Mother‐to‐child transmission of hepatitis B virus after amniocentesis: A retrospective matched cohort study

Abstract

Objective The objective of this study is to determine whether amniocentesis increases the risk of mother‐to‐child transmission (MTCT) of hepatitis B virus (HBV) and evaluate risk factors for MTCT. Methods One hundred forty‐three hepatitis B surface antigen (HBsAg)–positive women with amniocentesis were enrolled into the amniocentesis group. Six hundred five nonamniocentesis cases were matched with amniocentesis cases based on maternal viral loads, antiviral therapy regimens, and delivery dates. MTCT of HBV was defined as HBsAg and/or DNA positivity in infants from birth to age 7 to 12 months. Results Mother‐to‐child transmission rate was significantly higher in HBsAg‐positive women with amniocentesis than in those without amniocentesis (2.80% vs 0.50%; relative risk [RR], 5.64; 95% CI, 1.28‐24.93). In the amniocentesis group, maternal HBV DNA more than or equal to 7.0 log10 IU/mL and hepatitis B e‐antigen (HBeAg) positivity were associated with higher MTCT rates than maternal HBV DNA less than 7.0 log10 IU/mL (10.81% vs 0%, p = .004) and HBeAg negativity (8.16% vs 0%, p = .013), and antiviral therapy reduced MTCT rate from 14.3% to 0% (p = .554) when maternal HBV DNA was more than or equal to 7.0 log10 IU/mL. Conclusions Amniocentesis increases the risk of MTCT in women with hepatitis B, and maternal HBV DNA more than or equal to 7.0 log10 IU/mL and HBeAg positivity are risk factors for MTCT. Antiviral therapy may be effective to prevent MTCT after amniocentesis in highly viremic mothers.

Comment on “Mother‐to‐child transmission of hepatitis B virus after amniocentesis: A retrospective matched cohort study”

“…On the other hand, MTCT rate in the comparison group in the study of Han et al was very low, only 0.5% (3 of 605) in all children and 1.6% (3 of 188) in children of HBeAg‐positive mothers, much lower than the rate previously reported by the same authors group; in which the overall infection rate was 1.54% (21 of 1360), and the infection rate in children of HBeAg‐positive mothers was 4.44% (21 of 473) . The low transmission rate cannot be explained by the antiviral therapy during pregnancy, because only 10.74% women received the therapy .…”

“…On the other hand, MTCT rate in the comparison group in the study of Han et al was very low, only 0.5% (3 of 605) in all children and 1.6% (3 of 188) in children of HBeAg‐positive mothers, much lower than the rate previously reported by the same authors group; in which the overall infection rate was 1.54% (21 of 1360), and the infection rate in children of HBeAg‐positive mothers was 4.44% (21 of 473) . The low transmission rate cannot be explained by the antiviral therapy during pregnancy, because only 10.74% women received the therapy . Recent two reports also show that the transmission rate in infants born to HBeAg‐positive mothers without antiviral therapy during pregnancy was 1.3% and 2.0%, respectively, which was attributed to the immediate use (within median 0.5 or 1.2 hr after birth) of HBIG and hepatitis B vaccine .…”

“…In their study, Han et al reported that the overall transmission rate in children born to mothers who underwent amniocentesis was 2.8% (4 of 143) and the rate in children of HBeAg‐positive mothers was 8.2% (4 of 49) . The rates are not higher than the reported infection rate of 2% to 3% of children born to HBsAg‐positive mothers and 5% to 10% of children born to HBeAg‐positive mothers …”

“…Recent two reports also show that the transmission rate in infants born to HBeAg‐positive mothers without antiviral therapy during pregnancy was 1.3% and 2.0%, respectively, which was attributed to the immediate use (within median 0.5 or 1.2 hr after birth) of HBIG and hepatitis B vaccine . But in the study of Han et al, HBIG and the vaccine were used within 6 hr after birth . Thus, it is difficult to explain the low transmission rate in children of HBeAg‐positive mothers in the study of Han et al Since the 605 mothers in the comparison group were retrospectively selected from 3487 HBsAg‐positive mothers and detailed information on the selection was not provided, whether the low infection rate was associated with sampling bias is unknown.…”

“…We read with interest the article of Dr. Han and colleagues on the incidence of mother‐to‐child transmission (MTCT) of hepatitis B virus (HBV) after amniocentesis . The authors concluded that amniocentesis increases the risk of MTCT of HBV in children born to mothers with hepatitis B, based on the findings that 2.8% of the children born to mothers with positive hepatitis B surface (HBsAg) who underwent amniocentesis were infected with HBV and only 0.5% of the offsprings born to HBsAg‐positive mothers who did not undergo amniocentesis was infected.…”