Key Discipline of Infectious Diseases, Department of Infectious Diseases, Shenzhen, China
| | - Huijuan Li
- State Key Discipline of Infectious Diseases, Department of Infectious Diseases, Shenzhen, China
| | - Wen Zeng
- State Key Discipline of Infectious Diseases, Department of Infectious Diseases, Shenzhen, China
| | - Yong Deng
- State Key Discipline of Infectious Diseases, Department of Infectious Diseases, Shenzhen, China
| | - Rongrong Zou
- State Key Discipline of Infectious Diseases, Department of Infectious Diseases, Shenzhen, China
| | - Jie Li
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Jia Xiao
- State Key Discipline of Infectious Diseases, Department of Infectious Diseases, Shenzhen, China.,Department of Immunobiology, Institute of Tissue Transplantation and Immunology, Jinan University, Guangzhou, China
| |
Collapse
|
32
|
Visvanathan K, Dusheiko G, Giles M, Wong ML, Phung N, Walker S, Le S, Lim SG, Gane E, Ngu M, Hardikar W, Cowie B, Bowden S, Strasser S, Levy M, Sasaduesz J. Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow-up: position paper produced by Australian, UK and New Zealand key opinion leaders. Gut 2016; 65:340-50. [PMID: 26475631 DOI: 10.1136/gutjnl-2015-310317] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/11/2015] [Indexed: 12/13/2022]
Abstract
Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These include the lack of a current cohesive strategy for treatment and follow-up of mothers and their babies; the uncertain risk of postpartum HBV flares; the lack of randomised trial data on the safety and efficacy of antiviral treatment in pregnancy; the lack of head-to-head studies comparing different antivirals in pregnancy; and the lack of epidemiologic information regarding infection across different populations globally. This position paper provides a comprehensive review of the management of women with HBV infection prior to conception, throughout each stage of pregnancy and postpartum, as well as recommendations and clinical approaches for the follow-up of children born to infected mothers, based on available evidence in the literature and recommendations from international experts. Prevention of perinatal transmission is an important component of global efforts to reduce the burden of chronic HBV since vertical transmission is responsible for most of the chronic infection worldwide.
Collapse
Affiliation(s)
- Kumar Visvanathan
- St. Vincent's Hospital, Fitzroy, Australia Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Geoff Dusheiko
- Institute of Liver and Digestive Health, Royal Free Hospital London, London, UK
| | - Michelle Giles
- Department of Infectious Diseases and Department of Obstetrics and Gynaecology Monash Health, The Alfred Hospital, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - May-Ling Wong
- Department of Gastroenterology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Nghi Phung
- Liver Addiction Research Unit and Storr Liver Unit, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, New South Wales, Australia Drug Health Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Susan Walker
- Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Victoria, Australia Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Suong Le
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Victoria, Australia
| | - Seng Gee Lim
- Department of Hepatology, National University Health System, Singapore, Singapore
| | - Ed Gane
- Liver Transplant Unit, Auckland City Hospital Auckland, Auckland, New Zealand
| | - Meng Ngu
- Gastroenterology and Hepatology Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Winita Hardikar
- Department of Gastroenterology, Royal Children's Hospital, Melbourne, Victoria, Australia Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Ben Cowie
- Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Victoria, Australia Victorian Infectious Disease Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Scott Bowden
- Victorian Infectious Disease Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Simone Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Miriam Levy
- Liverpool Hospital, Sydney, New South Wales, Australia Department of Medicine, University of NSW, Sydney, New South Wales, Australia
| | - Joe Sasaduesz
- Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
33
|
MEILANI MEILANI, UTSUMI TAKAKO, JUNIASTUTI JUNIASTUTI, AMIN MOCHAMAD, SOETJIPTO SOETJIPTO, HAYASHI YOSHITAKE, INGE LUSIDA MARIA. High Prevalence of Occult Hepatitis B Infection (OBI) and its Molecular Characteristics among Pregnant Women in Surabaya, Indonesia. MICROBIOLOGY INDONESIA 2016. [DOI: 10.5454/mi.10.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
34
|
Jin L, Nie R, Li Y, Xiao N, Zhu L, Zhu G. Hepatitis B surface antigen in oocytes and embryos may not result in vertical transmission to offspring of hepatitis B virus carriers. Fertil Steril 2015; 105:1010-3. [PMID: 26730499 DOI: 10.1016/j.fertnstert.2015.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To investigate the vertical transmission of hepatitis B virus (HBV) via embryos to children and whether HBV in embryos has an effect on the development of the fetus and pregnancy outcomes of in vitro fertilization and embryo transfer (IVF-ET). DESIGN Long-term follow-up study. SETTING Research laboratory. PATIENT(S) Thirty-one couples with a hepatitis B surface antigen (HBsAg)-negative woman and HBsAg-positive man, and 41 couples with a HBsAg-positive woman and HBsAg-negative man, whose unfertilized oocytes and nonviable embryos were tested for HBV DNA, RNA, or HBsAg. INTERVENTION(S) HBV DNA, RNA, or HBsAg analyses in unfertilized oocytes and nonviable embryos. MAIN OUTCOME MEASURE(S) HBV serologic markers analyses. RESULT(S) We obtained follow-up data for 71 couples. A total of 24 babies were born, and no newborns exhibited defects at birth. Twelve babies were born to couples with HBV-positive oocytes and/or embryos. The pregnancy outcomes were not associated with the presence of HBV in oocytes and embryos. Three patterns of HBV serologic markers were screened. Twenty babies were anti-HBs-positive. Three babies were negative for HBsAg, antibody to hepatitis B surface antigen (anti-HBs), antibody to hepatitis B core antigen (anti-HBc), HBeAg, and antibody to hepatitis B e antigen (anti-HBe). One baby was seropositive for anti-HBs, anti-HBc, and anti-HBe at 6 months of age but seroconverted from anti-HBe-positive to anti-HBe-negative at 9 months of age. CONCLUSION(S) The presence of HBsAg in oocytes and embryos may not result in the vertical transmission of HBV in the offspring of HBV carriers.
Collapse
Affiliation(s)
- Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Rui Nie
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
| | - Yufeng Li
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Nan Xiao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lixia Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Guijin Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| |
Collapse
|
35
|
Fei QJ, Yang XD, Ni WH, Pan CS, Huang XF. Can hepatitis B virus DNA in semen be predicted by serum levels of hepatitis B virus DNA, HBeAg, and HBsAg in chronically infected men from infertile couples? Andrology 2015; 3:506-11. [PMID: 25873521 DOI: 10.1111/andr.12021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/08/2015] [Accepted: 01/26/2015] [Indexed: 12/29/2022]
Abstract
Hepatitis B virus (HBV) in semen is important for father-to-child transmission of HBV and has adverse effects on sperm quality. However, risk factors associated with HBV in semen remain unclear. Serum HBV DNA and hepatitis B e antigen (HBeAg) levels may pose a risk on HBV in semen. This study aims to examine whether serum HBV DNA, HBeAg, and hepatitis B surface antigen (HBsAg) level were associated with HBV DNA in semen. 151 male patients chronically infected with HBV from infertile couples were included. Serum HBsAg and HBeAg were determined using an electrochemiluminescence immune assay (ECLIA). Serum and seminal plasma HBV DNA were detected by the QIAGEN Real-Time HBV DNA assay. Of 151 patients, 143 (94.7%) were serum HBV DNA-positive and 65 (43.0%) were seminal plasma HBV DNA-positive. Serum HBV DNA and HBeAg level of seminal plasma HBV DNA-positive patients were significantly higher (p < 0.001) as compared with those of seminal plasma HBV DNA-negative patients, HBsAg level of seminal plasma HBV DNA-positive patients was significantly lower (p < 0.001) compared with that of seminal plasma HBV DNA-negative patients. The best serum HBV DNA, HBeAg, and HBsAg value for discriminating between seminal plasma HBV DNA-positive and HBV DNA-negative patients were ≥6.9 log10 IU/mL (sensitivity 100.0%, specificity 90.7%), >14.8 S/CO (sensitivity 96.9%, specificity 81.5%), and <1791.5 S/CO (sensitivity 81.5%, specificity 81.2%), respectively. The combination of serum HBV DNA and HBeAg had high diagnostic sensitivity (100.0%) and specificity (95.4%) for the presence of HBV DNA in semen. As such, these serum markers especially the combination of HBV DNA and HBeAg are useful predictors of the presence of HBV DNA in semen in HBV chronically infected men from infertile couples.
Collapse
Affiliation(s)
- Q J Fei
- Reproductive Medicine Center, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - X D Yang
- Department of Infectious Disease, Yuying Children's Hospital Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - W H Ni
- Reproductive Medicine Center, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - C S Pan
- Reproductive Medicine Center, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - X F Huang
- Reproductive Medicine Center, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| |
Collapse
|
36
|
Mansour W, Lemoine M, Neri Pinto F, Llabador de Royer MA, Le Gal F, Yazbeck C, Patrat C, Gordien E. Markers of hepatitis delta virus infection can be detected in follicular fluid and semen. J Clin Virol 2014; 61:279-81. [DOI: 10.1016/j.jcv.2014.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/27/2014] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
|
37
|
Nelson NP, Jamieson DJ, Murphy TV. Prevention of Perinatal Hepatitis B Virus Transmission. J Pediatric Infect Dis Soc 2014; 3 Suppl 1:S7-S12. [PMID: 25232477 PMCID: PMC4164184 DOI: 10.1093/jpids/piu064] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hepatitis B virus (HBV) infection, the most common form of chronic hepatitis worldwide, is a major public health problem affecting an estimated 360 million people globally. Mother-to-child transmission (MTCT) is responsible for more than one third of chronic HBV infections worldwide. An estimated 15%-40% of persons chronically infected develop HBV-related complications, such as cirrhosis and hepatic carcinoma, and 25% die from these complications. MTCT can occur during pregnancy or during delivery. Screening pregnant women for HBV infection, providing infant postexposure prophylaxis, and maternal treatment with antiviral medications are strategies for reducing MTCT transmission rates and the global burden of new chronic HBV infections. Administration of hepatitis B immune globulin (HBIG) and hepatitis B (HepB) vaccine within 24 hours of birth, followed by completion of the vaccine series, is 85%-95% efficacious for prevention of MTCT. Despite timely post-exposure prophylaxis, MTCT occurs in 5%-15% of infants. Hepatitis B surface antigen (HBsAg) positive, hepatitis e antigen (HBeAg) positive mothers with HBV DNA level ≥10(6) copies/mL (>200 000 IU/mL) are at greatest risk of transmitting HBV to their infants. Consensus recommendations and evidence-based guidelines for management of chronic HBV infection and screening of pregnant women have been developed. The safety and efficacy of antiviral drug use during pregnancy are areas of ongoing research. Substantial advances have been achieved globally in reducing MTCT, but MTCT remains an ongoing health problem. Attaining a better understanding of the mechanisms of MTCT, implementing existing policies on maternal screening and infant follow-up, and addressing research gaps are critical for further reductions in MTCT transmission.
Collapse
Affiliation(s)
- Noele P. Nelson
- Division of Viral Hepatitis, Vaccine Research and Policy Unit, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
| | - Denise J. Jamieson
- Women's Health and Fertility Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Trudy V. Murphy
- Division of Viral Hepatitis, Vaccine Research and Policy Unit, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
| |
Collapse
|
38
|
Park JS, Pan C. Current recommendations of managing HBV infection in preconception or pregnancy. Front Med 2014; 8:158-65. [PMID: 24871444 DOI: 10.1007/s11684-014-0340-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 02/28/2014] [Indexed: 02/08/2023]
Abstract
Hepatitis B remains a leading cause of cirrhosis, hepatocellular carcinoma and liver transplantation worldwide. Management of chronic hepatitis B during pregnancy is challenging. Transmission of hepatitis B to infants still occurs perinatally although immunoprophylaxis is widely available for infants born to mothers with chronic hepatitis B infection. The emerging data suggest that initiation of antiviral therapy in the beginning of the third trimester in highly viremic mothers can prevent immunoprophylaxis failure in their infants. The available drug safety data show that lamivudine, telbivudine and tenofovir are generally safe to be used during the pregnancy. In order to minimize the fetal exposure to the antiviral medication, antiviral therapy during the pregnancy should be limited to a selected group of patients with cirrhosis, high hepatitis B viral load, or prior history immunoprophylaxis failure. An elective Caesarean section may reduce the risk of perinatal transmission. For those females planning for pregnancy or in early stage of pregnancy, communication and follow-up among obstetrician, gastroenterologist, and primary care physician are important. In this article, we will review the features of hepatitis B infection before, during and after the pregnancy; the risk factors that increase mother-to-child transmission; safety data on antiviral drug use during pregnancy; and the potential role of Caesarean section in selected cases.
Collapse
Affiliation(s)
- James S Park
- Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, NYU School of Medicine, New York, 10016, USA
| | | |
Collapse
|
39
|
Risk of vertical transmission of hepatitis B after amniocentesis in HBs antigen-positive mothers. J Hepatol 2014; 60:523-9. [PMID: 24269471 DOI: 10.1016/j.jhep.2013.11.008] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 11/05/2013] [Accepted: 11/08/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND & AIMS Despite appropriate immunoprophylaxis, HBV vertical transmission (VT) occurs in 5-10% of infants born to HBs-antigen (HBsAg)+ mothers. We investigated whether amniocentesis increases the risk of transmission. METHODS We performed a case-control study on infants who were born to HBsAg+ mothers without antiviral exposure and completed appropriate immunization. Infants born to mothers with amniocentesis were compared to those without amniocentesis to assess VT rates, which were defined by the percentage of infants with HBsAg positivity when they were 7-12 months old. RESULTS Of the 642 consecutive infants enrolled, 63 infants with amniocentesis were compared with 198 matched infants selected from the remaining 579 infants without amniocentesis. There was a higher VT rate in infants with amniocentesis than in those without amniocentesis (6.35% vs. 2.53%; p=0.226). Maternal HBV DNA levels before amniocentesis were further stratified to <500 copies/ml, 500-6.99 log10 copies/ml, and ⩾ 7 log10 copies/ml for subset analyses. There were no significant differences in the VT rates between the amniocentesis group and the control group if the maternal HBV DNA levels were <6.99 log10 copies/ml. However, a significantly higher VT rate was observed in the amniocentesis group vs. the control group if the maternal HBV DNA levels were ⩾ 7 log10 copies/ml (50% vs. 4.5%, respectively, p=0.006). According to baseline value risk analyses, performing amniocentesis on highly viremic mothers was a risk factor for HBV transmission (OR=21.3, 95% CI: 2.960-153.775). CONCLUSIONS Amniocentesis performed on HBsAg+ mothers with HBV DNA ⩾ 7 log10 copies/ml significantly increased the frequency of VT. HBsAg+ women who plan to have amniocentesis should be evaluated for the risk of VT and stratified according to their HBV DNA levels. Further prospective studies are warranted to verify our findings.
Collapse
|
40
|
Zhang H, Pan CQ, Pang Q, Tian R, Yan M, Liu X. Telbivudine or lamivudine use in late pregnancy safely reduces perinatal transmission of hepatitis B virus in real-life practice. Hepatology 2014; 60:468-476. [PMID: 25227594 PMCID: PMC4282428 DOI: 10.1002/hep.27034] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 12/31/2013] [Indexed: 12/12/2022]
Abstract
Little observational data exist describing telbivudine (LdT) or lamivudine (LAM) use in late pregnancy for preventing hepatitis B mother-to-child transmission (MTCT) in real-world settings. During the period of January 2009 to March 2011, we enrolled hepatitis B e antigen-positive mothers with HBV DNA >6 log10 copies/mL in China. At gestation week 28, the mothers received LdT or LAM until postpartum week 4 or no treatment (NTx). The study endpoints were the safety of LdT/LAM use and MTCT rates. Of the 700 mothers enrolled, 648 (LdT/LAM/NTx = 252/51/345) completed the 52-week study with 661 infants (LdT/LAM/NTx = 257/52/352). On treatment, viral rebound occurred in 1.6% of mothers, all resulting from medication noncompliance. There was no genotypic mutation detected. At delivery, significantly lower HBV DNA levels were noted in mothers who received LdT or LAM versus NTx. Alanine aminotransferase flares were observed in 17.1% of treated mothers versus 6.3% of untreated mothers (P < 0.001). At birth, hepatitis B surface antigen (HBsAg) was detected in 20% and 24% of newborns in the treated and NTx groups, respectively. At week 52, an intention-to-treat analysis indicated 2.2% (95% confidence [CI]: 0.6-3.8) of HBsAg+ infants from the treated group versus 7.6% (95% CI: 4.9-10.3) in the NTx group (P = 0.001) and no difference of HBsAg+ rate between infants in the LdT and LAM groups (1.9% vs. 3.7%; P = 0.758). On-treatment analysis indicated 0% of HBsAg+ infants in the treated group versus 2.84% in the NTx group (P = 0.002). There were no differences for gestational age or infants' height, weight, Apgar scores, or birth defect rates between infants from the treated and untreated groups. Conclusions: LdT and LAM use in late pregnancy for highly viremic mothers was equally effective in reducing MTCT. The treatment was well tolerated with no safety concerns identified. (Hepatology 2014).
Collapse
Affiliation(s)
- Hua Zhang
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | | |
Collapse
|
41
|
Chen H, Ge HS, Lv JQ, Wu XM, Xi HT, Huang JY, Zhu CF. Chronic hepatitis B virus infection in women is not associated with IVF/ICSI outcomes. Arch Gynecol Obstet 2013; 289:213-7. [DOI: 10.1007/s00404-013-2975-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/18/2013] [Indexed: 11/25/2022]
|
42
|
Tong MJ, Huynh TT, Siripongsakun S. Familial clustering of hepatocellular carcinoma in HBsAg-positive patients in the United States. Hepatol Int 2013. [PMID: 26202031 DOI: 10.1007/s12072-013-9447-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The impact of familial clustering of hepatocellular carcinoma (HCC) in hepatitis B virus (HBV)-infected persons in a low HBV endemic area was investigated. METHODS Four hundred thirteen HBsAg-positive patients, 173 with HCC and 240 without HCC, were subgrouped into those with or without a family history of HCC and analyzed for risk factors associated with HCC development. In families with HCC clustering, the ages of HCC onset in parents and siblings were compared. RESULTS Forty-four of 173 (25.4 %) HCC patients, all of Asian descent, had 82 other blood relatives with HCC. Of these, 69 (84.1 %) were first-degree relatives. Compared to HCC patients without HCC family history, male HCC patients with family history developed HCC at a younger age than either their mothers or fathers with HCC (45.2 ± 10.3 years vs. 63.0 ± 6.8 years, p < 0.001 and 41.2 ± 14.8 years vs. 60.5 ± 5.5 years, p = 0.001, respectively); however, this was not observed in female HCC patients. In mothers of index HCC cases, 22/26 (84.6 %) tested were HBsAg positive and 14 (63.6 %) had HCC; in fathers, 11/21 (52.4 %) tested were HBsAg positive and 10 (90.9 %) had HCC. By multivariate analysis, independent risk factors for HCC development included family history (OR = 2.58, p = 0.05), male gender (OR = 3.23, p = 0.03), cirrhosis (OR = 2.4, p = 0.04), Child-Pugh classification (OR = 7.62, p = 0.004), AFP per log10 increase (OR = 1.68, p = 0.01), precore mutation (OR = 3.77, p = 0.003), and basal core promoter mutation (OR = 8.33, p < 0.001). CONCLUSIONS HBsAg-positive male HCC patients presented at a younger age than their parents with HCC. In adult patients with an HCC family history, HCC surveillance should begin at the time of the initial clinic encounter.
Collapse
Affiliation(s)
- Myron John Tong
- Liver Center, Huntington Medical Research Institutes, 660 South Fair Oaks Avenue, Pasadena, CA, 91105, USA.
- Pfleger Liver Institute and the Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Thatcher Thi Huynh
- Liver Center, Huntington Medical Research Institutes, 660 South Fair Oaks Avenue, Pasadena, CA, 91105, USA
| | - Surachate Siripongsakun
- Liver Center, Huntington Medical Research Institutes, 660 South Fair Oaks Avenue, Pasadena, CA, 91105, USA
- Pfleger Liver Institute and the Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Chalubhorn Hospital, Bangkok, Thailand
| |
Collapse
|
43
|
Cheung KW, Seto MTY, Wong SF. Towards complete eradication of hepatitis B infection from perinatal transmission: review of the mechanisms of in utero infection and the use of antiviral treatment during pregnancy. Eur J Obstet Gynecol Reprod Biol 2013; 169:17-23. [PMID: 23465469 DOI: 10.1016/j.ejogrb.2013.02.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 12/27/2012] [Accepted: 02/03/2013] [Indexed: 02/07/2023]
Abstract
Hepatitis B infection remains the most common form of chronic hepatitis. Mother to child transmission occurs despite immunoprophylaxis with vaccination and immunoglobulin. In utero infection is suggested to account for most of the cases with immunoprophylaxis failure. Infants who suffer from hepatitis B infection at birth have a higher risk of becoming chronic carriers and may develop liver cirrhosis or hepatocellular carcinoma in the future. Infected germ cells, transplacental infection, invasive prenatal diagnostic tests and various perinatal factors are possible factors leading to in utero infection and subsequent immunoprophylaxis failure. Hepatitis B e antigen positive status and high viral load increase the risk of immunoprophylaxis failure. Recent evidence shows promising results regarding the use of antiviral treatment in late gestation to suppress viral load, so as to decrease the risk of vertical transmission. This review discusses the possible mechanisms of in utero infection and the use of antiviral treatment during pregnancy.
Collapse
Affiliation(s)
- K W Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
| | | | | |
Collapse
|
44
|
Abstract
Hepatitis B is a serious public health problem all around the world. It is a blood-borne and sexually transmitted DNA virus in adults, but mother to child transmission of hepatitis B virus also occurs in infants born to hepatitis B surface antigen positive mothers.
Collapse
|
45
|
Mufti AR, Reau N. A pregnant patient with a positive hepatitis B surface antigen. Frontline Gastroenterol 2013; 4:12-19. [PMID: 28839696 PMCID: PMC5369788 DOI: 10.1136/flgastro-2012-100147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 04/22/2012] [Accepted: 05/30/2012] [Indexed: 02/04/2023] Open
Abstract
Hepatitis B is a major cause of liver disease worldwide. The highest rates of chronic infection occur in subjects who are infected early in life and these patients are also at the greatest risk of developing complications such as hepatocellular carcinoma and cirrhosis from the disease. There has been a concerted worldwide effort to immunise newborns that are at the highest risk of acquiring infection. In 1992, when WHO recommended global vaccination against hepatitis B, only 31 countries elected to participate in the programme. By 2009, 177 countries were part of WHO national infant immunisation programme. Consequently, maternal screening and infant immunoprophylaxis have significantly reduced vertical transmission of hepatitis B. In this paper, we will review the management of hepatitis B in the pregnant population and identify some of the challenges that are encountered in this specialised population.
Collapse
Affiliation(s)
- Arjmand Rasool Mufti
- Department of Gastroenterology, Hepatology and Nutrition, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Nancy Reau
- Center for Liver Disease, University of Chicago Medical Center, Chicago, Illinois, USA
| |
Collapse
|
46
|
Kumar M, Singh T, Sinha S. Chronic hepatitis B virus infection and pregnancy. J Clin Exp Hepatol 2012; 2:366-81. [PMID: 25755458 PMCID: PMC3940289 DOI: 10.1016/j.jceh.2012.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 09/06/2012] [Indexed: 02/06/2023] Open
Abstract
Planning of pregnancy and management of chronic hepatitis B virus during pregnancy includes recognition of maternal virological status, assessment of liver disease severity and minimization of risk for mother to infant transmission of infection. Decisions regarding the use of antivirals during pregnancy need to be individualized. Monitoring for infection and immunization in newborns is also important. For mothers on antiviral therapy, breastfeeding is not recommended.
Collapse
Key Words
- ALT, alanine aminotransferase
- APASL, Asian Pacific Association for the Study of the Liver
- APR, Antiretroviral Pregnancy Registry
- CDC, Centers for Disease Control and Prevention
- CI, confidence interval
- DART, Development of Antiretroviral Therapy Study
- EASL, European Association for the Study of the Liver
- ECS, elective caesarian section
- FDA, Food and Drug Administration
- HBIg, hepatitis B immunoglobulin
- HBV, hepatitis B virus
- HBeAg, hepatitis B e antigen
- HBsAg, hepatitis B surface antigen
- HIV, human immunodeficiency virus
- NA, nucleot(s)ide analog
- PEG-IFN, pegylated interferon
- PHACS, Pediatric HIV/AIDS Cohort Study
- RCTs, randomized clinical trials
- breast feeding
- chronic hepatitis B
- pregnancy
Collapse
Affiliation(s)
- Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India
| | - Tarandeep Singh
- Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India
| | - Swati Sinha
- Department of Obstetrics and Gynecology, Sitaram Bhartia Institute of Science and Research, B-16, Qutab Institutional Area, New Delhi 110016, India
| |
Collapse
|
47
|
Pan CQ, Duan ZP, Bhamidimarri KR, Zou HB, Liang XF, Li J, Tong MJ. An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clin Gastroenterol Hepatol 2012; 10:452-9. [PMID: 22079509 DOI: 10.1016/j.cgh.2011.10.041] [Citation(s) in RCA: 181] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 10/11/2011] [Accepted: 10/30/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Despite immunoprophylaxis, mother to child transmission (MTCT) of hepatitis B virus (HBV) still occurs in infants born to hepatitis B surface antigen (HBsAg)-positive mothers. We analyzed methods of risk assessment and interventions for MTCT. METHODS We reviewed 63 articles and abstracts published from 1975-2011 that were relevant to MTCT; articles were identified using the PubMed bibliographic database. RESULTS Administration of HB immunoglobulin and HB vaccine to infants at birth (within 12 hours), followed by 2 additional doses of vaccines within 6-12 months, prevented approximately 95% of HBV transmission from HBsAg-positive mothers to their infants. However, HBV was still transmitted from 8%-30% of mothers with high levels of viremia. It is important to assess the risk for MTCT and identify mothers who are the best candidates for intervention. The most important risk factor is maternal level of HBV DNA >200,000 IU (10(6) copies)/mL; other factors include a positive test result for the HB e antigen, pregnancy complications such as threatened preterm labor or prolonged labor, and failure of immunoprophylaxis in prior children. Antiviral therapy during late stages of pregnancy is the most effective method to reduce transmission from mothers with high levels of viremia, but elective cesarean section might also be effective. Antepartum administration of HB immunoglobulin, giving infants a double dose of HB vaccine, or avoiding breastfeeding had no impact on MTCT. CONCLUSIONS HBsAg-positive mothers should be assessed for risk of MTCT, and infants should receive immunoprophylaxis. Pregnant women with levels of HBV DNA >200,000 IU/mL should be considered for strategies to reduce the risk for MTCT. We propose an algorithm for risk assessment and patient management that is based on a review of the literature and the opinion of a panel of physicians with expertise in preventing MTCT.
Collapse
Affiliation(s)
- Calvin Q Pan
- Division of Liver Diseases, Mount Sinai Medical Center, Mount Sinai School of Medicine, New York, New York 11355, USA.
| | | | | | | | | | | | | |
Collapse
|
48
|
Cobo A, Bellver J, de los Santos MJ, Remohí J. Viral screening of spent culture media and liquid nitrogen samples of oocytes and embryos from hepatitis B, hepatitis C, and human immunodeficiency virus chronically infected women undergoing in vitro fertilization cycles. Fertil Steril 2011; 97:74-8. [PMID: 22035968 DOI: 10.1016/j.fertnstert.2011.10.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 10/07/2011] [Accepted: 10/07/2011] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the presence of viral RNA or DNA sequences in spent culture media used after ovum pickup (OPU) or embryo culture and in liquid nitrogen (LN) used for oocyte or embryo vitrification in patients seropositive for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) undergoing IVF cycles. DESIGN Descriptive study. SETTING Private university-affiliated IVF center. PATIENT(S) Twenty-four women who underwent controlled ovarian stimulation for oocyte vitrification or IVF/ET. A total of 6, 11, and 6 patients were seropositive for HIV, HCV, and HBV, respectively, whereas 1 patient showed a coinfection with HCV and HBV. Seven patients presented positive blood viral load (HIV, n = 1; HBV, n = 1; HCV, n = 5). Sixty-three samples were analyzed: follicular fluid, n = 3; spent culture media, n = 33 (20 after OPU and 13 after embryo culture); and LN, n = 27 (14 and 10 after oocyte and embryo vitrification; and 3 LN storage tank samples). INTERVENTION(S) Ovum pickup, oocyte and/or embryo culture, and/or vitrification by the Cryotop open device. Reverse transcription-polymerase chain reaction analysis was performed for viral screening. MAIN OUTCOME MEASURE(S) Detection of viral sequences of HIV, HCV, and HVB. RESULT(S) All the samples analyzed tested negative for the detection of viral RNA or DNA sequences. CONCLUSION(S) We have not detected viral sequences after culture and vitrification of oocytes/embryos from HIV-, HBV-, and HCV-seropositive patients. These findings represent good evidence of the lack of risk of cross-contamination among seropositive patients, even using an open device for vitrification.
Collapse
Affiliation(s)
- Ana Cobo
- IVI-Valencia, Institut Universitari IVI, Valencia, Spain.
| | | | | | | |
Collapse
|