Chibber Rachana M, Usmani M Assad, Al-Sibai Mohammed H
Department of Obstetrics and Gynaecology, College of Medicine and Medical Science, King Faisal University, PO Box 2208, 31952 Dammam, Al Khobour, Kingdom Of Saudia Arabia. rchibber@ hospital.kfu.edu.sa
Arch Gynecol Obstet. 2004 Jul;270(1):15-20. doi: 10.1007/s00404-002-0466-5. Epub 2003 Apr 16.
The aim of this study was to determine by a prospective study: the presence of anti-hepatitis E virus (HEV) and or HEV RNA in the colostrum of HEV infected mothers; transmission of HEV to infants from their mothers by breast-feeding.
Ninety-three infected pregnant mothers in the third trimester of pregnancy of which 36 were positive for anti-HEV antibodies and 57 for HEV RNA (index patients) and 90 healthy pregnant mothers (control subjects) were studied. Maternal blood was taken at 7th and 9th of gestation and also within 5 days post-partum, along with colostrum and tested for anti-HEV and HEV RNA. Blood samples were collected from all infants at birth (cord blood) and at 1, 3, and 6 and 9 months of age.
There were 12 cesarean sections and eighty full term vaginal deliveries. Anti-HEV antibody and HEV-RNA was present in the colostral samples but in significantly lower levels ( p<0.001) as compared to corresponding maternal levels. Within 2 weeks post-partum, 6 of these 93 index patients, whose infants were anti-HEV antibody and HEV RNA negative at birth, developed acute hepatic disease. These mothers, four of whom delivered by cesarean section, had anti-HEV titers ranging from 1:10,000 to 1:60,000 and HEV RNA ranging from 1.5x10(6) to 2.5x10(4) copies/ml. Due to acute maternal disease their six respective infants were formula fed. Four of these infants were in close maternal contact, frequently kissed and cuddled, and developed symptomatic liver disease by 6-8 weeks of age. Apart from these 6 infants the remaining were exclusively breast-fed for 3.6+/-0.32 months. There was no evidence of HEV infection in the remaining babies. All mother-infant pairs from the control group remained anti-HEV negative throughout this study.
Although anti-HEV antibody and HEV-RNA are present in the colostrum of HEV infected mothers, breast-feeding appears to be safe for these infants. However this report must be confirmed by others. Transmission of infection may occur postpartum, through close contact of mother-infant pairs, especially in the presence of acute maternal disease.
本研究旨在通过前瞻性研究确定：戊型肝炎病毒（HEV）感染母亲的初乳中抗HEV及/或HEV RNA的存在情况；通过母乳喂养，母亲将HEV传播给婴儿的情况。
对93名妊娠晚期感染的孕妇进行了研究，其中36名抗HEV抗体呈阳性，57名HEV RNA呈阳性（索引患者），并研究了90名健康孕妇（对照对象）。在妊娠第7天和第9天以及产后5天内采集母亲血液，同时采集初乳，检测抗HEV和HEV RNA。在所有婴儿出生时（脐带血）以及1、3、6和9个月大时采集血液样本。
有12例剖宫产和80例足月阴道分娩。初乳样本中存在抗HEV抗体和HEV-RNA，但与相应的母亲水平相比，其水平显著较低（p<0.001）。产后2周内，这93名索引患者中有6名，其婴儿出生时抗HEV抗体和HEV RNA呈阴性，随后患上急性肝病。这些母亲中有4名通过剖宫产分娩，抗HEV滴度范围为1:10,000至1:60,000，HEV RNA范围为1.5×10⁶至2.5×10⁴拷贝/毫升。由于母亲患有急性疾病，她们各自的6名婴儿采用配方奶喂养。其中4名婴儿与母亲密切接触，经常亲吻和拥抱，在6至8周龄时出现有症状的肝病。除了这6名婴儿外，其余婴儿纯母乳喂养3.6±0.32个月。其余婴儿没有HEV感染的证据。在整个研究过程中，对照组的所有母婴对抗HEV均为阴性。
尽管HEV感染母亲的初乳中存在抗HEV抗体和HEV-RNA，但母乳喂养对这些婴儿似乎是安全的。然而，本报告必须得到其他人的证实。感染可能在产后通过母婴密切接触传播，尤其是在母亲患有急性疾病的情况下。
