Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.
Clin Mol Hepatol. 2018 Dec;24(4):374-383. doi: 10.3350/cmh.2017.0082. Epub 2018 Jun 26.
BACKGROUND/AIMS: There have been numerous efforts to reduce mother-to-child transmission (MTCT) of hepatitis B virus (HBV) with antiviral agents during pregnancy. However, there are limited data regarding the outcomes of pregnant women after delivery. This study was performed to evaluate the efficacy of antiviral agents in preventing MTCT of HBV and maternal long-term outcomes.
The HBV-infected pregnant women treated with antiviral agents to prevent MTCT were retrospectively reviewed. Forty-one pregnant women who received telbivudine or tenofovir during late pregnancy (28-34 week) were analyzed. Hepatitis B virus surface antibody (HBsAb) positivity was tested in 43 infants after 7 months of birth. Eleven mothers were followed >1 year after delivery.
The mean HBV DNA titer before antiviral therapy was 8.67 (6.60-9.49) log copies/mL, and the median age at delivery was 32 years (range, 22-40). Eleven patients were treated with tenofovir and 30 with telbivudine. The median duration was 57 days (range, 23-100), and the median HBV DNA titer at birth was 5.06 log copies/mL (range, 2.06-6.50). Antiviral treatments were associated with significant HBV DNA reduction (P<0.001). Among 43 infants (two cases of twins), HBsAb was not detected in two, subsequently confirmed to have HBV infection. Biochemical flare was observed in two of 11 mothers followed >12 months, and an antiviral agent was administered.
Antiviral treatment during late pregnancy effectively reduced MTCT. Long-term follow-up should be required in such cases. In addition, given that maternal biochemical flare occurred in 18% of mothers, re-administration of antiviral agents might be required.
背景/目的：已有大量研究尝试使用抗病毒药物在孕期降低乙型肝炎病毒（HBV）母婴传播（MTCT）的风险。然而，目前关于产妇产后结局的数据有限。本研究旨在评估抗病毒药物在预防 HBV 母婴传播和产妇长期结局方面的疗效。
回顾性分析了接受抗病毒药物治疗以预防 MTCT 的 HBV 感染孕妇。分析了 41 例在妊娠晚期（28-34 周）接受替比夫定或替诺福韦治疗的孕妇。43 例婴儿在出生后 7 个月检测 HBV 表面抗体（HBsAb）阳性。11 例母亲在分娩后随访>1 年。
抗病毒治疗前 HBV DNA 载量平均为 8.67（6.60-9.49）log 拷贝/ml，分娩时中位年龄为 32 岁（范围 22-40）。11 例患者接受替诺福韦治疗，30 例患者接受替比夫定治疗。中位治疗时间为 57 天（范围 23-100），出生时中位 HBV DNA 载量为 5.06 log 拷贝/ml（范围 2.06-6.50）。抗病毒治疗与 HBV DNA 显著降低相关（P<0.001）。在 43 例婴儿（2 例双胞胎）中，有 2 例 HBsAb 未检测到，随后证实存在 HBV 感染。11 例随访>12 个月的母亲中有 2 例出现生化反弹，给予抗病毒药物治疗。
妊娠晚期抗病毒治疗可有效降低 MTCT。此类情况下应进行长期随访。此外，由于 18%的母亲出现了母体生化反弹，可能需要重新给予抗病毒药物治疗。
