Hepatitis B Infection and pregnancy: disease management and prevention of perinatal transmission
DOI:
https://doi.org/10.7175/rhc.v5i1S.923Keywords:
Chronic hepatitis B virus, Perinatal transmission, Antiviral drugsAbstract
Chronic hepatitis B virus (HBV) infection affects about 350 million individuals worldwide. Perinatal transmission is a common mode of HBV transmission. Without prophylaxis the risk of mother-to-child transmission is very high and it depends on the HBeAg status of mothers, being 85%-90% for HBeAg-positive mothers, and 32% for HBeAg-negative mothers. Maternal screening programs aimed at identifying HBsAg-positive mothers should be part of pregnancy routine examinations. Once HBsAg-positive mothers are identified, their babies receive passive-active immunoprophylaxis at birth, this reduces the risk of vertical HBV transmission from 90% to 5-10%. The present review aimed to show the peculiar and sometimes controversial aspects which concern both the mother and the fetus in the case of HBV infection in pregnancy, including the effect of pregnancy on HBV infection and of HBV infection on pregnancy; the potential viral transmission from mother to newborn; and prevention of mother-to-child transmission through antiviral drugs, and the type of antiviral drug to use considering their efficacy and potential teratogenic effect.
References
Sookoian S. Liver disease during pregnancy: acute viral hepatitis. Ann Hepatol 2006; 5: 231-6
Hieber JP, Dalton D, Shorey J, et al. Hepatitis and pregnancy. J Pediatr 1977; 91: 545-9
Jonas MM. Hepatitis B and pregnancy: an underestimated issue. Liver Int 2009; 29 Suppl 1: 133-9; http://dx.doi.org/10.1111/j.1478-3231.2008.01933.x
Lao TT, Chan BC, Leung WC, et al. Maternal hepatitis B infection and gestational diabetes mellitus. J Hepatol 2007; 47: 46-50
Tse KY, Ho LF, Lao T. The impact of maternal HBsAg carrier status on pregnancy outcomes: a case-control study. J Hepatol 2005; 43: 771-5
Lao TT, Tse KY, Chan LY, et al. HBsAg carrier status and the association between gestational diabetes with increased serum ferritin concentration in Chinese women. Diabetes Care 2003; 26: 3011-6
Lobstein S, Faber R, Tillmann HL. Prevalence of hepatitis B among pregnant women and its impact on pregnancy and newborn complications at a tertiary hospital in the eastern part of Germany. Digestion 2011; 83: 76- 82; http://dx.doi.org/10.1159/000320455
Connell LE, Salihu HM, Salemi JL, et al. Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes. Liver Int 2011; 31:1163- 70; http://dx.doi.org/10.1111/j.1478-3231.2011.02556.x
Tan HH, Lui HF, Chow WC. Chronic hepatitis B virus (HBV) infection in pregnancy. Hepatol Int 2008; 2: 370- 5; http://dx.doi.org/10.1007/s12072-008-9063-4
Söderström A, Norkrans G, Lindh M. Hepatitis B virus DNA during pregnancy and post partum: aspects on vertical transmission. Scand J Infect Dis 2003; 35: 814-9
Rawal BK, Parida S, Watkins RP, et al. Symptomatic reactivation of hepatitis B in pregnancy. Lancet 1991; 337: 364
Lin HH, Wu WY, Kao JH, et al. Hepatitis B post-partum e antigen clearance in hepatitis B carrier mothers: Correlation with viral characteristics. J Gastroenterol Hepatol 2006; 21: 605-9
ter Borg MJ, Leemans WF, de Man RA, et al. Exacerbation of chronic hepatitis B infection after delivery. J Viral Hepat 2008; 15: 37-41
Yang YB, Li XM, Shi ZJ, et al. Pregnant woman with fulminant hepatic failure caused by hepatitis B virus infection: a case report. World J Gastroenterol 2004; 10: 2305-6
Nguyen G, Garcia RT, Nguyen N, et al. Clinical course of hepatitis B virus infection during pregnancy. Aliment Pharmacol Ther 2009; 29: 755- 64; http://dx.doi.org/10.1111/j.1365-2036.2009.03932.x
Wong S, Chan LY, Yu V, et al. Hepatitis B carrier and perinatal outcome in singleton pregnancy. Am J Perinatol 1999; 16: 485-8
Shaheen AA, Myers RP. The outcomes of pregnancy in patients with cirrhosis: a population-based study. Liver Int 2010; 30:275 -83; http://dx.doi.org/10.1111/j.1478-3231.2009.02153.x
Degertekin B, Lok AS. Indications for therapy in hepatitis B. Hepatology 2009; 49: S129-37; http://dx.doi.org/10.1002/hep.22931
Potthoff A, Rifai K, Wedemeyer H, et al. Successful treatment of fulminant hepatitis B during pregnancy. Z Gastroenterol 2009; 47: 667-70; http://dx.doi.org/10.1055/s-0028-1109148
Stevens CE, Beasley RP, Tsui J, et al. Vertical transmission of hepatitis B antigen in Taiwan. N Engl J Med 1975; 292: 771-4
Xu DZ, Yan YP, Choi BC, et al. Risk factors and mechanism of transplacental transmission of hepatitis B virus: a case-control study. J Med Virol 2002; 67: 20-6
Stevens CE, Toy PT, Tong MJ, et al. Perinatal hepatitis B virus transmission in the United States. Prevention by passive-active immunization. JAMA 1985; 253: 1740-5
Chen HL, Lin LH, Hu FC, et al. Effects of maternal screening and universal immunization to prevent mother-to-infant transmission of HBV. Gastroenterology 2012; 142: 773-81.e2; http://dx.doi.org/10.1053/j.gastro.2011.12.035
Burk RD, Hwang LY, Ho GY, et al. Outcome of perinatal hepatitis B virus exposure is dependent on maternal virus load. J Infect Dis 1994; 170: 1418-23
Li XM, Shi MF, Yang YB, et al. Effect of hepatitis B immunoglobulin on interruption of HBV intrauterine infection. World J Gastroenterol 2004; 10: 3215-7
Wiseman E, Fraser MA, Holden S, et al. Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust 2009; 190: 489-92
Pan C, Han GR, Zhao W, et al. Virologic factors associated with failure to passive-active immunoprophylaxis in infants with HBsAg-positive at birth. Hepatology 2011; 54: 878A. Abstract n.42
Thompson ND, Perz JF, Moorman AC, et al. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008. Ann Intern Med 2009; 150: 33-9
Bai H, Zhang L, Ma L, et al. Relationship of hepatitis B virus infection of placental barrier and hepatitis B virus intra-uterine transmission mechanism. World J Gastroenterol 2007; 13: 3625-30
Lin HH, Lee TY, Chen DS, et al. Transplacental leakage of HBeAg-positive maternal blood as the most likely route in causing intrauterine infection with hepatitis B virus. J Pediatr 1987; 111: 877-81
Ohto H, Lin HH, Kawana T, et al. Intrauterine transmission of hepatitis B virus is closely related to placental leakage. J Med Virol 1987; 21: 1-6
Zhang SL, Yue YF, Bai GQ, et al. Mechanism of intrauterine infection of hepatitis B virus. World J Gastroenterol 2004; 10: 437-8
López M, Coll O. Chronic viral infections and invasive procedures: risk of vertical transmission and current recommendations. Fetal DiagnTher 2010; 28: 1-8; http://dx.doi.org/10.1159/000309155
Towers CV, Asrat T, Rumney P. The presence of hepatitis B surface antigen and deoxyribonucleic acid in amniotic fluid and cord blood. Am J ObstetGynecol 2001; 184: 1514-8
Ko TM, Tseng LH, Chang MH, et al. Amniocentesis in mothers who are hepatitis B virus carriers does not expose the infant to an increased risk of hepatitis B virus infection. Arch GynecolObstet 1994; 255: 25-30
Chen LZ, Zhou WQ, Zhao SS, et al. A nested case-control study of maternal-neonatal transmission of hepatitis B virus in a Chinese population. World J Gastroenterol 2011; 17: 3640-4; http://dx.doi.org/10.3748/wjg.v17.i31.3640
Song YM, Sung J, Yang S, et al. Factors associated with immunoprophylaxis failure against vertical transmission of hepatitis B virus. Eur J Pediatr 2007; 166: 813-8
Beasley RP, Stevens CE, Shiao IS, et al. Evidence against breast-feeding as a mechanism for vertical transmission of hepatitis B. Lancet 1975; 2: 740-1
Hill JB, Sheffield JS, Kim MJ, et al. Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers. Obstet Gynecol 2002; 99: 1049-52
Guidelines for Perinatal Care. American Academy of Pediatrics and American College of Obstetricians and Gynecologists. 4th ed. Washington: 1997
Wang J, Zhu Q, Zhang X. Effect of delivery mode on maternal-infant transmission of hepatitis B virus by immunoprophylaxis. Chin Med J (Engl) 2002; 115: 1510-2
Yang J, Zeng XM, Men YL, et al. Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus – a systematic review. Virol J 2008; 5: 100; http://dx.doi.org/10.1186/1743-422X-5-100
Centers for Disease Control and Prevention (CDC). MMWR – A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. 2005; 54: No. RR-16. Disponibile su http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a1.htm
Borgia G, Carleo MA, Gaeta GB, et al. Management of HBV infection in pregnancy. World J Gastroenterol 2012; 18: 4677-83
Bzowej NH. Hepatitis B therapy in pregnancy. Curr Hepat Rep 2010; 9: 197-204
European Association For The Study Of The Liver. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol 2012; 57: 167-85; http://dx.doi.org/10.1016/j.jhep.2012.02.010
The Antiretroviral Pregnancy Registry. Disponibile su www.apregistry.com
Gibb DM, Kizito H, Russell EC, et al. Pregnancy and infant outcomes among HIV-infected women taking long-term ART with and without tenofovir in the DART trial. PLoS Med 2012; 9: e1001217; http://dx.doi.org/10.1371/journal.pmed.1001217
Brown RS Jr, Verna EC, Pereira MR, et al. Hepatitis B virus and human immunodeficiency virus drugs in pregnancy: findings from the Antiretroviral Pregnancy Registry. J Hepatol 2012; 57: 953-9; http://dx.doi.org/10.1016/j.jhep.2012.06.031
The Antiretroviral Pregnancy Registry Interim Report. 1 January 1989 through 31 January 2012. Issue June 2012
Pan CQ, Liu M, Cai H, et. Safety of Tenofovir Disoproxil Fumarate (TDF) treatment for the entire pregnancy in mothers with active chronic hepatitis B or cirrhosis. Hepatology 2013; 58: 624A
Van Rompay KK, Durand-Gasselin L, Brignolo LL, et al. Chronic administration of tenofovir to rhesus macaques from infancy through adulthood and pregnancy: summary of pharmacokinetics and biological and virological effects. Antimicrob Agents Chemother 2008; 52: 3144-60; http://dx.doi.org/10.1128/AAC.00350-08
Gill US, et al. Factors determining bone mineral density loss in chronic hepatitis B patients: is tenofovir disoproxil fumarate the main culprit? Gut 2011; 60:A230
Viganò A, Mora S, Giacomet V, et al. In utero exposure to tenofovirdisoproxilfumarate does not impair growth and bone health in HIV-uninfected children born to HIV-infected mothers. Antivir Ther 2011; 16: 1259-66; http://dx.doi.org/10.3851/IMP1909
Siberry GK, Williams PL, Mendez H, et al. Safety of tenofovir use during pregnancy: early growth outcomes in HIV-exposed uninfected infants. AIDS 2012; 26: 1151- 9; http://dx.doi.org/10.1097/QAD.0b013e328352d135
Benaboud S, Pruvost A, Coffie PA, et al. Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan, Cote d’Ivoire, in the ANRS 12109 TEmAA Study, Step 2. Antimicrob Agents Chemother 2011; 55: 1315-7; http://dx.doi.org/10.1128/AAC.00514-10
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