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Todd IMF, Magnus MC, Pedersen LH, Burgner D, Miller JE. Caesarean section and risk of infection in offspring: systematic review and meta-analysis of observational studies. BMJ MEDICINE 2024; 3:e000995. [PMID: 39610396 PMCID: PMC11603743 DOI: 10.1136/bmjmed-2024-000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 10/14/2024] [Indexed: 11/30/2024]
Abstract
Objective To compare the risk of hospital admissions with infections and infections not in hospital in children born by caesarean section with children born by vaginal birth. Data sources Medline, Embase, and PubMed were searched with no restriction on start date up to 12 February 2024. Study selection Observational studies were included that reported the association between caesarean section and vaginal birth in relation to the risk of infections (both those that lead to hospital admission and those that do not) up to 18 years of age. Studies were excluded if they were not representative of a general population or if they focused on congenital, neonatal, or vertically acquired infections. No restrictions were made for language, publication date, or setting. Review methods Findings for hospital admissions with infection were synthesised by meta-analyses of specific infection outcomes and type of caesarean birth (emergency v elective) and findings for other infections (ie, infection episodes reported by parents and primary care visits) by direction of effect. Risk of bias was assessed using the ROBINS-E tool and the overall certainty of evidence through the GRADE framework. Results 31 eligible studies of over 10 million children were included. Findings were from population-based birth cohorts and registry data linkage studies in high income countries. Cohort sizes ranged from 288 to 7.2 million and follow up age was from one to 18 years. Outcomes included overall and specific clinical categories of infection. From studies of overall admission to hospital with infection, the proportion of children admitted ranged between 9-29% across exposure groups. In random-effects meta-analyses combining hazard ratios, children delivered by caesarean section had an increased rate of hospital admission with infections overall and in three common clinical infection categories: (1) overall admissions to hospital with infection (emergency caesarean section: n=6 study populations, hazard ratio 1.10 (95% confidence interval 1.06 to 1.14), τ 2=0.0009, I2=96%; elective caesarean section: n=7, 1.12 (1.09 to 1.15), τ 2=0.0006, I2=88%); (2) admission to hospital for upper respiratory infections (emergency caesarean section: n=7, 1.11 (1.09 to 1.13), τ 2=0.0003, I2=73%; elective caesarean section: n=7, 1.16 (1.12 to 1.20), τ 2=0.0012, I2=89%); (3) admission to hospital for lower respiratory infections (emergency caesarean section: n=8, 1.09 (1.06 to 1.12), τ 2=0.0010, I2=88%; elective caesarean section: n=8, 1.13 (1.10 to 1.16), τ 2=0.0009, I2=84%); (4) admission to hospital for gastrointestinal infections (emergency caesarean section: n=7, 1.19 (1.13 to 1.26), τ 2=0.0025, I2=86%; elective caesarean section: n=7, 1.20 (1.15 to 1.25), τ 2=0.0009, I2=67%). Eight of 11 studies of other infections suggested an increased risk of their primary infection outcome in those born by caesarean section. Risk of bias concerns primarily related to confounding. Conclusions Findings from high income countries showed a consistent association between caesarean section birth and greater risk of infections in children across various settings. Limitations of existing studies include the potential for unmeasured confounding, specifically confounding by indication, and a scarcity of studies from low and middle income countries. Review registration PROSPERO (CRD42022369252).
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Affiliation(s)
- Isobel Masson Francis Todd
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Lars Henning Pedersen
- Clinical Medicine, Aarhus University, Aarhus, Denmark
- Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - David Burgner
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Infectious Diseases, Royal Children's Hospital Melbourne Department of General Medicine, Parkville, Victoria, Australia
| | - Jessica Eden Miller
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
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Abstract
PURPOSE The purpose of this document is to describe the specific types of viral hepatitis, their implications during pregnancy, the risk of perinatal transmission, and issues related to both treatment and prevention of infection. TARGET POPULATION Pregnant or postpartum women and individuals who screen positive for viral hepatitis infection. The onset of these conditions may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes recommendations on hepatitis B virus and hepatitis C virus screening in pregnancy; prepregnancy, antepartum, intrapartum, and postpartum management for patients with hepatitis B virus infection or hepatitis C virus infection; management of accidental and occupational exposure to hepatitis B virus or hepatitis C virus in pregnant health care workers; and hepatitis A virus and hepatitis B virus vaccination in pregnancy. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
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Dokmak A, Trivedi HD, Bonder A, Wolf J. Pregnancy in Chronic Liver Disease: Before and After Transplantation. Ann Hepatol 2021; 26:100557. [PMID: 34656772 DOI: 10.1016/j.aohep.2021.100557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 02/04/2023]
Abstract
Chronic liver disease poses various challenges for women of reproductive age. Cirrhosis, particularly if decompensated, and liver transplantation may impact gestation and perinatal outcomes. Tailored management of underlying liver disease is critical to optimize maternal and fetal wellbeing. Early education, timely intervention, close monitoring, and a multidisciplinary approach are key elements required to minimize complications and increase chances of a safe and successful pregnancy. In this review, we focus on the pregnancy-related implications of chronic liver disease and liver transplantation on women of reproductive age and highlight disease-specific management considerations.
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Affiliation(s)
- Amr Dokmak
- Department of Hospital Medicine, Catholic Medical Center, Manchester, NH, USA.
| | - Hirsh D Trivedi
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alan Bonder
- Liver Center, Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jacqueline Wolf
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Influence of different delivery modes and HBV DNA titers on mother-to-child transmission of hepatitis B. Clin Res Hepatol Gastroenterol 2021; 45:101542. [PMID: 33067171 DOI: 10.1016/j.clinre.2020.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/22/2020] [Accepted: 08/31/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The influence of different delivery modes on the mother-to-child transmission (MTCT) rate of pregnant women with high hepatitis B viremia was investigated. METHODS A retrospective analysis was performed on data for 855 hepatitis- B -virus (HBV) carrier mothers who received regular prenatal care and delivered at the First Affiliated Hospital of Jinan University from January 2011 to October 2015. The neonates were classified into three groups according to the delivery mode: eutocia (438 cases), Non-parturient cesarean delivery (371 cases), and parturient cesarean delivery (46 cases). The neonatal HBV surface antigen (HBsAg) positive rates of the three delivery groups were comparatively analyzed to determine the influence of the delivery mode on HBV MTCT. Of the 855 HBV-carrier mothers, 480 mothers and respective newborns were tested for HBV-DNA and classified into four groups: HBV DNA≥107 copies/mL (96 cases), 105≤HBV DNA<107 copies/mL (37 cases), 103≤HBV DNA<105 copies/mL (85 cases), and HBV DNA<103 copies/mL (262 cases). The effect of the HBV DNA titers of these pregnant women on HBV MTCT was analyzed. RESULTS Statistically significant (P<0.05) differences were found among the HBsAg positive rates of neonates of HBV-carrier pregnant women delivered by the three methods from HBV-carrier pregnant women with HBV DNA≥107 copies/mL. No statistically significant (P>0.05) differences among the HBsAg positive rates were found for neonates delivered by the three methods from HBV-carrier pregnant women with HBV DNA<107 copies/mL. CONCLUSIONS The delivery mode may influence the risk of HBV maternal-to-infant vertical transmission for HBV-carrier pregnant women with HBV DNA≥107 copies/mL. That is, elective cesarean section may reduce the HBV maternal-to-infant vertical transmission.
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Zeleke ED, Assefa DG, Joseph M, Bekele D, Tesfahunei HA, Getachew E, Manyazewal T. Tenofovir disoproxil fumarate for prevention of mother-to-child transmission of hepatitis B virus: A systematic review and meta-analysis of randomised control trials. Rev Med Virol 2021; 31:1-16. [PMID: 33483986 DOI: 10.1002/rmv.2216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
Hepatitis B virus (HBV) infection caused by mother-to-child transmission (MTCT) continues to pose challenges to global health. This study aimed to assess the efficacy and safety of tenofovir disoproxil fumarate (TDF) for preventing HBV MTCT. PubMed and the Cochrane Central Register of Controlled Trials were searched through August 2020. Randomised controlled trials (RCTs) were selected that evaluated the efficacy and safety of TDF for preventing MTCT of HBV compared with the standard of care, placebo or other HBV therapies. The primary outcomes were HBV MTCT rate and maternal HBV DNA level. Secondary outcomes were infant and maternal safety outcomes. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines, and prospectively registered on PROSPERO (CRD42020186275). Of 240 citations, three RCTs that involved 651 participants were included. The pooled result showed that TDF can reduce the risk of HBV MTCT after 6 months postpartum by 80% (risk ratio [RR] 0.2, 95% confidence interval [CI 0.06-0.7], n = 584) with low heterogeneity (I2 = 0%). TDF demonstrated HBV DNA suppression at delivery, though there was heterogeneity among individual studies (RR 0.13, 95% CI [0.08-0.20] and (RR 0.36, 95% CI [0.27-0.49]). Maternal and infant safety outcomes were comparable among treated and untreated mothers and infants born to them. The quality of evidence varied from high to very low. There is evidence that TDF effectively interrupted MTCT of HBV and suppressed HBV DNA level. Available studies on safety are very limited and heterogeneous, emphasising the need for additional RCTs with complete safety indicators.
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Affiliation(s)
- Eden Dagnachew Zeleke
- Department of Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Midwifery, College of Health and Medical Science, Bule Hora University, Bule Hora, Ethiopia
| | - Dawit Getachew Assefa
- Department of Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Nursing, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Michele Joseph
- Department of Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Delayehu Bekele
- Department of Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Hanna Amanuel Tesfahunei
- Department of Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Public Health, Hager Biomedical Research Institute, Asmara, Eritrea
| | - Emnet Getachew
- Department of Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Public Health, Arsi University, Asella, Ethiopia
| | - Tsegahun Manyazewal
- Department of Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Sarkar M, Brady CW, Fleckenstein J, Forde KA, Khungar V, Molleston JP, Afshar Y, Terrault NA. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021; 73:318-365. [PMID: 32946672 DOI: 10.1002/hep.31559] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Monika Sarkar
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | - Jean P Molleston
- Indiana University and Riley Hospital for Children, Indianapolis, IN
| | - Yalda Afshar
- University of California, Los Angeles, Los Angeles, CA
| | - Norah A Terrault
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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He R, Wen P, Xiong M, Fan Z, Li F, Luo D, Xie X. Cesarean section in reducing mother-to-child HBV transmission: a meta-analysis. J Matern Fetal Neonatal Med 2020; 35:3424-3432. [PMID: 32954878 DOI: 10.1080/14767058.2020.1819229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND A meta-analysis (MA) of natural vs. cesarean births in HBV infected mothers was performed to assess which delivery methods could minimize the mother-to-child transmission (MTCT) of Hepatitis B virus (HBV). METHODS Electrical databases PubMed, Embase and Cochrane Library were searched for the English papers about the HBV MTCT up to 19 August 2019. STATA 11.0 software was used for all analysis. Odds ratio (OR) and 95% confidence interval (CI) were used to present the effect size for MTCT at birth and MTCT more than 6 months. Heterogeneity was evaluated using the chi-squared Q and I 2 test to determine the use of random effects model or fixed effects model. RESULTS A total of 19 articles involving 11,144 HBV-positive pregnant women (5251 underwent natural delivery and 5893 received a cesarean section) were included in the study. The pooled OR for MTCT at birth was 0.42, 95% CI: 0.23-0.76 based on random effect model (I 2 = 69.9%, p = .019). Meanwhile, in fixed effect model (I 2 = 0.0%, p = .470), the pooled OR for MTCT more than 6 months was 0.62, 95% CI: 0.48-0.81. The results indicated that HBV infection in cesarean births significantly lower than that of vaginal delivery. Subgroup analysis of MTCT more than 6 months was clearly, and the results indicated that cesarean section significantly reduced the risk of MTCT (OR = 0.62, 95% CI: 0.48-0.81, p < .001). CONCLUSIONS Cesarean section can reduce the risk of HBV MTCT and should be employed as a preventive measure. Due to the limitations of this study, further multi-center, large-sample randomized controlled trials must be performed to confirm these findings.
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Affiliation(s)
- Rongfang He
- Department of Infectious Disease, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Psychiatry, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Sichuan Clinical Research Center for Birth Defects, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ping Wen
- Sichuan Clinical Research Center for Birth Defects, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Mei Xiong
- Department of Pediatric Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zenan Fan
- Clinical Medical College, Southwest Medical University, Luzhou, China
| | - Fang Li
- Key Laboratory of Medical Electrophysiology of Ministry of Education, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Dan Luo
- Key Laboratory of Medical Electrophysiology of Ministry of Education, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Xin Xie
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Sichuan Clinical Research Center for Birth Defects, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Sichuan Clinical Research Center for Nephropathy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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8
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Gilleece DY, Tariq DS, Bamford DA, Bhagani DS, Byrne DL, Clarke DE, Clayden MP, Lyall DH, Metcalfe DR, Palfreeman DA, Rubinstein DL, Sonecha MS, Thorley DL, Tookey DP, Tosswill MJ, Utting MD, Welch DS, Wright MA. British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018. HIV Med 2020; 20 Suppl 3:s2-s85. [PMID: 30869192 DOI: 10.1111/hiv.12720] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Dr Yvonne Gilleece
- Honorary Clinical Senior Lecturer and Consultant Physician in HIV and Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust
| | - Dr Shema Tariq
- Postdoctoral Clinical Research Fellow, University College London, and Honorary Consultant Physician in HIV, Central and North West London NHS Foundation Trust
| | - Dr Alasdair Bamford
- Consultant in Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London
| | - Dr Sanjay Bhagani
- Consultant Physician in Infectious Diseases, Royal Free Hospital NHS Trust, London
| | - Dr Laura Byrne
- Locum Consultant in HIV Medicine, St George's University Hospitals NHS Foundation Trust, London
| | - Dr Emily Clarke
- Consultant in Genitourinary Medicine, Royal Liverpool and Broadgreen University Hospitals NHS Trust
| | - Ms Polly Clayden
- UK Community Advisory Board representative/HIV treatment advocates network
| | - Dr Hermione Lyall
- Clinical Director for Children's Services and Consultant Paediatrician in Infectious Diseases, Imperial College Healthcare NHS Trust, London
| | | | - Dr Adrian Palfreeman
- Consultant in Genitourinary Medicine, University Hospitals of Leicester NHS Trust
| | - Dr Luciana Rubinstein
- Consultant in Genitourinary Medicine, London North West Healthcare University NHS Trust, London
| | - Ms Sonali Sonecha
- Lead Directorate Pharmacist HIV/GUM, Chelsea and Westminster Healthcare NHS Foundation Trust, London
| | | | - Dr Pat Tookey
- Honorary Senior Lecturer and Co-Investigator National Study of HIV in Pregnancy and Childhood, UCL Great Ormond Street Institute of Child Health, London
| | | | - Mr David Utting
- Consultant Obstetrician and Gynaecologist, Brighton and Sussex University Hospitals NHS Trust
| | - Dr Steven Welch
- Consultant in Paediatric Infectious Diseases, Heart of England NHS Foundation Trust, Birmingham
| | - Ms Alison Wright
- Consultant Obstetrician and Gynaecologist, Royal Free Hospitals NHS Foundation Trust, London
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9
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Vaginal delivery and HBV mother to child transmission risk after immunoprophylaxis: A systematic review and a meta-analysis. Midwifery 2019; 74:116-125. [PMID: 30953967 DOI: 10.1016/j.midw.2019.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/15/2019] [Accepted: 03/29/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE HBV mother to child transmission (MTCT) can be prevented by passive and active immunoprophylaxis. In this study, we aim to assess whether vaginal delivery is safe for HBV MTCT after immunoprophylaxis. MATERIAL AND METHODS PubMed and Web of Science were systematically searched. We compared the MTCT incidence of infants at 6 months or older between vaginal delivery and caesarean section. Serological HBV positive incidences for newborns at birth were also compared. RESULTS Eighteen studies with 11,446 mother-child pairs were included in the meta-analysis. The average incidence of serological HBV positive for newborns at birth was 7.2% in the cesarean section group, and 16.6% in the vaginal delivery group. The summary odds ratio (OR) was 0.499 (95% CI 0.364-0.684; Z = 4.33, P < 0.00001) between two groups. However, the average incidences of MTCT were 3.3% and 4.1% for the cesarean section group and the vaginal delivery group, respectively. The summary OR compared between two groups was 0.790 (95% CI 0.614 to 1.016; Z = 1.83, P = 0.067). The funnel plot, Begg's Test (z = -0.55, P = 0.583) and Egger's test (t = -0.29, P = 0.777) suggested there was no publication bias among the included studies. Sensitive analyze showed the ORs were 0.764 (95% CI 0.490 to 1.192; Z = 1.19, P = 0.236), and 0.386 (95% CI 0.132 to 1.125; Z = 1.74, P = 0.0081), respectively. CONCLUSION The vaginal delivery did not increase the HBV MTCT incidence after immunoprophylaxis at 6 months old or more. The existing evidence does not support the conclusion that caesarean section can prevent MTCT in HBsAg-positive mother after immunoprophylaxis. However, this conclusion should be cautious in the HBV mother with high viral load.
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10
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Maternal Hepatitis B Infection Burden, Comorbidity and Pregnancy Outcome in a Low-Income Population on the Myanmar-Thailand Border: A Retrospective Cohort Study. J Pregnancy 2019; 2019:8435019. [PMID: 30931155 PMCID: PMC6413357 DOI: 10.1155/2019/8435019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/21/2019] [Indexed: 12/15/2022] Open
Abstract
Objectives Hepatitis B virus (HBV) was believed to have minimal impact on pregnancy outcomes apart from the risk of perinatal transmission. In more recent years, there have been reports of adverse associations, most consistently preterm birth (PTB), but this is in the context of high rates of caesarean section. The aim of this study was to explore the association of HBV on pregnancy outcomes in marginalized, low-income populations on the Myanmar-Thailand border. Methods HBsAg positive (+) point of care rapid detection tests results were confirmed by immunoassays. Women with a confirmed HBsAg status, HIV- and syphilis-negative at first antenatal care screening, singleton fetus and known pregnancy outcome (Aug-2012 to Dec-2016) were included. Logistic regression analysis was used to evaluate associations between HBV group (controls HBsAg negative, HBsAg+/HBeAg-, or HBsAg+/HBeAg+) and pregnancy outcome and comorbidity. Results Most women were tested, 15,046/15,114 (99.6%) for HBV. The inclusion criteria were not met for 4,089/15,046 (27.2%) women due mainly to unavailability of pregnancy outcome and nonconfirmation of HBsAg+. In evaluable women 687/11,025 (6.2%) were HBsAg+, with 476/11,025 (4.3%) HBsAg+/HBeAg- and 211/11,025 (1.9%) were HBsAg+/HBeAg+. The caesarean section rate was low at 522/8,963 (5.8%). No significant associations were observed between pregnancy comorbidities or adverse pregnancy outcomes and HBV status. Conclusions The results highlight the disease burden of HBV in women on the Myanmar-Thailand border and support original reports of a lack of significant associations with HBsAg+ irrespective of HBeAg status, for comorbidity, and pregnancy outcomes in deliveries supervised by skilled birth attendants.
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Tziomalos K, Neokosmidis G, Mavromatidis G, Dinas K. Novel insights in the prevention of perinatal transmission of hepatitis B. World J Hepatol 2018; 10:795-798. [PMID: 30533180 PMCID: PMC6280156 DOI: 10.4254/wjh.v10.i11.795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/14/2018] [Accepted: 08/26/2018] [Indexed: 02/06/2023] Open
Abstract
Perinatal transmission of hepatitis B virus (HBV) infection is major contributor to the growing burden of chronic hepatitis B worldwide. Administration of HBV immunoglobulin and HBV vaccination as soon after pregnancy as possible are the mainstay of prevention of perinatal transmission of HBV infection. In women with high viral loads, antiviral prophylaxis also appears to be useful. Lamivudine, telbivudine and tenofovir have been shown to be both safe and effective in this setting but tenofovir is the first-line option due to its low potential for resistance and more favorable safety profile.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece.
| | - Georgios Neokosmidis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece
| | - Georgios Mavromatidis
- Third Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki 54642, Greece
| | - Konstantinos Dinas
- Second Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki 54642, Greece
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12
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Bhamidimarri KR, Pan CQ. Update in the Management of Chronic Hepatitis B in Pregnancy. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s11901-018-0437-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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13
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Maraolo AE, Gentile I, Buonomo AR, Pinchera B, Borgia G. Current evidence on the management of hepatitis B in pregnancy. World J Hepatol 2018; 10:585-594. [PMID: 30310536 PMCID: PMC6177570 DOI: 10.4254/wjh.v10.i9.585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/26/2018] [Accepted: 06/09/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) infection is one of the main public health problems across the globe, since almost one third of the world population presents serological markers of contact with the virus. A profound impact on the epidemiology has been exerted by universal vaccination programmes in many countries, nevertheless the infection is still widespread also in its active form. In the areas of high endemicity (prevalence of hepatitis B surface antigen positivity > 7%), mother-to-child transmission represents the main modality of infection spread. That makes the correct management of HBV in pregnancy a matter of utmost importance. Furthermore, the infection in pregnancy needs to be carefully assessed and handled not only with respect to the risk of vertical transmission but also with respect to gravid women health. Each therapeutic or preventive choice deserves to be weighed upon attentively. On many aspects evidence is scarce or controversial. This review will highlight the latest insights into the paramount steps in managing HBV in pregnancy, with particular attention to recommendations from recent guidelines and data from up-do-date research syntheses.
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Affiliation(s)
- Alberto Enrico Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Antonio Riccardo Buonomo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Biagio Pinchera
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Guglielmo Borgia
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
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Abstract
Several infections have unique consequences or considerations in pregnancy. Some common infections such as urinary tract infections, influenza, sexually transmitted diseases, and vaginitis affect pregnant women differently than the general population, can cause pregnancy complications, and require treatments that are safe in pregnancy. Infections such as hepatitis B and C and human immunodeficiency virus can be transmitted vertically and therefore management focuses on decreasing perinatal transmission. Certain infections can be transmitted in utero and cause congenital infections. Classically, these were grouped together as the TORCH infections, although now several others, including varicella virus, parvovirus, and Zika virus, have also been recognized.
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Affiliation(s)
- Connie Leeper
- Department of Family, Internal, and Rural Medicine, University of Alabama, 850 Peter Bryce Boulevard, Tuscaloosa, AL 35401, USA.
| | - Andrew Lutzkanin
- Department of Family and Community Medicine, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
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Sarpel D, Kushner T, Carter D, Huisman T, Chiu S, Dieterich D. Mother-to-child transmission of hepatitis B and C virus: review of the epidemiology and current treatment options. Future Virol 2018. [DOI: 10.2217/fvl-2017-0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Hepatitis B and C viruses are the leading causes of liver-related morbidity and mortality throughout the world. Hepatitis B virus is predominantly transmitted perinatally, particularly in endemic areas. The rate of mother-to-child transmission of hepatitis C virus is on the rise, largely due to the increasing opioid epidemic. While there are guidelines established for the screening and treatment of pregnant females at risk for chronic hepatitis B infection, there no such guidelines or treatment options available in pregnant females with chronic hepatitis C infection. This review examines the epidemiology of mother-to-child transmission of chronic hepatitis B and C as well as the current treatment options during pregnancy and breastfeeding for both.
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Affiliation(s)
- Dost Sarpel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai West/St Luke's Campus, 1000 10th Avenue, Clinic 2T, New York, NY 10019, USA
| | - Tatyana Kushner
- Department of Medicine, Institute of Liver Medicine, Icahn School of Medicine at Mount Sinai, Annenberg 5–04, 1468 Madison Ave Box 1123, New York, NY 10029, USA
| | - Danielle Carter
- Department of Medicine, Institute of Liver Medicine, Icahn School of Medicine at Mount Sinai, Annenberg 5–04, 1468 Madison Ave Box 1123, New York, NY 10029, USA
| | - Tsipora Huisman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029, USA
| | - Sophia Chiu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029, USA
| | - Douglas Dieterich
- Department of Medicine, Institute of Liver Medicine, Icahn School of Medicine at Mount Sinai, Annenberg 5–04, 1468 Madison Ave Box 1123, New York, NY 10029, USA
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Konerman MA, Lok AS. Epidemiology, Diagnosis, and Natural History of Hepatitis B. ZAKIM AND BOYER'S HEPATOLOGY 2018:474-484.e4. [DOI: 10.1016/b978-0-323-37591-7.00032-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Yang M, Qin Q, Fang Q, Jiang L, Nie S. Cesarean section to prevent mother-to-child transmission of hepatitis B virus in China: A meta-analysis. BMC Pregnancy Childbirth 2017; 17:303. [PMID: 28899348 PMCID: PMC5596961 DOI: 10.1186/s12884-017-1487-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/04/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) is predominantly transmitted through mother-to-child transmission (MTCT). To date, it remains unclear whether the method of parturition affects MTCT of HBV. In order to clarify whether cesarean section, when compared with vaginal delivery, could reduce the risk of MTCT of HBV in China, we conducted this meta-analysis. METHODS A systematic literature search was performed of the PubMed (Medline), Embase, ISI Web of Science, China Biological Medicine Database, China National Knowledge Infrastructure, and VIP Database for Chinese Technical Periodicals databases for articles written in English or Chinese through July 2015.The reference lists of relevant articles were also scrutinized for additional papers. Randomized controlled trials, cohort studies, or case-control studies investigating the effect of delivery mode on MTCT of HBV were included. RESULTS This analysis involved 28 articles containing 30 datasets. The data encompassed 9906 participants. The MTCT rate of HBV was 6.76% (670 of 9906) overall, with individual rates of 4.37% (223 of 5105) for mothers who underwent cesarean section and 9.31% (447 of 4801) for those who underwent vaginal delivery. The summary relative risk (RR) was 0.51 (95%CI: 0.44-0.60, P < 0.001), indicating a statistically significant decrease in HBV vertical transmission via cesarean section compared with vaginal delivery. The heterogeneity among studies was moderate with an I 2 of29.3%.Publication bias was not detected by the Egger's and Begg's tests, and the funnel plot was symmetric. In the subgroup analyses, maternal hepatitis B e antigen status and follow-up time did not affect the significance of the results, but hepatitis B immune globulin (HBIG) administration to mother and infant did. CONCLUSIONS Cesarean section could reduce the risk of MTCT of HBV in comparison to vaginal delivery in China. However, owing to several limitations of our meta-analysis, future well-designed randomized controlled trials with adequate statistical power, might be a more appropriate next step.
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Affiliation(s)
- Mei Yang
- Futian District Center for Disease Control and Prevention of Shenzhen China, Futian District, Shenzhen, 518000, China
| | - Qin Qin
- Department of Health Prevention and Care, Zhongshan Hospital, Xiamen University, Xiamen, 361004, China.,Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China
| | - Qiong Fang
- Futian District Center for Disease Control and Prevention of Shenzhen China, Futian District, Shenzhen, 518000, China
| | - Lixin Jiang
- Futian District Center for Disease Control and Prevention of Shenzhen China, Futian District, Shenzhen, 518000, China
| | - Shaofa Nie
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China.
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Tanadi MR, Lusida MI, Joewono HT. PROPORTION OF HBsAg AND HBeAg POSITIVE IN MATERNAL PATIENTS AND THEIR HBsAg POSITIVES BABIES WITH IMMUNOPROPHYLAXIS OF HBV IMMUNIZATION IN Dr. SOETOMO GENERAL HOSPITAL, SURABAYA. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2017. [DOI: 10.20473/ijtid.v6i4.1372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hepatitis B Virus (HBV) can be transmitted vertically from mother to her baby. Mothers with HBsAg and HBeAg positives have more risk of transmitting HBV to her baby rather than HBsAg positives only. The aim of this study is to determine the proportion of maternal patient with HBsAg and HBeAg positives and their HBsAg positives babies with immunoprophylaxis of HBV immunization. This study was performed by analytical observation using medical records in 2013-2014 at Obstetric and Gyn ecology Department, Dr. Soetomo Hospital. The samples were all maternal patients (3796) during that period and also their babies from HBsAg positives mothers. Unfortunately, several original medical records were not available. Thirty two (0,85%) out of 3781 maternal patients were found to be HBsAg positives, and three (9,37%) of 32 patients with HBsAg positives were HBeAg positives. From 32 mothers who were positive HBsAg, 22 complete medical records of their babies were found and all of them (100%) had been given Hepatitis B Immunoglobulin (HBIG) and hepatitis B vaccine less than twelve hours after birth. In three cases of the babies from HBeAg positives mothers which had been given prophylaxis properly, two cases each of which was with caesarean and spontaneous delivery were HBsAg negatives. Interestingly, the other one which born with spontaneous delivery was found to be HBsAg positives. Further study in this HBsAg positives baby, especially in analyzing its HBV DNA is needed. The epidemiology of hepatitis B in maternal patients, especially that with complete and neat data needs further research.
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Borgia G, Maraolo AE, Gentile I. Hepatitis B mother-to-child transmission and infants immunization: we have not come to the end of the story yet. Infect Dis (Lond) 2017; 49:584-587. [PMID: 28316268 DOI: 10.1080/23744235.2017.1303746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Guglielmo Borgia
- a Department of Clinical Medicine and Surgery, Section of Infectious Diseases , University of Naples 'Federico II' , Naples , Italy
| | - Alberto Enrico Maraolo
- a Department of Clinical Medicine and Surgery, Section of Infectious Diseases , University of Naples 'Federico II' , Naples , Italy
| | - Ivan Gentile
- a Department of Clinical Medicine and Surgery, Section of Infectious Diseases , University of Naples 'Federico II' , Naples , Italy
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Pawlowska M, Pniewska A, Pilarczyk M, Kozielewicz D, Domagalski K. Prophylaxis of vertical HBV infection. Expert Opin Drug Saf 2016; 15:1361-8. [PMID: 27402246 DOI: 10.1080/14740338.2016.1211106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION An appropriate management of HBV infection is the best strategy to finally reduce the total burden of HBV infection. Mother-to-child transmission (MTCT) is responsible for more than one third of chronic HBV infections worldwide. Because HBV infection in infancy or early childhood often leads to chronic infection, appropriate prophylaxis and management of HBV in pregnancy is crucial to prevent MTCT. AREAS COVERED The prevention of HBV vertical transmission is a complex task and includes: universal HBV screening of pregnant women, administration of antivirals in the third trimester of pregnancy in women with high viral load and passive-active HBV immunoprophylaxis with hepatitis B vaccine and hepatitis B immune globulin in newborns of all HBV infected women. EXPERT OPINION Universal screening of pregnant women for HBV infection, early identification of HBV DNA level in HBV-infected mothers, maternal treatment with class B according to FDA antivirals and passive/active anti-HBV immunoprophylaxis to newborns of HBV-positive mothers are crucial strategies for reducing vertical HBV transmission rates. Consideration of caesarean section in order to reduce the risk of vertical HBV transmission should be recommend in HBV infected pregnant women with high viral load despite antiviral therapy or when the therapy in the third trimester of pregnancy is not available.
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Affiliation(s)
- Malgorzata Pawlowska
- a Department of Pediatric Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum Bydgoszcz , Nicolaus Copernicus University , Toruń , Poland
| | - Anna Pniewska
- a Department of Pediatric Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum Bydgoszcz , Nicolaus Copernicus University , Toruń , Poland
| | - Malgorzata Pilarczyk
- a Department of Pediatric Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum Bydgoszcz , Nicolaus Copernicus University , Toruń , Poland
| | - Dorota Kozielewicz
- b Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum Bydgoszcz , Nicolaus Copernicus University , Toruń , Poland
| | - Krzysztof Domagalski
- c Centre For Modern Interdisciplinary Technologies , Nicolaus Copernicus University , Toruń , Poland
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