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Mao K, Jiang P, Cai W, Lin Y, Zhou Y, Li D. Association of gestational hepatitis B virus infection and antiviral therapy with pregnancy outcomes: A retrospective study. Int J Gynaecol Obstet 2024; 166:115-125. [PMID: 38831742 DOI: 10.1002/ijgo.15716] [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: 05/15/2023] [Revised: 04/29/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE To explore the relationships between gestational hepatitis B virus (HBV) infection, antiviral therapy, and pregnancy outcomes. METHODS We retrospectively selected hepatitis B surface antigen (HBsAg)-positive pregnant women hospitalized for delivery at Fujian Medical University Affiliated Hospital from October 1, 2016 to October 1, 2020. The control group included randomly selected healthy pregnant women hospitalized for delivery during the same time. RESULTS Overall, 1115 participants were enrolled and grouped into control (n = 380) and HBsAg-positive groups (n = 735), which were further divided into groups I (n = 407; low viral load), II (n = 207; high viral load without antiviral therapy), and III (n = 121; high viral load with antiviral therapy). Pregnant women with HBV were positively correlated with the incidence of intrahepatic cholestasis of pregnancy (ICP) (adjusted odds ratio [aOR] 5.1, 95% confidence interval [CI] 2.62-9.92, P < 0.001), neonatal jaundice (aOR 10.56, 95% CI 4.49-24.83, P < 0.001), and neonatal asphyxia (aOR 5.03, 95% CI 1.46-17.27, P = 0.01). Aspartate aminotransferase (AST) greater than the upper limit of normal (ULN) was an independent risk factor for increased ICP incidence (aOR 3.49, 95% CI 1.26-9.67, P = 0.019). Antiviral therapy considerably reduced HBV DNA and improved liver function. High viral load and antiviral therapy did not correlate significantly with adverse pregnancy outcomes (P < 0.05). CONCLUSION Pregnant women with HBV have significantly elevated incidence of ICP, neonatal jaundice, and neonatal asphyxia not significantly correlated with viral load. AST greater than ULN independently increases the risk of ICP. Antiviral therapy effectively reduces viral replication and improves liver function without increasing the risk of adverse outcomes.
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Affiliation(s)
- Kaiyi Mao
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Pingying Jiang
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Weiqi Cai
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yongxu Lin
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yu Zhou
- Department of Obstetrics and Gynecology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Dan Li
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Clinical Research Center for Digestive System Tumors and Upper Gastrointestinal Diseases, Fuzhou, China
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Badell ML, Prabhu M, Dionne J, Tita ATN, Silverman NS. Society for Maternal-Fetal Medicine Consult Series #69: Hepatitis B in pregnancy: updated guidelines. Am J Obstet Gynecol 2024; 230:B2-B11. [PMID: 38141870 DOI: 10.1016/j.ajog.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
More than 290 million people worldwide, and almost 2 million people in the United States, are infected with hepatitis B virus, which can lead to chronic hepatitis B, a vaccine-preventable communicable disease. The prevalence of chronic hepatitis B infection in pregnancy is estimated to be 0.7% to 0.9% in the United States, with >25,000 infants born annually at risk for chronic infection due to perinatal transmission. Given the burden of disease associated with chronic hepatitis B infection, recent national guidance has expanded both the indications for screening for hepatitis B infection and immunity and the indications for vaccination. The purpose of this document is to aid clinicians caring for pregnant patients in screening for hepatitis B infection and immunity status, discuss the perinatal risks of hepatitis B infection in pregnancy, determine whether treatment is indicated for maternal or perinatal indications, and recommend hepatitis B vaccination among susceptible patients. The following are the Society for Maternal-Fetal Medicine recommendations: (1) we recommend triple-panel testing (hepatitis B surface antigen screening, antibody to hepatitis B surface antigen, and total antibody to hepatitis B core antigen) at the initial prenatal visit if not previously documented or known to have been performed (GRADE 1C); (2) we recommend universal hepatitis B surface antigen screening alone at the initial prenatal care visit for all pregnancies where there has been a previously documented negative triple-panel test (GRADE 1B); (3) we recommend that individuals with unknown hepatitis B surface antigen screening status be tested on any presentation for care in pregnancy; we also recommend that those with clinical hepatitis or those with risk factors for acute hepatitis B infection be tested at the time of admission to a birthing facility when delivery is anticipated (GRADE 1B); (4) we do not recommend altering routine intrapartum care in individuals chronically infected with hepatitis B; administration of neonatal immunoprophylaxis is standard of care in these situations (GRADE 1B); (5) we do not recommend cesarean delivery for the sole indication of reducing perinatal hepatitis B virus transmission (GRADE 1B); (6) we recommend that individuals with HBV infection can breastfeed as long as the infant has received immunoprophylaxis at birth (GRADE 1C); (7) we suggest individuals with hepatitis B infection who desire invasive testing may have the procedure performed after an informed discussion on risks and benefits in the context of shared decision-making and in the context of how testing will affect clinical care (GRADE 2C); (8) in individuals with hepatitis viral loads >200,000 IU/mL (>5.3 log 10 IU/mL), we recommend antiretroviral therapy with tenofovir (tenofovir alafenamide at 25 mg daily or tenofovir disoproxil fumarate at 300 mg daily) in the third trimester (initiated at 28-32 weeks of gestation) as an adjunctive strategy to immunoprophylaxis to reduce perinatal transmission (GRADE 1B); (9) we recommend administering hepatitis B vaccine and hepatitis B immunoglobin within 12 hours of birth to all newborns of hepatitis B surface antigen-positive pregnant patients or those with unknown or undocumented hepatitis B surface antigen status, regardless of whether antiviral therapy has been given during the pregnancy to the pregnant patient (GRADE 1B); and (10) we recommend hepatitis B vaccination in pregnancy for all individuals without serologic evidence of immunity or documented history of vaccination (GRADE 1C).
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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: 9] [Impact Index Per Article: 9.0] [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.
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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
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4
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Veronese P, Dodi I, Esposito S, Indolfi G. Prevention of vertical transmission of hepatitis B virus infection. World J Gastroenterol 2021; 27:4182-4193. [PMID: 34326618 PMCID: PMC8311536 DOI: 10.3748/wjg.v27.i26.4182] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/29/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) is the leading cause of chronic viral hepatitis. Annually, almost two million children younger than 5 years acquire the infection, mostly through vertical or horizontal transmission in early life. Vertical transmission of HBV is a high efficacy phenomenon ranging, in the absence of any preventive interventions, from 70% to 90% for hepatitis e antigen positive mothers and from 10% to 40% for hepatitis e antigen-negative mothers. Maternal viraemia is a preeminent risk factor for vertical transmission of HBV. Maternal screening is the first step to prevent vertical transmission of HBV. Hepatitis B passive and active immunoprophylaxis at birth together with antiviral treatment of highly viraemic mothers are the key strategies for global elimination of HBV infection. Strategies are needed to promote implementation of birth-dose vaccination and hepatitis B immunoglobulins in low- and middle-income countries where the prevalence of the infection is at the highest.
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Affiliation(s)
- Piero Veronese
- Department of Medicine and Surgery, University of Parma, Parma 43121, Italy
| | - Icilio Dodi
- Department of Pediatrics, Pietro Barilla Children's Hospital, Parma 43121, Italy
| | - Susanna Esposito
- Department of Medicine and Surgery, University of Parma, Parma 43121, Italy
| | - Giuseppe Indolfi
- Department Neurofarba, University of Florence, Florence 50129, Italy
- Department Neurofarba, Meyer Children's University Hospital, Florence 50129, Italy
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Castillo E, Murphy K, van Schalkwyk J. N° 342-L'hépatite B et la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:191-201. [DOI: 10.1016/j.jogc.2017.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Wang Z, Zeng J, Li T, Zheng X, Xu X, Ye X, Lu L, Zhu W, Yang B, Allain JP, Li C. Prevalence of hepatitis B surface antigen (HBsAg) in a blood donor population born prior to and after implementation of universal HBV vaccination in Shenzhen, China. BMC Infect Dis 2016; 16:498. [PMID: 27647214 PMCID: PMC5028969 DOI: 10.1186/s12879-016-1834-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/14/2016] [Indexed: 02/06/2023] Open
Abstract
Background Neonatal hepatitis B vaccination program at birth has been implemented nationwide since 1992 in China. However, current HBV prevalence status in blood donors has not been entirely examined, which may impact HBV safety in blood donations as the vaccinees over 18 years old progressively become the majority population of blood donors. Methods In this study, 569,145 blood donors were screened for HBsAg by rapid tests and enzyme immunoassays, among them 475,538 blood samples with negative HBsAg were further screened for HBV DNA by nucleic acid testing between 2005 and 2014 at Shenzhen blood center. Results An overall 2.3 % HBsAg prevalence was found in the blood donor population during the past 10 years (2.86 % in 2005, 1.76 % in 2010, and 2.79 % in 2014, respectively). HBsAg seroconversion occurred in 0.37 % of repeat-donors. When stratified by age, the prevalence of HBsAg was found significantly higher in younger donors age 18–25 years (2.73 %) than in those 26–35 years (2.13 %), 36–45 years (2.03 %) and 46–58 years (1.71 %) (P < 0.001), unexpectedly suggesting that younger donors remained at risk of chronic HBV infection. Assuming that donors aged 18–22 born before or after 1992 were non-vaccinated and vaccinated, respectively, HBsAg prevalence was higher in first-time donors born ≥1992 (3.9 %) than prior to 1992 (3.5 %, P = 0.005). The incidence of HBV infection in the 5-year period examined was significantly lower in repeat-donors born ≥1992 (0.27 %) than prior to 1992 (0.6 %, P = 0.008). The yield of HBV DNA+/HBsAg- donors was 1:3,302, including 1:4,486 occult infections and 1:43,231 window period infections. Conclusion Young blood donors born after implementation of universal HBV vaccination in China presented higher prevalence of HBsAg but lower incidence of HBsAg seroconversion than older, presumed unvaccinated, donors. HBV vaccine boosting for adolescents at 15–17 years old prior to reaching blood donor age might help improve blood safety.
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Affiliation(s)
- Zhen Wang
- Department of Transfusion Medicine, Southern Medical University, Guangzhou, 510515, China
| | | | - Tingting Li
- Department of Transfusion Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Xin Zheng
- Baoan Central Blood Station, Shenzhen, China
| | | | | | - Liang Lu
- Shenzhen Blood Center, Shenzhen, China
| | | | | | - Jean-Pierre Allain
- Department of Transfusion Medicine, Southern Medical University, Guangzhou, 510515, China.,Department of Haematology, University of Cambridge, Cambridge, UK
| | - Chengyao Li
- Department of Transfusion Medicine, Southern Medical University, Guangzhou, 510515, China. .,School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China.
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Ren Y, Guo Y, Feng L, Li T, Du Y. Controversy and Strategies Exploration in Blocking Mother-to-Child Transmission of Hepatitis B. Int Rev Immunol 2016; 35:249-59. [PMID: 27119534 DOI: 10.3109/08830185.2015.1096934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Hepatitis B, a serious infectious disease caused by the hepatitis B virus (HBV), remains a worldwide social and public health problem. Hepatitis B has a particularly high incidence rate in the world, whereas approximately 35-50% HBV carriers are infected through vertical transmission. Even after newborn immunoprophylaxis, vertical transmission still accounts for 5-10% in China according to plenty of literature in Chinese language. For these reasons, it is important to determine how to effectively intervene in mother-to-child transmission (MTCT). To date, though, intervention methods and measures remain controversial. In order to understand the mechanism of MTCT intervention further and develop effective preventions and interventions, a comprehensive analysis and presentation on some of its more controversial issues will be given in this paper. And eventually we conclude three measures and strategies for these issues: (1) emancipate the mind and seek truth from facts to understand the controversial issues pertaining to MTCT of HBV; (2) treat the basic rules and changing characteristics of MTCT blocking process of hepatitis B with holistic medical thought dialectically and (3) further explore the interaction of genetic susceptibility and environmental factors of MTCT of hepatitis B.
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Affiliation(s)
- Yali Ren
- a School of Public Health, Tongji Medical College , Huazhong University of Science and Technology , Hangkong , P. R. China
| | - Yiyang Guo
- a School of Public Health, Tongji Medical College , Huazhong University of Science and Technology , Hangkong , P. R. China
| | - Li Feng
- a School of Public Health, Tongji Medical College , Huazhong University of Science and Technology , Hangkong , P. R. China
| | - Tongyang Li
- a School of Public Health, Tongji Medical College , Huazhong University of Science and Technology , Hangkong , P. R. China
| | - Yukai Du
- a School of Public Health, Tongji Medical College , Huazhong University of Science and Technology , Hangkong , P. R. China
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#38: Hepatitis B in pregnancy screening, treatment, and prevention of vertical transmission. Am J Obstet Gynecol 2016; 214:6-14. [PMID: 26454123 DOI: 10.1016/j.ajog.2015.09.100] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 12/15/2022]
Abstract
Between 800,000-1.4 million people in the United States and more than 240 million people worldwide are infected with hepatitis B virus (HBV). Specific to pregnancy, an estimated prevalence of 0.7-0.9% for chronic hepatitis B infection among pregnant women in the United States has been reported, with >25,000 infants at risk for chronic infection born annually to these women. Vertical transmission of HBV from infected mothers to their fetuses or newborns, either in utero or peripartum, remains a major source of perpetuating the reservoir of chronically infected individuals globally. Universal screening for hepatitis B infection during pregnancy has been recommended for many years. Identification of pregnant women with chronic HBV infection through universal screening has had a major impact in decreasing the risk of neonatal infection. The purpose of this document is to aid clinicians in counseling their patients regarding perinatal risks and management options available to pregnant women with hepatitis B infection in the absence of coinfection with HIV. We recommend the following: (1) perform routine screening during pregnancy for HBV infection with maternal HBsAg testing (grade 1A); (2) administer hepatitis B vaccine and HBV immunoglobulin within 12 hours of birth to all newborns of HBsAg-positive mothers or those with unknown or undocumented HBsAg status, regardless of whether maternal antiviral therapy has been given during the pregnancy (grade 1A); (3) In pregnant women with HBV infection, we suggest HBV viral load testing in the third trimester (grade 2B); (4) in pregnant women with HBV infection and viral load >6-8 log 10 copies/mL, HBV-targeted maternal antiviral therapy should be considered for the purpose of decreasing the risk of intrauterine fetal infection (grade 2B); (5) in pregnant women with HBV infection who are candidates for maternal antiviral therapy, we suggest tenofovir as a first-line agent (grade 2B); (6) we recommend that women with HBV infection be encouraged to breast-feed as long as the infant receives immunoprophylaxis at birth (HBV vaccination and hepatitis B immunoglobulin) (grade 1C); (7) for HBV infected women who have an indication for genetic testing, invasive testing (eg amniocentesis or chorionic villus sampling) may be offered-counseling should include the fact that the risk for maternal-fetal transmission may increase with HBV viral load >7 log 10 IU/mL (grade 2C); and (8) we suggest cesarean delivery not be performed for the sole indication for reduction of vertical HBV transmission (grade 2C).
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Salman K, Rashmi, Priti S, Molly M, Kumar VS, Zeenat S. Hepatitis B virus infection in pregnant women and transmission to newborns. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(15)60809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abdi F, Novin MG, Afrakhteh M, Khorvash F. Hepatitis B and pregnancy: An update review article. World J Obstet Gynecol 2015; 4:1-8. [DOI: 10.5317/wjog.v4.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/24/2014] [Accepted: 11/03/2014] [Indexed: 02/05/2023] Open
Abstract
Chronic hepatitis B, as a global health problem, is a disease that begins in the prenatal period and its complications gradually become clear later in life. About 5% of women worldwide are carriers of chronic hepatitis B virus (HBV). The most common method of transmission of HBV around the world is from mother to infant. This article aims to review the unique challenges of hepatitis B in pregnancy. Data for this review were collected from our previous studies and experiences plus various data banks, such as PubMed, EMBASE, ISI Web of science, Scopus, Google Scholar and Iranian databases. A comprehensive search was performed using the combinations of the keywords to review relevant literature and higher education journals. All published data up to February 2014 have been included in this review. This article addresses several interesting aspects. First, hepatitis B in pregnancy can vary regarding prevalence, virus behavior, prenatal transmission and outcome of the pregnancy. Second, the women of reproductive age with chronic HBV remain a major source for continued spread of the virus. Finally, pregnant women need screening in prenatal care to enable early intervention when necessary.
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12
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Analysis on the outcomes of hepatitis B virus perinatal vertical transmission: nested case-control study. Eur J Gastroenterol Hepatol 2014; 26:1286-91. [PMID: 25171026 DOI: 10.1097/meg.0000000000000189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Hepatitis B virus (HBV) infection is a public health problem worldwide, with vertical transmission as the leading transmission route. Therefore, it is very important to explore the risk factors associating with HBV perinatal transmission, providing valuable information for preventive and curative means for HBV perinatal infections. In this study, we systematically investigated the impact of adverse outcomes of HBV maternal infection on fetal intrauterine infection. PATIENTS AND METHODS This is a nested case-control study that included 42 hepatitis B surface antigen (HBsAg)-positive pregnant women. Gestational weeks, delivery modes, alanine aminotransferase levels, platelet counts, liver ultrasonography results as well as adverse pregnancy outcomes for the pregnant mothers and Apgar scores at both 1 and 5 min, birth weight, and height for the newborn infants were recorded. Vein blood from pregnant mothers and cord blood immediately after delivery were collected for the detection of HBsAg, antibodies to hepatitis B surface antigen, hepatitis B e antigen (HBeAg), antibody to hepatitis B e antigen, hepatitis B core antigen, and HBV DNA. Placental tissues were collected for detection of HBV DNA. RESULTS Positive HBeAg as well as HBV DNA in the mother's serum were correlated closely with HBV intrauterine infection. Mother's age, delivery mode, alanine aminotransferase, blood platelet count, clinical HBV infection features, premature labor, gestational diabetes mellitus, pre-eclampsia, fetal growth retardation, fetal distress, Apgar scores of the infant as well as the HBV infection status of the placenta all failed to show a statistically significant correlation with intrauterine infection. CONCLUSION High level of HBV in maternal blood was one of the risk factors accounting for intrauterine infection.
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Immunoprophylaxis failure against vertical transmission of hepatitis B virus in the Chinese population: a hospital-based study and a meta-analysis. Pediatr Infect Dis J 2014; 33:897-903. [PMID: 25361021 DOI: 10.1097/inf.0000000000000315] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Despite effective immunoprophylaxis, vertical transmission of hepatitis B virus (HBV) from infected mothers still occurs. This study aimed to provide an estimate of the prevalence of immunoprophylaxis failure and evaluate associated risk factors. METHODS A hospital-based prospective study was conducted from June 1, 2008, to June 30, 2012. In this prospective study, 294 HBsAg-positive mothers were followed up from their first prenatal care visits until their infants completed the proposed vaccination schedule. Further, studies providing prevalence rates of immunoprophylaxis failure in the Chinese population were identified from electronic databases and were collected for a meta-analysis. RESULTS In the prospective study, 16 (5.44%) infants developed HBV infection despite passive-active immunoprophylaxis. Twelve of these infants were born to HBeAg-positive mothers with cord blood that was positive for HBV DNA. After adjusting for maternal and infant factors, HBV DNA detectable in cord blood (odds ratio: 22.32, 95% confidence interval: 4.00-124.47) was associated with a significantly greater risk of immunoprophylaxis failure. The prospective study and 23 previous studies were included in the meta-analysis, constituting a total of 7561 Chinese participants. The overall estimated rates of immunoprophylaxis failure for infants with HBsAg-positive and HBeAg-positive mothers were 4.87% and 9.66% respectively. CONCLUSIONS Immunoprophylaxis failure is an extensive problem, and further studies should design and assess novel strategies for the prevention of immunoprophylaxis failure, especially for cases involving HBeAg-positive mothers and infants with cord blood that is positive for HBV DNA.
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Hu Y, Ding YL, Yu L. The impact of intrahepatic cholestasis of pregnancy with hepatitis B virus infection on perinatal outcomes. Ther Clin Risk Manag 2014; 10:381-5. [PMID: 24920912 PMCID: PMC4043812 DOI: 10.2147/tcrm.s61530] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Introduction To investigate the impact of intrahepatic cholestasis of pregnancy (ICP) with hepatitis B virus (HBV) infection on perinatal outcomes. Methods In the study, 200 pregnant women were divided into four groups, including 50 cases with ICP and HBV infection, 50 cases with ICP, 50 cases with HBV infection, and 50 healthy pregnancies. The delivery process and perinatal outcomes were analyzed among different groups. Results When compared to the healthy pregnancy group, significantly increased rates of premature rupture of membranes, meconium-stained amniotic fluid, and cesarean section were observed in cases of ICP, HBV infection, or ICP patients with HBV (P<0.05). Specifically, the rates of HBV infection in the newborn, fetal distress, neonatal asphyxia, and birth defects in the newborn, and infant Apgar scores were higher in ICP pregnancies with HBV (56%, 48%, 16%, and 48%, respectively) than in the other groups (P<0.05). Conclusion ICP combined with HBV infection has a clear influence on perinatal infant outcomes.
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Affiliation(s)
- Yun Hu
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Yi-Ling Ding
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Ling Yu
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
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Abstract
With an annual birth rate of 12‰, or 16 millions, of all population (1.34 billions), and an implementation of universal healthcare policy for all rural residents in recent years, China is undergoing a dramatic and profound transition in perinatal and neonatal healthcare as a part of the global campaign for reduction in mortality of children under 5 years old. This review describes recent development in neonatal-perinatal medicine, with special emphasis on general neonatal-perinatal care, respiratory and intensive care, neurological and infectious diseases, for a comprehensive view of the trend and challenge in relation with problems and solutions of the field.
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Affiliation(s)
- Bo Sun
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
| | - Xiaomei Shao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China,Laboratory of Neonatal Medicine, Ministry of Health, Shanghai, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China,Laboratory of Neonatal Medicine, Ministry of Health, Shanghai, China
| | - Shiwen Xia
- Department of Neonatology, Hubei Provincial Women and Children's Hospital, Wuhan, China
| | - Hongni Yue
- Department of Neonatology and Obstetrics, Huai'an Women and Children's Hospital, Huai'an, Jiangsu, China
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Celikel A, Ustunsoz A, Guvenc G. Determination of vaccination status of pregnant women during pregnancy and the affecting factors. J Clin Nurs 2013; 23:2142-50. [PMID: 23815510 DOI: 10.1111/jocn.12351] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To determine the vaccination status of pregnant women during pregnancy and factors affecting their vaccination. BACKGROUND Immunisation provided through vaccination is one of the most effective ways to reduce or prevent the risks of disease, disability and death. Maternal and newborn health may be protected and morbidity may be decreased through vaccinating pregnant women when necessary. DESIGN This was a descriptive and cross-sectional survey. METHODS This study was conducted in a university hospital in Ankara, Turkey, between 01 March and 31 May 2010. The study was carried out with 198 healthy pregnant women who had completed the 26th week of gestation. Data were collected using the data collection form composed of questions enquiring about the demographic and obstetric features of pregnant women and whether or not they knew that vaccinations could be given during pregnancy, and which vaccines could be used during pregnancy, which vaccine/vaccines they had previously received and the reasons for having been vaccinated or not. RESULTS Approximately half of the participants had received at least one of the vaccines that may be used in pregnancy (52·0%). The pregnant women received vaccinations for tetanus (47·0%), H1N1 (9·1%), seasonal influenza (3·0%) and hepatitis B (0·5%), respectively. The pregnant women who had been educated about vaccinations had been vaccinated at a statistically significantly higher rate compared with those who had not. CONCLUSION This study revealed that pregnant women's knowledge about the required vaccines during pregnancy affected their behaviour towards vaccination. Acquiring knowledge about vaccines that may be used during pregnancy from health personnel is effective to increase vaccination. This result may be interpreted as 'acquired information affects behaviour towards vaccination'. RELEVANCE TO CLINICAL PRACTICE Providing information about immunisation to pregnant women at the antenatal clinic is important in terms of maternal and newborn health. Nurses and midwives working in the antenatal field should be sufficiently educated about immunisation.
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Affiliation(s)
- Aysegul Celikel
- Department of Obstetrics and Gynecology, School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey
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Han GR, Xu CL, Zhao W, Yang YF. Management of chronic hepatitis B in pregnancy. World J Gastroenterol 2012; 18:4517-21. [PMID: 22969224 PMCID: PMC3435776 DOI: 10.3748/wjg.v18.i33.4517] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 03/15/2012] [Accepted: 03/29/2012] [Indexed: 02/06/2023] Open
Abstract
Pregnancy associated with chronic hepatitis B (CHB) is a common and important problem with unique challenges. Pregnant women infected with CHB are different from the general population, and their special problems need to be considered: such as the effect of hepatitis B virus (HBV) infection on the mother and fetus, the effect of pregnancy on replication of the HBV, whether mothers should take HBV antiviral therapy during pregnancy, the effect of these treatments on the mother and fetus, how to carry out immunization of neonates, whether it can induce hepatitis activity after delivery and other serious issues. At present, there are about 350 million individuals with HBV infection worldwide, of which 50% were infected during the perinatal or neonatal period, especially in HBV-endemic countries. Currently, the rate of HBV infection in the child-bearing age group is still at a high level, and the infection rate is as high as 8.16%. Effective prevention of mother-to-child transmission is an important means of reducing the global burden of chronic HBV infection. Even after adopting the combined immunization measures, there are still 5%-10% of babies born with HBV infection in hepatitis B e antigen positive pregnant women. As HBV perinatal transmission is the main cause of chronic HBV infection, we must consider how to prevent this transmission to reduce the burden of HBV infection. In this population of chronic HBV infected women of childbearing age, specific detection, intervention and follow-up measures are particularly worthy of attention and discussion.
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