Hep B Moms: A cross‐sectional study of mother‐to‐child transmission risk among pregnant Asian American women with chronic hepatitis B in New York City, 2007‐2017

Abstract

| INTRODUC TI ONMother-to-child transmission (MTCT) is responsible for the majority of chronic hepatitis B virus (HBV) infections worldwide. Infection during infancy is associated with a 90% chance of developing chronic HBV infection, 1,2 which leads to premature death from liver cancer or other liver complications in up to 25% of those unmonitored and untreated. 3 Timely HBV immunoprophylaxis of neonates has reduced MTCT worldwide; however, immunoprophylaxis failures still occur in approximately 8%-32% of infants born to mothers with high levels of HBV viremia. 4-7 Identification and evaluation of pregnant women with HBV infection and proper vaccination of infants are Abstract Mother-to-child transmission (MTCT) is responsible for the majority of chronic hepatitis B virus (HBV) infections worldwide. Despite timely HBV immunoprophylaxis of neonates, MTCT can occur in infants born to mothers with high levels of HBV viremia. We performed a retrospective cross-sectional analysis of Asian American women with chronic HBV evaluated with HBV DNA during prenatal care at two community health sites in New York City from 2007 to 2017. We described patient's demographic and clinical characteristics, categorized their HBV disease phase and analysed for variables associated with high MTCT risk (defined by HBV DNA level >200 000 IU/mL) using multivariable logistic regression. A total of 1298 pregnancies among 1012 mostly China-born (97.6%) women with chronic HBV were included in the study. Of the 1241 pregnancies among women not on antiviral treatment, 22.4%were considered high risk for MTCT and, of these, 255 (91.7%) were HBV e antigen (HBeAg)-positive and 19 (6.8%) were HBeAg-negative. HBeAg-positive status and ALT levels between 26 and 50 U/L were associated with higher likelihood for being high risk for MTCT. Only 0.8% of pregnancies low risk for MTCT were in the immune active phase while the majority (58.4%) were in the inactive chronic HBV phase of infection. Approximately one in five (22.4%) pregnancies among Asian American women with chronic HBV was considered high risk for MTCT and met criteria for antiviral therapy. Full assessment of HBV pregnant women and early coordinated care is needed to deliver interventions to prevent MTCT during critical windows of time. K E Y W O R D Santiviral therapy, hepatitis B, mother-to-child transmission, pregnancy, prevention | 169 LYU et aL.

A cautionary note to hepatitis B e antigen (HBeAg)‐negative test results in pregnant women in an area prevalent of HBeAg‐negative chronic hepatitis B

“…7 This is especially important for pregnant women living or born in regions where e-CHB is prevalent. 11,34,37 Several limitations were present in this study. First, the limited number of pregnant women led to an inadequate number of HBV nucleotide sequences for broader analysis.…”

“…The WHO 2020 recommendations can be viewed as a step forward in the efforts to attain the 2030 goal 33 . However, there remain challenges as we embark on this journey to eliminate hepatitis B by halting the MTCT of this virus, particularly regarding HBV‐infected pregnant women who have negative HBeAg status but high levels of viremia 34 . These women still pose the risk to transmit HBV to their neonates, especially those with variants defective for HBeAg production.…”

“…With forethought, it would be necessary to develop further strategies to identify and rescue mothers with negative HBeAg status who are at risk of MTCT and also eligible for antiviral prophylaxis 7 . This is especially important for pregnant women living or born in regions where e‐CHB is prevalent 11,34,37 …”

“… 33 However, there remain challenges as we embark on this journey to eliminate hepatitis B by halting the MTCT of this virus, particularly regarding HBV‐infected pregnant women who have negative HBeAg status but high levels of viremia. 34 These women still pose the risk to transmit HBV to their neonates, especially those with variants defective for HBeAg production. In addition, individuals carrying these mutations with high HBV DNA levels are still at risk of developing severe liver diseases.…”

Hepatitis B Virus Elimination in the U.S.: Time to Dismantle Barriers and Implement Solutions

“…Women living with HBV should not only receive HBV care during pregnancy-to evaluate those with high HBV DNA levels who are at greater risk of transmitting HBV to their newborns and could benefit from antiviral treatment [28]-but should continue after pregnancy for their own health. The Hep B Moms program implemented at Charles B. Wang Medical Center in New York City (NYC) published a study showing that > 20% of pregnant women had elevated HBV DNA (> 200,000 IU/mL) and were at high risk for transmitting the virus perinatally [34]. Additionally, identification of pregnant women with HBV infection should prompt testing in the household to identify family members with HBV or those who need immunization, an important public health step not routinely prioritized.…”