Management of mother-to-child transmission of hepatitis B virus: Propositions and challenges

Abstract

Chronic hepatitis B virus (HBV) infection due to mother-to-child transmission (MTCT) during perinatal period remains an important global health problem. Despite standard passive-active immunoprophylaxis with hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine in neonates, up to 9% of newborns still acquire HBV infection, especially these from hepatitis B e antigen (HBeAg) positive mothers. Management of HBV infection in pregnancy still need to draw careful attention because of some controversial aspects, including the failure of passive-active immunoprophylaxis in a fraction of newborns, the effect and necessity of periodical hepatitis B immunoglobulin (HBIG) injection to the mothers, the safety of antiviral prophylaxis with nucleoside/nucleotide analogs, the benefit of different delivery ways, and the safety of breastfeeding. In this review, we highlight these unsettled issues of preventive strategies in perinatal period, and we further aim to provide an optimal approach to the management of preventing MTCT of HBV infection.

Mother‐to‐child transmission of hepatitis B: Examining viral cut‐offs, maternalHBsAg serology and infant testing

“…Untreated infection may lead to hepatocellular carcinoma or death from liver‐related sequelae in 15%‐45% of those affected. CHB is usually the result of mother‐to‐child transmission (MTCT) because of impaired immunological response and clearance . Despite immune prophylaxis, up to 10% of babies from mothers with high viral loads (HVL) acquire HBV thus antepartum antiviral therapy (AVT) is recommended to reduce this .…”

Risks of Viral Hepatitis B Transmission in Mother-to-Infant of Pregnant Women Carriers of Chronic Viral Hepatitis B in Cote d’Ivoire

“…Considering the viral hepatitis impact due to the main way of the mother-to-infant transmission, the design and implementation of intervention strategies to reduce the vertical transmission of the VHB assume a fundamental importance. This deals with administering the VHB infected mothers the prophylaxis at birth of the new-born with a specific immunoglobulin and vaccine, together with the administration of antivirals (tenofovir or Lamuvidine) to the mother in the third term of pregnancy ( in case of a high viral load in mother) [39]. Treatment in the third term can be considered as a help to prevent the perinatal transmission, this seems to be the most recommended to mothers having a high viral load [40].…”

Current Management Strategies in Hepatitis B During Pregnancy

“…By contrast, the absence of the HBeAg in serum is associated with lower levels of viral replication and with a significantly lower risk of intrauterine HBV transmission. The infants born to HBeAg-positive mothers have up to 90 % chance of acquiring perinatal HBV without prophylaxis [13,14,31,32].…”

“…More than one third of patients with HBV acquired the infection during the perinatal period or in early childhood, even in low-endemic areas [13]. In highly endemic areas, at least 50 % of HBV infections are most commonly acquired either perinatally or in early childhood, during the first 5 years of life [2].…”