Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education of the People's Republic of China, Chengdu, China.
Department of Laboratory Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
Am J Obstet Gynecol. 2024 Feb;230(2):249.e1-249.e8. doi: 10.1016/j.ajog.2023.07.032. Epub 2023 Jul 25.
Amniocentesis is the most widely used invasive prenatal diagnostic sampling technique. However, whether this increases the risk of mother-to-child transmission of infectious diseases remains controversial.
This study aimed to determine whether amniocentesis increases the risk of hepatitis B virus infection in infants who received standard prophylaxis, and to assess the related risk factors for mother-to-child transmission in women who underwent amniocentesis during pregnancy.
This retrospective analysis used the clinical data of pregnant women with hepatitis B virus infection at West China Second University Hospital, Sichuan University in 2019. After meeting the inclusion criteria, the participants were divided into 2 groups on the basis of whether they had undergone amniocentesis during pregnancy. The infant hepatitis B virus serologic status was followed 1 to 6 months after completion of immunization. The infant testing positive for hepatitis B surface antigen and negative for Hepatitis B surface antibody indicated mother-to-child transmission of hepatitis B virus.
In total, 1764 pregnant women with hepatitis B virus infection were enrolled. Of these, 846 underwent amniocentesis during pregnancy and 918 did not. All offspring received a standardized immunoprophylaxis schedule. The overall mother-to-child transmission rate for hepatitis B virus was 0.6% (5/846) in the amniocentesis group and 0.4% (4/918) in the control group (P=.745). Subgroup analysis showed that the mother-to-child transmission rate in hepatitis B e antigen-positive women was 1.8% (2/111) in the amniocentesis group and 1.0% (2/209) in the control group (P=.612). In women with high viral load, the mother-to-child transmission rate was 1.3% (1/78) vs 0.9% (1/107) (amniocentesis group vs control group; P=1.000). In the amniocentesis group, 31 amniotic fluid specimens had an abnormal appearance (bloody or brown). Univariate analysis showed that the mother-to-child transmission rates of these mothers were statistically higher than those of mothers with pale yellow or transparent amniotic fluid (2/31 vs 3/815; relative risk, 17.527 [3.037-101.151]; P=.012).
Amniocentesis did not increase the risk of mother-to-child transmission of hepatitis B virus in infants who received a standardized immunoprophylaxis schedule, including those with mothers who were hepatitis B e antigen-positive or had a high viral load. However, the abnormal appearance (bloody or brown) of the amniotic fluid obtained during amniocentesis may indicate increased risk of mother-to-child transmission for hepatitis B virus.
羊膜穿刺术是最广泛使用的侵入性产前诊断取样技术。然而，这种方法是否会增加传染性疾病母婴传播的风险仍存在争议。
本研究旨在确定在接受标准预防措施的婴儿中，羊膜穿刺术是否会增加乙型肝炎病毒感染的风险，并评估在怀孕期间接受羊膜穿刺术的女性中母婴传播的相关危险因素。
这是一项回顾性分析，使用了 2019 年四川大学华西第二医院乙型肝炎病毒感染孕妇的临床数据。符合纳入标准后，根据孕妇在怀孕期间是否接受过羊膜穿刺术，将参与者分为 2 组。婴儿在免疫接种完成后 1 至 6 个月内检测乙型肝炎病毒血清学状态。婴儿乙型肝炎表面抗原阳性且乙型肝炎表面抗体阴性表明乙型肝炎病毒母婴传播。
共纳入 1764 例乙型肝炎病毒感染孕妇。其中，846 例孕妇在怀孕期间接受了羊膜穿刺术，918 例未接受。所有后代均接受了标准化免疫预防方案。羊膜穿刺术组的乙型肝炎病毒母婴传播总发生率为 0.6%（5/846），对照组为 0.4%（4/918）（P=.745）。亚组分析显示，乙型肝炎 e 抗原阳性妇女中，羊膜穿刺术组母婴传播率为 1.8%（2/111），对照组为 1.0%（2/209）（P=.612）。在病毒载量较高的妇女中，母婴传播率为 1.3%（1/78），对照组为 0.9%（1/107）（羊膜穿刺术组 vs 对照组；P=1.000）。在羊膜穿刺术组中，31 份羊水标本外观异常（血性或棕色）。单因素分析显示，这些母亲的母婴传播率明显高于羊水呈淡黄色或透明色的母亲（2/31 比 3/815；相对风险，17.527[3.037-101.151]；P=.012）。
在接受标准化免疫预防方案的婴儿中，包括乙型肝炎 e 抗原阳性或病毒载量较高的母亲，羊膜穿刺术并未增加乙型肝炎病毒母婴传播的风险。然而，羊膜穿刺术获得的羊水异常外观（血性或棕色）可能表明乙型肝炎病毒母婴传播的风险增加。
