Influence of amniocentesis on risk of mother-to-child transmission of hepatitis B virus

Abstract

Objective To investigate whether amniocentesis may increase the risk for mother-to-child transmission of hepatitis B virus (HBV). Methods Totally 40 children born to HBV-infected mothers who had amniocentesis performed in Nanjing Drum Tower Hospital, Nanjing University Medical School from January 2010 to December 2013, were followed up and screened for HBV markers. Amniotic fluid samples were collected and stored at -80 ℃ were tested for HBV markers. Among the 40 carrier mothers, three (7.5%) were hepatitis B e antigen (HBeAg)-positive. Relevant data such as antiviral history, administration of hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) in infants were collected. Chi-square test or Fisher's exact test was used for statistical analysis. Results The mothers were 21–41 years old, with a mean age of (31.5±5.5) years at the time of amniocentesis and mean gestational age of (21.2±1.6) weeks (18.4-24.9 weeks). Indications for amniocentesis were mainly abnormal maternal serum alpha-fetoprotein levels (65.0%, 26/40) and maternal age over 35 years (10.0%, 4/40). None of the mothers received antiviral therapy and 14 (35.0%) underwent transplacental amniocentesis. Among 28 cases who had a store of amniotic fluid sample and were followed-up, one (7.1%) was positive for both hepatitis B surface antigen (HBsAg) and HBV DNA, and another was positive for HBsAg only. The average age of 40 children at follow-up was (2.0±1.0) years (seven months to four years old), among which 23 were boys and 17 were girls. All of them received hepatitis B vaccine and HBIG. Positive rate of HBsAg and HBV DNA in HBeAg(+) mothers are higher than those in HBeAg(-) mothers [4.7%(2/43) vs 3/5, χ2=14.705; 0/43 vs 2/5, χ2=17.948; both P<0.05]. Thirty-seven children born to HBsAg(+)/HBeAg(-) mothers were negative for both HBsAg and hepatitis B core antibody (anti-HBc), and the other three born to HBsAg(+)/ HBeAg(+) mothers were also negative for HBsAg and anti-HBc. Additionally, the positive rate of hepatitis B surface antibody in children was 90.0% (36/40). Conclusions For those HBsAg(+)/HBeAg(-) mothers, amniocentesis does not elevate the risk for mother-to-child transmission of HBV, even performed transplacentally. However, further studies are needed for HBeAg-positive mothers. HBsAg or HBV DNA positive in amniotic fluid should be diagnosed as intrauterine infection of HBV. Key words: Hepatitis B virus; Hepatitis B; Infectious disease transmission, vertical; Amniocentesis