2019 Chinese Clinical Practice Guidelines for the Prevention of Mother-to-child Transmission of Hepatitis B Virus

Abstract

To develop the evidence-based guidelines for managing mother-to-child transmission of hepatitis B virus in China, a multidisciplinary guideline development group was established. Clinical questions were identified from two rounds of surveys on the concerns of first-line clinicians. We conducted a comprehensive search and review of the literature. A grading of recommendations' assessment, development, and evaluation system was adopted to rate the quality of evidence and the strength of recommendations. Recommendations were formulated based on the evidence, overall balance of benefits and harms (at individual and population levels), patient/health worker values and preferences, resources available, cost-effectiveness, and feasibility. Eventually, recommendations related to 13 main clinical concerns were developed, covering diagnostic criteria, treatment indications, antiviral therapy choice, timing to initiate and discontinue treatment, immunoprophylaxis strategy at birth, and how to deal with special situations, such as unintended pregnancy, assisted reproduction, and breastfeeding. The guidelines are intended to serve as guidance for clinicians and patients, to optimize the management of majority of pregnant women who are positive for hepatitis B surface antigen. Guideline registration: International Practice Guide Registration Platform (IPGRP-2018CN040).

Breast-Feeding is Not a Risk Factor of Mother-to-Child Transmission of Hepatitis B Virus

“…Five makers (HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb) of hepatitis B were detected at 1 month after the whole course of vaccination to evaluate the immune response to HBV, among these, HBsAb ≥100 mIU/mL was defined as an effective response (normal response), 10~100 mIU/mL was a low response, <10 mIU/mL meant without any response. 16 After the whole course of immunization, the average titer of HBsAb was the highest in the 7–11 months old infants, representing the peak of immunoreactivity. Newborns in this study were all inoculated with HBIG within 2 hours and at 15–30 days after birth, respectively, and fully vaccinated with the whole course of RHBV.…”

“…Newborns could produce antibody against HBV after reception of active and passive immunization, which may resist to the virus in breast milk. Newborns with HBVinfected mothers should be vaccinated with HBIG within 12 hours after birth and receive all-course inoculation (at 0 16 After the whole course of immunization, the average titer of HBsAb was the highest in the 7-11 months old infants, representing the peak of immunoreactivity. Newborns in this study were all inoculated with HBIG within 2 hours and at 15-30 days after birth, respectively, and fully vaccinated with the whole course of RHBV.…”

Immediate postpartum cessation of tenofovir did not increase risk of virological or clinical relapse in highly viremic pregnant mothers with chronic hepatitis B infection

“…PP-TDF was administered to pregnant women with high HBV DNA levels, defined as >200,000 IU/ml, at 24–28 weeks of gestation to prevent MTCT. 12 After initiation of PP-TDF, participants had blood tests every 4 weeks until delivery to monitor HBV DNA, liver, and renal function tests. HBeAg was also repeated at delivery.…”

High levels of serum superoxide dismutase as a biomarker of intrahepatic cholestasis of pregnancy in patients with viral hepatitis B

“…In developing nations, hepatitis B virus (HBV) infection has become one of the most common public health problems. In China, the prevalence of HBV infection among women of childbearing age ranges from 2 to 8% [ 4 ]. HBV infection has been linked to an increased risk of ICP, although the underlying mechanism has not yet been discovered [ 5 , 6 ].…”