Article collation: Director of Obstetrics Lu Linghui
Reference: Clinical Management Process for Interrupting Mother-to-Child Transmission of Hepatitis B Virus (Journal of Clinical Hepatobiliary Diseases, 2021)
Hepatitis B virus is one of the most harmful infectious diseases in China. There are many expectant mothers who are also carriers of the hepatitis B virus. How to deal with the pregnancy and childbirth period in order to minimize the risk of mother-to-child transmission is the biggest wish of all hepatitis B mothers.
Effects of mode of delivery on mother-to-child transmission
The results of existing studies on the relationship between mode of delivery and mother-to-child transmission of HBV are inconsistent. Although it has been shown that caesarean section can reduce HBV infection in infants born to pregnant women with a high viral load, the results of meta-analysis show that the mode of delivery is not exactly related to the risk of mother-to-child transmission of HBV, and that caesarean section does not reduce the incidence of mother-to-child transmission of HBV, so it is not recommended to choose the mode of delivery based on HBV DNA level or HbeAg status, and the mode of delivery should be determined based on obstetric indications.
breastfeeding
Breastfeeding does not increase the rate of HBV infection in infants, mothers infected with HBV can breastfeed after delivery, and there is no need to monitor HBSAg and/or HBV DNA in breast milk.
1) Mothers who have not taken antiviral drugs, newborns can be breastfed after receiving standardized combination immunization, breastfeeding does not increase the incidence of mother-to-child transmission of HBV, if the mother has hepatitis B activity during breastfeeding, antiviral therapy can be given with reference to the treatment principles for chronic hepatitis B patients in the "Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2019 Update)", and if TDF treatment is received, breastfeeding can be given.
2) Pregnant women who take antiviral drugs for the purpose of blocking the transmission of HBV can breastfeed after delivery and after the baby receives combined immunization.
3) Pregnant women taking antiviral drugs for the purpose of treating hepatitis B should continue to take the drug after delivery, if taking TDF treatment, because the drug content of TDF in breast milk is very small, the baby can be breastfed.
Postpartum follow-up of mothers
For those who discontinue the drug after childbirth and those who do not take antiviral drugs, the biochemical indicators of liver function and HBV DNA are reviewed 6-8 weeks after delivery. If liver function is normal, liver function and HBV DNA are reviewed every 3 months after delivery. If liver function is abnormal and the indications for antiviral therapy are met, antiviral therapy should be initiated.
Serological testing after infant immunization
Infants of HBSAg-positive mothers who, after 1-2 months of full immunization against hepatitis B, require venous blood to be drawn for HBV serological markers, including at least HBSAg and anti--HBS, and quantitative testing is recommended. If HBSAg is positive, further HBV DNA levels and biochemical indicators of liver function are required, and follow-up is carried out every 6 months thereafter to review the biochemical and virological indicators of liver function.