Analysis on ten-year data of individualized programs to prevent mother-to-child transmission of hepatitis B virus

doi:10.3877/cma.j.issn.1674-1358.2021.05.003

Abstract

Abstract:

Objective

To investigate the effect of individualized programs on blocking mother-to-child transmission (MTCT) of hepatitis B virus (HBV).

Methods

Based on the status of HBeAg and HBV DNA level in HBsAg-positive pregnant women, the Department of Hepatology and Obstetrics of the Fifth People’s Hospital of Suzhou optimized and refined the immunoblocking programs recommended by the domestic guidelines for liver disease, and formed an individualized immune blocking schemes. The clinical data of all HBsAg-positive pregnant women hospitalized in our hospital from September 2009 to May 2019, and the HBV serological markers of their infants aged 8-12 months (observation group) were collected. Individualized programs were used to block MTCT of HBV. Meanwhile, the corresponding clinical and follow-up data of all HBsAg-positive pregnant women and their infants delivered in Kunshan city from February 2015 to July 2019 were collected as control group. The newborns of the control group were given the immunoprophylaxis recommended by the domestic guidelines for liver diseases.

Results

Total of 2 702 pregnant women were enrolled in observation group, and 2 717 healthy newborns (including 15 twins) were delivered. Among them, 2 345 newborns (including 12 twins) were treated with immunoprophylaxis measures (program 1 and 2); 369 pregnant women were treated with nucleos(t)ide analogs (NAs) antiviral therapy (program 3), and 372 newborns (including 3 twins) were delivered. In control group, 2 616 pregnant women with HBsAg positive were enrolled, 2 620 healthy newborns (including 4 twins) were delivered and were given immunoblocking treatment. In observation group, 19 infants were detected positive for serum HBsAg, and their mothers were all with positive HBeAg. The HBV DNA loads of their mothers were all > 5 log₁₀IU/ml, and the women with HBV DNA level > 7 log₁₀IU/ml accounted for 84.21% (16/19). The overall failure rate of blocking MTCT was 0.70% (19/2 717), and the overall immunoblocking failure rate was 0.81% (19/2 345). Among pregnant women with HBeAg positive, the overall failure rate was 1.21% (19/1 574), the immunoblocking failure rate was 1.51% (19/1 256), which was 1.69% (16/949) in pregnant women with HBV DNA load > 7 log₁₀ IU/ml. For all pregnant women with negative HBeAg, HBV DNA load < 5 log₁₀IU/ml and NAs prophylaxis, the success rate of blocking MTCT was 100%. There was no significant difference in the failure rate between the two subgroups of immunoprophylaxis and NAs therapy (P = 0.096). A total of 53 infants were serum HBsAg positive in control group. The overall immunoblocking failure rate was 2.02% (53/2 620), which was significantly higher than that of the observation group (χ² = 12.733, P < 0.001). Among them, the failure rates were 2.87% (15/523) and 1.81% (38/2 097) in HBeAg positive and negative pregnant women, respectively, which were significantly higher than the corresponding failure rates of the observation group (χ² = 6.790, P = 0.009; and χ² = 20.958, P < 0.001). There was no significant difference of the failure rates between different delivery and feeding modes in observation group, respectively (χ² = 0.045, P = 0.832; χ² = 0.021, P = 0.884).

Conclusions

The individualized program remarkably improves the success rate of MTCT prevention for HBV. The individualized immunoprophylaxis strategy based on HBV infection of pregnant women significantly reduces the failure rate of combined immunoblocking program.

Key words: Hepatitis B virus, Mother-to-child transmission, Individualized program, Blocking, Effect analysis

Rong Zhang, Yongyan Tang, Qian Yu, Zhiyun Ding, Li Zhu, Jie Yao, Ji Zhao, Yu Zhang, Deming Ma, Lina Zhang, Xiaoying Yao, Shanwen Ding, Shanghu Shi, Yufang Jia, Jing Shen, Haiyan Wang, Chancong Gong, Xiujuan Shen, Ming Li, Feng Qian, Chuanwu Zhu. Analysis on ten-year data of individualized programs to prevent mother-to-child transmission of hepatitis B virus[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(05): 303-310.

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References 32

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组别		例数	婴儿总数[例（%）]	婴儿HBsAg阳性[例（%）]	阻断失败率（%）	χ²值	P值
观察组						13.894	< 0.001
	HBeAg（+）	1 568	1 574（57.93）	19（100.00）	1.21
	HBeAg（-）	1 134	1 143（42.07）	0（0.00）	0.00
对照组						2.355	0.125
	HBeAg（+）	522	523（19.96）	15（28.30）	2.87
	HBeAg（-）	2 094	2 097（80.04）	38（71.70）	1.81

组别		例数	婴儿总数[例（%）]	婴儿HBsAg阳性[例（%）]	阻断失败率（%）	χ²值	P值
观察组						13.894	< 0.001
	HBeAg（+）	1 568	1 574（57.93）	19（100.00）	1.21
	HBeAg（-）	1 134	1 143（42.07）	0（0.00）	0.00
对照组						2.355	0.125
	HBeAg（+）	522	523（19.96）	15（28.30）	2.87
	HBeAg（-）	2 094	2 097（80.04）	38（71.70）	1.81

HBV DNA载量（log₁₀IU/ml）	孕妇	婴儿HBsAg阳性
5~6	175（13.77）	2（10.53）
6~7	150（11.80）	1（5.26）
7~8	519（40.83）	8（42.11）
8~9	419（32.97）	7（36.84）
> 9	8（0.63）	1（5.26）
合计	1 271（100.00）	19（100.00）

HBV DNA载量（log₁₀IU/ml）	孕妇	婴儿HBsAg阳性
5~6	175（13.77）	2（10.53）
6~7	150（11.80）	1（5.26）
7~8	519（40.83）	8（42.11）
8~9	419（32.97）	7（36.84）
> 9	8（0.63）	1（5.26）
合计	1 271（100.00）	19（100.00）

组别		新生儿例数	婴儿HBsAg阳性[例（%）]	阻断失败率（%）	χ²值	P值
观察组		2 717	19（100.00）		0.045	0.832
	阴道产	1 507	11（57.89）	0.73
	剖宫产	1 210	8（42.11）	0.66
对照组		2 620	53（100.00）		0.083	0.774
	阴道产	1 431	30（56.60）	2.10
	剖宫产	1 189	23（43.40）	1.93

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