Cheung Ka Wang, Au Tiffany Sin-Tung, Li Ying Rong, Han Zhenyan, Zhang Zhu, Seto Mimi Tin Yan
Department of Obstetrics and Gynecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
Third Affiliated Hospital of Sun Yat-sen University, China.
EClinicalMedicine. 2025 Jan 13;80:103039. doi: 10.1016/j.eclinm.2024.103039. eCollection 2025 Feb.
Prenatal and intrapartum invasive tests are possible mechanisms of mother to child transmission (MTCT) of hepatitis B virus (HBV). The viral activity can affect the MTCT risk after invasive tests, but the evidence is scarce. This scoping review discussed the effects of prenatal or intrapartum invasive tests on the risk of HBV MTCT. The risk of MTCT after amniocentesis was low among hepatitis B infected pregnant individuals with negative hepatitis B e antigen (HBeAg) statuses or HBV DNA < 7 log IU/mL, and comparable to those that did not undergo prenatal invasive tests. Amniocentesis could increase the risk of MTCT among women with seropositive HBeAg statuses or HBV DNA ≥ 7 log IU/mL, but there were no MTCT among these women who received antiviral treatment. Data on CVS, cordocentesis and intrapartum invasive tests were insufficient to conclude their effects on MTCT. We also reviewed 50 international clinical practice guidelines. Most of them did not have recommendations on the management of hepatitis B infected pregnant individuals requiring prenatal or intrapartum invasive tests and significant discrepancies existed among the remaining guidelines. A workflow and two pragmatic approaches were discussed to assist clinical management. Furthermore, we would like to encourage future research to provide comprehensive data on the factors influencing the MTCT rate (such as maternal HBV DNA viral load and HBeAg status, availability and timing of neonatal birth dose immunizations, transplacental or transamniotic invasive tests, complications of the invasive tests and the use of antiviral prophylaxis).
产前和产时侵入性检测可能是乙型肝炎病毒（HBV）母婴传播（MTCT）的机制。病毒活性可影响侵入性检测后的MTCT风险，但相关证据较少。本综述讨论了产前或产时侵入性检测对HBV MTCT风险的影响。在乙型肝炎e抗原（HBeAg）状态为阴性或HBV DNA<7 log IU/mL的HBV感染孕妇中，羊膜穿刺术后的MTCT风险较低，与未进行产前侵入性检测的孕妇相当。羊膜穿刺术可能会增加HBeAg状态为血清阳性或HBV DNA≥7 log IU/mL的女性的MTCT风险，但在接受抗病毒治疗的这些女性中没有发生MTCT。关于绒毛取样、脐血穿刺和产时侵入性检测的数据不足以得出它们对MTCT影响的结论。我们还回顾了50项国际临床实践指南。其中大多数没有关于对需要产前或产时侵入性检测的HBV感染孕妇进行管理的建议，其余指南之间存在显著差异。讨论了一个工作流程和两种实用方法以协助临床管理。此外，我们鼓励未来的研究提供关于影响MTCT率的因素的全面数据（如母亲的HBV DNA病毒载量和HBeAg状态、新生儿出生剂量免疫接种的可及性和时间、经胎盘或经羊膜的侵入性检测、侵入性检测的并发症以及抗病毒预防的使用）。
