a Infectious Diseases and Tropical Medicine Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran.
b Department of Aerospace and Subaquatic Medicine, Infectious Diseases and Tropical Medicine Research Center (IDTMRC) , AJA University of Medical Sciences , Tehran , Iran.
Infect Dis (Lond). 2018 Feb;50(2):95-106. doi: 10.1080/23744235.2017.1384957. Epub 2017 Oct 11.
Women of childbearing age who have developed chronic hepatitis B (CHB) infection, especially HBeAg-positive highly viraemic pregnant women, are largely responsible for the familial transmission of the infection. Therefore, choosing the most effective and safest antiviral medications to manage pregnant CHB patients is of crucial importance.
The PubMed and Scopus databases were searched through September 2017, for all the journal articles possessing original results regarding treatment of CHB pregnant women with any nucleos(t)ide analogue (NA) therapies, including lamivudine (LAM), adefovir (ADV), entecavir (ETV), telbivudine (LdT), and tenofovir (TDF).
After the primary search, 882 studies were recognized, and updating the searching results, 41 journal articles with original data were investigated, involving 3874 newborn infants from mothers with CHB, and their mothers completed follow-up until the delivery. The most important basic data and results regarding the efficacy of drugs, the rate of vertical transmission, safety issues associated with pairs of mothers and infants, median levels of HBV DNA, breastfeeding data, and rate of rate of vaccination success were collected. Moreover, possible key conclusion, recommendations, and learned lessons were discussed. Among the evaluated NAs, all LAM was efficient and safe. LdT was found to be very effective but had some safety concerns. In contrast, TDF had the advantages of both effectiveness and safety.
According to data in the literature, initiation of TDF at the trimester of pregnancy in combination with immunoprophylaxis to prevent mother-to-child transmission (MTCT) of CHB infection is strongly recommended as well as successful immunization of CHB pregnant women by anti-HBV vaccines.
处于生育年龄且患有慢性乙型肝炎（CHB）感染的女性，尤其是 HBeAg 阳性高病毒血症的孕妇，在很大程度上导致了感染的家族传播。因此，选择最有效和最安全的抗病毒药物来治疗妊娠 CHB 患者至关重要。
通过 2017 年 9 月检索 PubMed 和 Scopus 数据库，以获取所有关于核苷（酸）类似物（NA）治疗 CHB 孕妇的原始研究结果的期刊文章，包括拉米夫定（LAM）、阿德福韦（ADV）、恩替卡韦（ETV）、替比夫定（LdT）和替诺福韦（TDF）。
经过初步搜索，识别出 882 项研究，更新搜索结果后，调查了 41 篇具有原始数据的期刊文章，涉及 3874 名来自 CHB 母亲的新生儿及其母亲完成了分娩前的随访。收集了关于药物疗效、垂直传播率、母婴配对安全性问题、HBV DNA 中位数、母乳喂养数据和疫苗接种成功率的最重要的基本数据和结果。此外，还讨论了可能的关键结论、建议和经验教训。在所评估的 NAs 中，所有 LAM 均有效且安全。LdT 非常有效，但存在一些安全性问题。相比之下，TDF 具有有效性和安全性的优势。
根据文献中的数据，强烈建议在妊娠中期开始使用 TDF 联合免疫预防以预防乙型肝炎病毒感染的母婴传播（MTCT），并成功对 CHB 孕妇进行抗 HBV 疫苗免疫接种。
