Clinical study on the efficacy and safety of oral nucleos(t)ide analogues in HBV mother-to-infant obstruction of pregnant women with high viral load

Abstract

Abstract: Objective To investigate the effect and safety of nucleos(t)ide analogues (NAs) in hepatitis B virus (HBV) mother-to-infant obstruction of pregnant women with high viral load, and to provide real-world clinical data for interrupting mother-to-child transmission of HBV. Methods A total of 411 pregnant women with HBV DNA≥1×10⁶ copies/mL were retrospectively selected from the follow-up cohort of chronic HBV infection in our hospital, and they were divided into preventing group (256 cases) and control group (155 cases) according to the oral administration of NAs during pregnancy. All infants were vaccinated with hepatitis B vaccine and hepatitis B immunoglobulin as standard after birth. The levels of HBV DNA, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the preventing group were compared at baseline. before delivery and 3 months after delivery. The levels of HBV DNA before delivery and hepatitis B surface antigen (HBsAg) positive rate in infants from 7 months to 1 year were compared between 2 groups. Results The levels of DNA, ALT and AST before delivery were lower than baseline in the preventing group [(3.16 ± 1.05) log₁₀ copies/mL vs. (7.09 ± 0.77) log₁₀ copies/mL, P＜0.01; (21.90 ± 12.00) U/L vs. (66.08 ± 89.35) U/L, P＜0.01; (29.16 ± 9.16) U/L vs. (52.12 ± 54.97) U/L, P＜0.01]. The level of HBV DNA before delivery and the positive rate of HBsAg of infants in the preventing group were lower than those in the control group [(3.16 ± 1.05) log₁₀ copies/mL vs. (6.96 ± 0.78) log₁₀ copies/mL, P＜0.01; 0.00% vs 9.68%, P＜0.01]. No perinatal adverse events were reported in both groups. The levels of HBV DNA, ALT and AST in parturients who stopped taking NAs after delivery were higher than those who continued taking NAs [(6.70 ± 1.39) log₁₀ copies/mL vs. (2.24 ± 0.54) log₁₀ copies/mL, P＜0.01; (54.19 ± 50.00) U/L vs. (34.62 ± 20.04) U/L,P＜0.01; (42.50 ± 28.04) U/L vs. (33.40 ± 11.66) U/L, P＜0.01]. Conclusion The combination of oral NAs, hepatitis B vaccination and HBIG during pregnancy for pregnant women with high viral load and continued antiviral treatment for postpartum patients can successfully interrupt mother-to-child transmission of HBV and ensure the safety of mother and child during pregnancy and postpartum.

Key words: Chronic hepatitis B, High viral load, Mother-to-infant obstruction, Pregnancy, Nucleos(t)ide analogues

LIANG Heng-kai, WEI Lu, SU Ming-hua, LIANG Huan, HU Bo-bin, HUANG Jian-fang, CHEN Yan-hong, JIANG Jian-ning. Clinical study on the efficacy and safety of oral nucleos(t)ide analogues in HBV mother-to-infant obstruction of pregnant women with high viral load[J]. Chinese Hepatolgy, 2023, 28(3): 296-298.

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