School of Public Health, Shanxi Medical University, Taiyuan030001, Shanxi, China.
Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University, Taiyuan030001, Shanxi, China.
Br J Nutr. 2023 May 28;129(10):1812-1819. doi: 10.1017/S000711452200229X. Epub 2022 Jul 25.
Immunoprophylaxis has not completely eliminated hepatitis B virus (HBV) infection due to hyporesponsiveness to hepatitis B vaccine (HepB). We explored the impact of folic acid supplementation (FAS) in pregnant women with positive hepatitis B surface antigen (HBsAg) on their infant hepatitis B surface antibody (anti-HBs) and the mediation effect of infant interleukin-4 (IL-4). We recruited HBsAg-positive mothers and their neonates at baseline. Maternal FAS was obtained via a questionnaire, and neonatal anti-HBs and IL-4 were detected. Follow-up was performed at 11-13 months of age of infants, when anti-HBs and IL-4 were measured. We applied univariate and multivariate analyses. A mediation effect model was performed to explore the mediating role of IL-4. A total of 399 mother-neonate pairs were enrolled and 195 mother-infant pairs were eligible for this analysis. The infant anti-HBs geometric mean concentrations in the maternal FAS group were significnatly higher than those in the no-FAS group (383·8 mIU/ml, 95 % CI: 294·2 mIU/ml to 500·7 mIU/ml . 217·0 mIU/ml, 95 % CI: 147·0 mIU/ml to 320·4 mIU/ml, z = -3·2, = 0·001). Infants born to women who took folic acid (FA) within the first trimester were more likely to have high anti-HBs titres (adjusted -value = 194·1, = 0·003). The fold change in IL-4 from neonates to infants partially mediated the beneficial influence of maternal FAS on infant anti-HBs (24·7 % mediation effect) after adjusting for confounding factors. FAS during the first trimester to HBsAg-positive mothers could facilitate higher anti-HBs levels in infants aged 11-13 months partly by upregulating IL-4 in infants.
由于对乙型肝炎疫苗（HepB）反应低下，免疫预防并未完全消除乙型肝炎病毒（HBV）感染。我们探讨了在乙型肝炎表面抗原（HBsAg）阳性的孕妇中补充叶酸（FAS）对其婴儿乙型肝炎表面抗体（抗-HBs）的影响，以及婴儿白细胞介素-4（IL-4）的中介作用。我们在基线时招募了 HBsAg 阳性的母亲及其新生儿。通过问卷获得母亲的 FAS 情况，检测新生儿的抗-HBs 和 IL-4。在婴儿 11-13 月龄时进行随访，检测抗-HBs 和 IL-4。我们应用单变量和多变量分析。采用中介效应模型探讨 IL-4 的中介作用。共纳入 399 对母婴对，其中 195 对母婴对符合本分析条件。FAS 组婴儿的抗-HBs 几何平均浓度明显高于无 FAS 组（383.8 mIU/ml，95 % CI：294.2 mIU/ml 至 500.7 mIU/ml；217.0 mIU/ml，95 % CI：147.0 mIU/ml 至 320.4 mIU/ml，z = -3.2， = 0.001）。在妊娠早期服用叶酸（FA）的女性所生婴儿更有可能具有高抗-HBs 滴度（校正 值 = 194.1， = 0.003）。调整混杂因素后，新生儿至婴儿的 IL-4 变化幅度部分介导了母体 FAS 对婴儿抗-HBs 的有益影响（24.7 %的中介效应）。妊娠早期 HBsAg 阳性母亲的 FAS 治疗可能通过上调婴儿的 IL-4 而部分促进 11-13 月龄婴儿的抗-HBs 水平升高。
