Instructor.
Professor, Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Obstet Gynecol Surv. 2020 Sep;75(9):557-565. doi: 10.1097/OGX.0000000000000831.
Vertical hepatitis B virus (HBV) transmission is the important route of chronic HBV infection. Although infant immunoprophylaxis is effective, a significant number of infants still become infected, most are associated with intrauterine infection. New evidences support intrauterine treatment in cases of high risk.
The aim of this study was to review the current evidences and recommendations for management of HBV infection in pregnancy.
Original research articles, review articles, and guidelines were reviewed.
The management can be summarized as follows: (1) all pregnant women should be screened for hepatitis B surface antigen (HBsAg) and antibody to HBsAg. High-risk HBsAg-negative pregnant women without immunity should be vaccinated during pregnancy. (2) HBsAg-positive pregnant women should undergo further workup for liver status and indicative factors for immunoprophylaxis failure. (3) Pregnant women should be treated with HBV DNA levels greater than 200,000 IU/mL or 6 log copies/mL. (4) Antiviral drug should be started around 28 to 32 weeks. The first-line drug is tenofovir disoproxil fumarate. (5) Delivery route should be chosen based only on obstetric indications. (6) Breastfeeding is not contraindicated because it does not increase the risk of transmission in neonates with HBV vaccine and immunoglobulin administration. (7) Neonates born to HBsAg-positive mothers should receive HBV vaccine and immunoglobulin after birth as soon as possible. (8) Follow-up of the mothers and neonates is important. Beware of hepatitis flare after birth and after antiretroviral drug discontinuation; alanine transaminase assessment every 1 to 3 months until 6 months is suggested. Also, the schedule of infant vaccination and follow-up of serologic testing at 9 to 12 months old is needed.
垂直传播乙型肝炎病毒（HBV）是慢性 HBV 感染的重要途径。虽然婴儿免疫预防措施有效，但仍有相当数量的婴儿感染，大多数与宫内感染有关。新的证据支持对高危病例进行宫内治疗。
本研究旨在回顾妊娠期间 HBV 感染管理的现有证据和建议。
对原始研究文章、综述文章和指南进行了回顾。
管理可概括如下：（1）所有孕妇均应筛查乙型肝炎表面抗原（HBsAg）和乙型肝炎表面抗体。无免疫的高风险 HBsAg 阴性孕妇应在孕期接种疫苗。（2）HBsAg 阳性孕妇应进一步检查肝脏状况和提示免疫预防失败的指标。（3）HBV DNA 水平大于 200,000 IU/mL 或 6 对数拷贝/mL 的孕妇应进行治疗。（4）抗病毒药物应在 28 至 32 周左右开始使用。一线药物是富马酸替诺福韦二吡呋酯。（5）分娩方式应仅根据产科指征选择。（6）母乳喂养不会增加接受 HBV 疫苗和免疫球蛋白接种的新生儿传播的风险，因此不被禁止。（7）HBsAg 阳性母亲所生新生儿应在出生后尽快接受 HBV 疫苗和免疫球蛋白。（8）对母亲和新生儿的随访很重要。注意产后和停药后肝炎发作；建议每 1 至 3 个月评估一次丙氨酸转氨酶，直至 6 个月。还需要安排婴儿疫苗接种计划和随访 9 至 12 个月龄时的血清学检测。
