Abstract
Background: Failure of immunoprophylaxis in the prevention of mother-to-infant transmission of hepatitis B virus (HBV) is usually attributed to in uterine infection. We aimed to clarify whether the presence of HBV markers in cord blood indicates exposure to or infection with HBV. Methods: We prospectively recruited hepatitis B surface antigen (HBsAg)-positive pregnant women and their neonates 2012 through 2015. All neonates received passive-active immunoprophylaxis after birth. The infants were followed up at 7-14 months of age. Findings: Totally 329 HBsAg-positive pregnant women and 333 neonates were enrolled. No cord blood was anti-HBc IgM positive. Of the neonates, 290 (87.1%) were followed up and 6 (2.1%) were infected with HBV. Of 146 neonates born to hepatitis B e antigen (HBeAg)-negative mothers, 38 (26.0%) and 30 (20.5%) had detectable HBsAg and HBV DNA in cord blood respectively, but none of 126 infants followed up was infected. Of 187 neonates born to HBeAg-positive mothers, 92 (49.2%) and 79 (42.2%) had detectable HBsAg and HBV DNA respectively; 6 (3.7%) of 164 infants followed up were infected. Of seven neonates with HBV DNA >10^5 IU/ml in cord blood, four had no infection and three others were infected. Interpretation: Presence of HBsAg and/or HBV DNA, even at high levels, in cord blood just indicates exposure to, but not infection with HBV. Presence of HBV markers in cord blood cannot define intrauterine infection. Funding: This work was supported by the Jiangsu Provincial Department of Health (H201537), the Science and Technology Department of Jiangsu Province (BK20161105), and the National Natural Science Foundation of China (81672002), China. Declaration of Interest: The authors have no conflict of interest to disclose. Ethical Approval: This study was approved by the institutional review board of each hospital. All methods were performed in accordance with the protocols set up based on the relevant guidelines and regulations. Written informed consent was obtained from each pregnant woman; the infant’s consent was assigned by his/her mother.
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