Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
Acta Obstet Gynecol Scand. 2022 Nov;101(11):1197-1206. doi: 10.1111/aogs.14448. Epub 2022 Sep 9.
Mother-to-child transmission (MTCT) of the hepatitis B virus (HBV) is a serious public health challenge. Estimating HBV MTCT incidence by region under different prophylaxis regimens is critical to understanding the regional disease burden and prioritizing interventions. This study aimed to calculate HBV MTCT incidence under different prophylaxis regimens globally and regionally and identify the HBV DNA threshold for maternal peripartum antiviral prophylaxis.
This review was registered in advance in PROSPERO (CRD 42019120567). We searched PubMed, Embase, China National Knowledge Infrastructure, ClinicalTrials.gov, and Cochrane Library databases for studies on MTCT in pregnant women with chronic HBV infection from their inception until June 13, 2022. MTCT was defined as hepatitis B surface antigen (HBsAg) or HBV DNA seropositivity in infants aged 6-12 months. We calculated the pooled HBV MTCT incidence using the DerSimonian-Laird random-effects model.
Among 300 studies, 3402 of 63 293 infants had HBV due to MTCT. Without prophylaxis regimens, the pooled HBV MTCT incidence was 31.3%, ranging from 0.0% (95% confidence interval [CI] 0.0%-6.0%; European Region) to 46.1% (95% CI 29.7%-63.0%; Western Pacific Region). Following the introduction of the hepatitis B vaccine, the HBV MTCT incidence decreased from 82.9% to 15.9% in HBeAg-positive women and from 10.3% to 2.3% in HBeAg-negative women. Maternal peripartum antiviral treatment alongside infant immunoprophylaxis further decreased MTCT incidence to 0.3% (95% CI 0.1%-0.5%). Despite infant immunoprophylaxis, the incidences of MTCT at maternal HBV DNA levels of <2.30, 2.00-3.29, 3.00-4.29, 4.00-5.29, 5.00-6.29, 6.00-7.29 and ≥7.00 log IU/ml were 0.0% (95% CI 0.0%-0.0%), 0.0% (95% CI 0.0%-0.0%), 0.0% (95% CI 0.0%-0.5%), 0.6% (95% CI 0.0%-2.6%), 1.0% (95% CI 0.0%-3.1%), 4.3% (95% CI 1.8%-7.5%), and 9.6% (95% CI 7.0%-12.5%), respectively.
HBV MTCT incidence varies across regions. The Western Pacific Region bears the heaviest burden. Peripartum antiviral prophylaxis plus infant immunoprophylaxis is promising for interrupting HBV MTCT. Regarding the HBV DNA threshold for peripartum antiviral prophylaxis, maternal HBV DNA of 4.00 log IU/ml or greater seems justified.
简介：乙型肝炎病毒（HBV）母婴传播是一个严重的公共卫生挑战。评估不同预防方案下的 HBV 母婴传播发生率对于了解区域性疾病负担和确定干预措施的优先级至关重要。本研究旨在计算全球和各区域不同预防方案下的 HBV 母婴传播发生率，并确定母婴围产期抗病毒预防的 HBV DNA 阈值。
材料与方法：本综述在 PROSPERO（CRD42019120567）提前注册。我们检索了 PubMed、Embase、中国知网、ClinicalTrials.gov 和 Cochrane 图书馆数据库，以获取从研究伊始至 2022 年 6 月 13 日期间患有慢性 HBV 感染的孕妇母婴传播的研究。HBV 母婴传播定义为婴儿在 6-12 个月时 HBsAg 或 HBV DNA 血清阳性。我们使用 DerSimonian-Laird 随机效应模型计算了 HBV 母婴传播的汇总发生率。
结果：在 300 项研究中，63293 名婴儿中有 3402 名因 HBV 而母婴传播。没有预防方案时，HBV 母婴传播的总发生率为 31.3%，范围为 0.0%（95%置信区间 0.0%-6.0%；欧洲区域）至 46.1%（95%置信区间 29.7%-63.0%；西太平洋区域）。在乙型肝炎疫苗问世后，HBeAg 阳性女性的 HBV 母婴传播发生率从 82.9%降至 15.9%，HBeAg 阴性女性的发生率从 10.3%降至 2.3%。母婴围产期抗病毒治疗联合婴儿免疫预防进一步将母婴传播发生率降低至 0.3%（95%置信区间 0.1%-0.5%）。尽管有婴儿免疫预防，HBV 母婴传播的发生率在母体 HBV DNA 水平<2.30、2.00-3.29、3.00-4.29、4.00-5.29、5.00-6.29、6.00-7.29 和≥7.00 log IU/ml 时分别为 0.0%（95%置信区间 0.0%-0.0%）、0.0%（95%置信区间 0.0%-0.0%）、0.0%（95%置信区间 0.0%-0.5%）、0.6%（95%置信区间 0.0%-2.6%）、1.0%（95%置信区间 0.0%-3.1%）、4.3%（95%置信区间 1.8%-7.5%）和 9.6%（95%置信区间 7.0%-12.5%）。
结论：HBV 母婴传播的发生率因区域而异。西太平洋区域的负担最重。围产期抗病毒预防加婴儿免疫预防似乎有望阻断 HBV 母婴传播。关于母婴围产期抗病毒预防的 HBV DNA 阈值，母体 HBV DNA 为 4.00 log IU/ml 或更高似乎是合理的。
