Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus – a systematic review

Yang, Jin; Zeng, Xuemei; Men, Ya-lin; Zhao, Liangyu

doi:10.1186/1743-422x-5-100

Cited by 110 publications

(88 citation statements)

References 19 publications

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“…A large retrospective study of 569 HBeAg-positive mothers showed that the rate of immunoprophylaxis failure was significantly reduced by Cesarean section to 2.1% at 7-12 months after birth, compared with 5.9% associated with vaginal delivery (p<0.017) (20). In addition, a meta-analysis of four randomized trials of 789 pregnant mothers showed that Cesarean section effectively reduces the MTCT of HBV compared to vaginal delivery (10.5 % vs. 28.0%) (21). However, Cesarean section plays no role in reducing intrauterine infection and must be performed before the onset of labor or rupture of membranes in order to be effective (21).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, a meta-analysis of four randomized trials of 789 pregnant mothers showed that Cesarean section effectively reduces the MTCT of HBV compared to vaginal delivery (10.5 % vs. 28.0%) (21). However, Cesarean section plays no role in reducing intrauterine infection and must be performed before the onset of labor or rupture of membranes in order to be effective (21).…”

Section: Discussionmentioning

confidence: 99%

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Factors Associated with Mother-to-child Transmission of Hepatitis B Virus Despite Immunoprophylaxis

et al. 2015

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Objective This study aimed to assess risk factors for mother-to-child transmission (MTCT) of hepatitis B virus (HBV) after immunoprophylaxis. Methods Risk factors for MTCT were assessed using a multivariate logistic regression model. Patients We enrolled 256 mother-child pairs with positive maternal hepatitis B surface antigens (HBsAg) between January 2010 and June 2013. All children received passive-active immunization after birth. The children were tested for HBsAg at birth and 6-12 months and/or 1-3 years of age. Results Among 256 children, 10 (3.9%) developed HBV infection, all of whom were born to hepatitis B e antigen (HBeAg)-positive mothers with a high HBV DNA level (median, 7.36; range, 6.75-8.00 log10 IU/ mL). A total of 20 mothers received antiviral treatment during pregnancy. The maternal viral load decreased from an average of 7.16 to 3.08 log10 IU/mL (p<0.0001) at delivery. The multivariate logistic regression analysis showed that a high maternal HBV DNA level [odds ratio (OR) for each log10 IU/mL increase, 2.44; 95% confidence interval (CI), 1.13-5.29, p=0.023] and vaginal delivery (OR=6.96, 95% CI, 1.80-26.93, p= 0.005) were risk factors for HBV immunoprophylaxis failure. Conclusion Additional treatment strategies should be considered in HBeAg-positive mothers with an HBV DNA level above 6-7 log10 IU/mL. In addition, our study supports the use of Cesarean section for infants born to HBsAg-positive mothers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors Associated with Mother-to-child Transmission of Hepatitis B Virus Despite Immunoprophylaxis

et al. 2015

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“…The difference between the two groups (elective caesarian section versus vaginal delivery) had statistical significance (Relative risk (RR) 0.41, 95% CI 0.28-0.60, P < 0.001). 99 However, methodological concerns including lack of information on randomization procedure, lack of allocation concealment, and lack of blinding, make the role of elective caesarian section for preventing mother to infant transmission of HBV uncertain. More high quality controlled trials are required for assessing the effects of elective caesarian section in comparison to vaginal delivery for preventing mothers to infant transmission of HBV.…”

Section: Natal (Intrapartum) Stage Interventions Caesarian Section Ormentioning

confidence: 99%

“…In addition, elective CS has to be performed before the onset of labor or before the rupture of membranes to achieve effectiveness. 99 At this point, most obstetrical algorithms do not include change in the planned mode of delivery for HBsAgpositive women regardless of HBeAg status or level of viremia. 99 Current available data did not show any association between the risk of transmission and forceps/vacuum extraction during delivery.…”

Section: Natal (Intrapartum) Stage Interventions Caesarian Section Ormentioning

confidence: 99%

Chronic Hepatitis B Virus Infection and Pregnancy

Kumar

Singh

Sinha

2012

Journal of Clinical and Experimental Hepatology

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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. ( J CLIN EXP HEPATOL 2012;2:366-381) A pproximately 400 million people are chronically infected with hepatitis B virus (HBV) worldwide, 1 and almost half have acquired their infections either through mother to infant transmission or in early childhood, especially in countries where HBV has intermediate to high prevalence.2 In Asia, 8%-10% of the population is chronically infected with HBV, and up to 50% of new cases of hepatitis B infection are due to mother to infant transmission.3 In contrast, the majority of new hepatitis B cases in developed countries are the result of horizontal transmission in adulthood. Before the adoption of standard passive-active immunoprophylaxis treatment, approximately 70%-90% of infants born to hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive mothers became chronically infected with HBV. 4 The mother to infant transmission rate was reduced to 5%-10% when infants received appropriate postnatal hepatitis B immunoglobulin (HBIg) and a series of HBV vaccines. However, despite passive-active immunoprophylaxis provided to infants, up to 8%-30% of infants born to highly viremic mothers still become infected with HBV (Figures 1-3). This review will address several issues important to chronic hepatitis B virus infection and pregnancy including effect of pregnancy on chronic HBV infection, effect of chronic HBV infection on pregnancy, mother to infant transmission, safety data on HBV antivirals during pregnancy, management of chronic HBV infection in women who desire pregnancy or become pregnant while taking antivirals. PREVALENCE OF CHRONIC HEPATITIS B VIRUS INFECTION AMONG PREGNANT WOMEN IN INDIAThe prevalence of chronic HBV infection varies widely, with rates ranging from 0.1% to 20% in different parts of the world.2 "High" prevalence (HBsAg positivity rates > 8%) regions include the Asia (except Japan), parts of the Middle East, sub-Saharan Africa, and the Amazon basin. "Intermediate" (2%-7% HBsAg positive) prevalence regions include, the Indian subcontinent, parts of central Asia and the Middle East, Eastern and Southern Europe, as well as parts of South America. "Low" prevalence (<2% HBsAg positive) regions include the United States, Northern Europe, Australia, Japan and the southern part of South America. Overall, 45% of the world population lives in "high" prevalence regions.The HBsAg positivity rate of Hepatitis B in India is different in the different regions of the country. The overall chronic HBsAg positivity rate is often quoted as being 4.7%.5 In India, the prevalence rate of HBsAg...

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“…• Until now it was quite unclear whether the mode of delivery influences the likelihood of HBV transmission as far as passive and active immunization were implied [94][95][96][97][98].…”

Section: Pregnant Women With Hepatitis Bmentioning

confidence: 99%