The Second College of Clinical Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lingjiang Road, Central District, Chongqing, 400010, China,
Dig Dis Sci. 2014 Feb;59(2):242-58. doi: 10.1007/s10620-013-2918-0. Epub 2013 Nov 6.
Mother-to-child transmission (MTCT) is the main mode of spread of hepatitis B virus (HBV) in China. We performed a meta-analysis to compare the effects of three measures for prevention of MTCT.
A meta-analysis was performed on randomized controlled trials and non-randomized studies comparing the index of MTCT among five groups of pregnant women: hepatitis B immunoglobulin (HBIG) administration, antiviral treatment, placebo, elective caesarean section, and vaginal delivery.
Compared with the control group, the incidence of HBV intrauterine infection (RR = 0.42, 95 % CI 0.27-0.64, P < 0.0001) and the number of chronic hepatitis B (CHB) infants (RR = 0.44, 95 % CI 0.32-0.61, P < 0.00001) were lower in the HBIG administration group. In the antiviral treatment group, serum HBV DNA levels were lower (MD = -4.01, 95 % CI -5.07 to -2.94, P < 0.00001) at the time of delivery, and normalization of ALT levels was better (RR = 1.11, 95 % CI 1.06-1.17, P < 0.0001). Infant serum HBsAg positivity (RR = 0.45, 95 % CI 0.22-0.91, P = 0.03) and incidence of infant HBV transmission RR = 0.06, 95 % CI 0.01-0.24, P < 0.0001) were reduced in antiviral the treatment group. Infant serum anti-HBs positivity at birth (RR = 1.24, 95 % CI 0.89-1.74, P = 0.2) or at 6-7 months (RR = 0.98, 95 % CI 0.86-1.11, P = 0.73) was not significantly different between the caesarean section and vaginal delivery groups. The incidence of infant CHB infection may have been higher in the vaginal delivery group (RR = 2.20, 95 % CI 1.02-4.74, P = 0.04).
Administration of HBIG or antiviral therapy to HBV carrier mothers during pregnancy is effective in reducing MTCT.
母婴传播（MTCT）是中国乙型肝炎病毒（HBV）传播的主要模式。我们进行了一项荟萃分析，比较了预防 MTCT 的三种措施的效果。
对比较五组孕妇（乙型肝炎免疫球蛋白（HBIG）组、抗病毒治疗组、安慰剂组、选择性剖宫产组和阴道分娩组）间 MTCT 指标的随机对照试验和非随机研究进行了荟萃分析。
与对照组相比，HBIG 组宫内感染 HBV 的发生率（RR=0.42，95%CI 0.27-0.64，P<0.0001）和慢性乙型肝炎（CHB）婴儿的数量（RR=0.44，95%CI 0.32-0.61，P<0.00001）均较低。在抗病毒治疗组中，分娩时血清 HBV DNA 水平较低（MD=-4.01，95%CI-5.07 至-2.94，P<0.00001），且 ALT 水平恢复正常的情况更好（RR=1.11，95%CI 1.06-1.17，P<0.0001）。抗病毒治疗组婴儿血清 HBsAg 阳性率（RR=0.45，95%CI 0.22-0.91，P=0.03）和婴儿 HBV 传播发生率（RR=0.06，95%CI 0.01-0.24，P<0.0001）均降低。出生时婴儿血清抗-HBs 阳性率（RR=1.24，95%CI 0.89-1.74，P=0.2）或 6-7 个月时（RR=0.98，95%CI 0.86-1.11，P=0.73），剖宫产组和阴道分娩组之间没有显著差异。阴道分娩组婴儿 CHB 感染的发生率可能更高（RR=2.20，95%CI 1.02-4.74，P=0.04）。
在 HBV 携带者孕妇怀孕期间给予 HBIG 或抗病毒治疗可有效降低 MTCT。
