HBV-positive Pregnant Women Research Articles

Hepatitis B virus preCore/Core region variability in pregnant women in the Republic of Guinea

Introduction. The vertical route of hepatitis B virus (HBV) transmission is a significant problem in African countries, which is characterized by late diagnosis of the disease and high mortality. The high prevalence of hepatocellular carcinoma (HCC) in Africa may be due to variability in the HBV preCore/Core region, mutations in which contribute to disease progression. Molecular genetic characterization of strains circulating among pregnant women may reflect the overall mutational profile of the pathogen in the population.
 The objective of this study was to analyze the variability of the HBV preCore/Core region circulating among pregnant women in the Republic of Guinea.
 Materials and methods. The study material included 480 plasma samples obtained from HBV-positive pregnant women from the Republic of Guinea. For all samples, the nucleotide sequences of the preCore/Core region of the HBV genome were sequenced and analyzed.
 Results. Amino acid variability in the preCore region was determined in 211 (43.96%), and in the Core region in 473 (98.54%) patients. 12 polymorphic sites of the preCore region were identified in which amino acid substitutions occurred, including 8, 2 and 5 positions identified for genotypes E, A and D, respectively. In the Core region, 67 substitution positions were identified, including 46 in samples of genotype E, 23 in HBV genotype A and 26 in genotype D. It was shown that the distribution of substitutions in the preCore and Core regions in HBV genotypes E, A and D differs significantly with a predominance in mutations among HBV genotype E — p 0.0001. Individual characteristic mutations have been identified for each genotype. The most common clinically significant mutations in the preCore/Core region in the study group were identified, including pc-H5D (27,08%), pc-W28* (35,21%), c-E64D (33,54%), c-L116I/V/G (91,46 %), c-T146N (73,13%). The double mutation A1762T/G1764A in the basal core promoter was shown in 74 samples of HBV genotype E, which accounted for 15.42% of the total group and 16.59% of patients with HBV genotype E.
 Conclusion. The frequency of clinically significant preCore/Core mutations among pregnant women in the Republic of Guinea was determined. The data obtained reflect their prevalence in the general population and can be used to predict the progression of chronic HBV among the region's population.

Impact of lamivudine treatment in late pregnancy on the development of the foetal immune response to hepatitis B virus: a meta-analysis in R with the metafor package.

Hepatitis B virus (HBV) infection is a worldwide public health burden, especially in Asia and Africa. Concerns were raised that foetal exposure to HBV and antiretroviral therapy (ART) might suppress the innate immune response and reduce the production of hepatitis B surface antibody (HBsAb) in foetuses and infants. We therefore conducted the current study to evaluate the impact of ART on the development of the immune response to HBV in foetuses and infants. We selected lamivudine instead of telbivudine or tenofovir as the intervention measurement because it was the oldest and most widely used ART during pregnancy and its safety data have been sufficiently documented. A comprehensive search was conducted in eight electronic databases, including four Chinese and four English databases. Studies that met the following eligibility criteria were included: human randomized controlled trials (RCTs); participants in the treatment group were exclusively exposed to lamivudine; participants in the control group were exposed to placebo, no treatment or hepatitis B immunoglobulin; all participants were HBV-positive pregnant women with a high viral load and the main outcome of interest was neonatal HBsAb seropositivity. Data were tabulated and analysed using R software. Nine RCTs were included and analysed. Compared with controls, lamivudine significantly decreased HBsAb seronegativity in the newborn within 24h after birth (indicating the foetal immune response to HBV). Similar results were noted in infants within 6-7months after birth and infants within 12months (indicating the neonatal immune response to HBV vaccine). Lamivudine treatment in late pregnancy boosted the foetal immune response to HBV in utero and enhanced the neonatal immune response to hepatitis B vaccine after birth.

KNOWLEDGE LEVEL OF THE MANAGEMENT OF HEPATITIS B DURING PREGNANCY AMONG SPECIALIST AND RESIDENTS OF THE OBSTETRICS AND GYNECOLOGY: A SURVEY STUDY FROM TURKEY

In this study, it is aimed to assess the levels of knowledge of specialists and residents of gynecology and obstetrics in Turkey, concerning management of Hepatitis B virus (HBV)-positive pregnant women. A cross-sectional online survey study was conducted on Gynecology and Obstetrics specialists and residents between November 2019 and February 2020. Questionnaire form concerning management of HBV-positive pregnant women, which was prepared by researchers on the basis of literature, has been sent to Gynecology and Obstetrics Clinics and departments of Turkey via online means. The questionnaire form consisted of sections including socio-demographic characteristics (age group, gender, time spent as a specialist doctor/resident (years), place of work) and assessing the level of knowledge concerning the management of HBV(+) pregnant women. The questions in this section were created by the researchers based on the literature. These questions are not questions of a scale whose validity and reliability studies have been conducted. Knowledge Level Score on the management of HBV-positive pregnant women (KLS) has been calculated in a range of 0 to 18 points. Statistics Package for the Social Sciences (SPSS) version 25.0 was used for statistical analysis. A total of 215 physicians, including 50 residents (23.3%) and 165 (76.7%) specialists, have participated in the study. Since normal distribution was not observed as a result of normality evaluation, mean values are presented as median (25%-75%). Median KLS was found as 8.0 (7.0-10.0). In residents, KLS was 8.0 (6.75-9.0), and in specialists, it was 8.0 (7.0-10.0). There was no statistically significant difference between the scores of residents and specialists. The median level of knowledge of the physicians participating in the study about Hepatitis B treatment in pregnant women was 8.0 (7.0-10.0). This score was interpreted as “inadequate” out of a maximum of 18 points, by researchers. Despite limitations, this study has shown the inadequacy of level of knowledge of gynecologists and obstetricians in Turkey concerning management of Hepatitis B in pregnant women. There is a need for further studies and continuous training of Gynecologists and Obstetricians.

Prevalence, genotype distribution and mutations of hepatitis B virus and the associated risk factors among pregnant women residing in the northern shores of Persian Gulf, Iran.

Considering perinatal transmission and the high rate of chronic hepatitis B virus (HBV) infection in infants, diagnosis of HBV infection during pregnancy and timely interventions are of great importance. Therefore, this study was performed to investigate the prevalence and genotype distribution of HBV infection and the associated risk factors among pregnant women in the northern shores of the Persian Gulf, South of Iran. Serum samples of 1425 pregnant women were tested for the presence of HBsAg and HBcAb by ELISA (HBsAg one-Version ULTRA and HBc Ab ELISA kits, DIA.PRO, Milan, Italy). The seropositive samples were tested for the presence of HBV DNA by nested PCR, targeting S, X, pre-core (pre-C), and basal core promoter (BCP) regions of the HBV genome. The amplified fragments were sequenced by Sanger dideoxy sequencing technology to evaluate the genotype distribution and mutations of HBV infection by using the MEGA 7 software. The HBV seropositive pregnant women were tested for HCV and HIV coinfections by ELISA (HCV Ab and HIV Ab/Ag ELISA kits, DIA.PRO, Milan, Italy). Of 1425 participants, 15 pregnant women (1.05%, 95% CI: 0.64%-1.73%) were positive for HBsAg, 41 women (2.88%, 95% CI: 2.10%-3.88%) were positive for HBcAb, and 5 women (0.35%, 95% CI: 0.15% -0.82%) had HBV viremia with genotype D, sub-genotype D3 and subtype ayw2. One of the viremic samples was positive for HBcAb but negative for HBsAg, which is indicative of an occult HBV infection. HBsAg seroprevalence was higher among pregnant women aged 20 to 29 years, women in the third trimester of pregnancy, residents of Khormuj city, Afghan immigrants, illiterate women, and pregnant women with a history of tattoo and HBV vaccination. The highest rate of HBcAb seroprevalence was observed in residents of Borazjan city, Turk ethnicity, the age group >39 years, and those women with more parities and a history of abortion. Nevertheless, HBV seroprevalence among pregnant women was not statistically associated with these variables. In contrast, HBcAb seropositivity was significantly associated with the history of tattoo (P = 0.018). According to mutations analyses, seven amino acid substitutions in the HBsAg, one point mutation in the pre-C region, and five points mutations in the BCP region were detected. Besides, the BCP mutations caused amino acid substitutions in the X protein. Of note, the conversion of Ala → Val at amino acid 168 (A168V) and Thr → Pro at amino acid 127 (T127P) were detected in HBsAg of the occult HBV strain. These results indicate a relatively low prevalence of HBV infection among pregnant women in the South of Iran, while tattooing is a risk factor for exposure to HBV infection. Moreover, all of the HBV-positive pregnant women were asymptomatic and unaware of their infection. Therefore, routine screening for HBV markers during pregnancy, appropriate treatment of HBV-infected women, and HBV vaccination are recommended to decrease mother-to-child transmission of HBV.

Prevention, control, and management of HBV infection among pregnant women in China: from a life-cycle perspective.

Hepatitis B virus (HBV) infection is a global public health problem, causing a high disease burden worldwide.[1] As a country previously with a high burden of hepatitis, about 70 million people in China are infected with HBV now, and mother-to-child transmission (MTCT) is still a predominant mode of HBV infection in China.[2] Preventing mother-to-child transmission is the key to eliminating HBV infection, and standardized management of HBV-infected pregnant women and their newborns can effectively cut off the mother-to-child transmission.[3] Neonatal hepatitis B immune globulin and hepatitis B vaccine can effectively reduce neonatal HBV infection in infants of HBV-positive pregnant women. Peripartum antiviral prophylaxis after 28 pregnant weeks is proved to be highly effective at reducing the risk of HBV (MTCT).[4] Furthermore, controlling hepatitis B infection in pregnant women not only reduces the risk of transmission within the family and vertical transmission from mother to child,[5] but also might reduce the risk of adverse pregnancy outcomes.[6] Therefore, understanding the epidemiological characteristics of HBV infection in pregnant women in China and better regulating the prevention, diagnosis, and treatment of this population is of great significance for realizing the goal of “eliminating viral hepatitis as a major public health threat by 2030” proposed by World Health Organization (WHO). Based on recent data from the first nationwide observational study on HBV infection among pregnant women in China, the prevalence of HBV infection among pregnant women in China continued to decline from 2015 to 2020.[7] Data were obtained from the National Integrated Prevention of Mother-to-Child Transmission of HIV, Syphilis, and Hepatitis B (iPMTCT) Program. From 2015 to 2020, a total of 90.87 million pregnant women in 2853 counties of China were tested for HBV, of which about 5.6 million tested positive for HBV infection (defined as a positive outcome for hepatitis B surface antigen). The prevalence of HBV infection among pregnant women decreased from 7.30% in 2015 to 5.44% in 2020, which is at the moderate epidemic level defined by WHO.[7] It reflected the effectiveness of comprehensive prevention and control measures, mainly hepatitis B vaccination for newborns, in reducing the prevalence of HBV infection among adults in China.[7] Compared with 2015, the prevalence of HBV infection among pregnant women in eastern, central, and western China all decreased, from 8.72% to 6.04% (a relative decline of 30.73%) in eastern China and from 6.76% to 4.93% (a relative decline of 20.07%) in central China. In the west, it dropped from 6.40% to 5.43% with a relative decline of 14.48%. The regional gap also narrowed, and the prevalence of HBV infection decreased in most provinces (90.30%) and counties (76.96%) from 2015 to 2020.[7] The study suggests that provinces with a relatively high burden of HBV infection should be given more investment in health resources and more attention in the future. This is the first study on the status quo and trend of HBV infection among pregnant women in China at the national level, which is of great significance.[7] The results provide important basic data for understanding the current burden of hepatitis B among pregnant women in China and realizing the goal of eliminating hepatitis B. The findings also prove the great achievements of hepatitis B prevention and control in China over the years. The results of this study provide scientific evidence for China to better achieve the 2030 goal of eliminating hepatitis B as a public health threat proposed by WHO. How to achieve the WHO 2030 goal of eliminating the public health threat caused by hepatitis B on time is a global common concern.[1,2] From the perspective of life-cycle management, countries can integrate existing public health and medical services to establish a comprehensive prevention and control system covering the whole life cycle of HBV infection prevention, screening, diagnosis, and treatment.[2,7] For example, the integration of the National Free Pre-Pregnancy Health Examination Project and the iPMTCT Program provides a unique opportunity and management platform to better achieve the goal of eliminating hepatitis B by 2030. Through this platform, we can recognize the HBV infection in reproductive women and their family members at risk in the early stages of the disease. The life-cycle management of HBV prevention and control could be implemented in positive families, that is, prevention and treatment management of HBV infection and disease is carried out from pre-pregnancy, during pregnancy, infanthood, childhood, adolescent, child-bearing age, and old age, to achieve the goal of reducing the incidence and mortality of hepatitis B infection, and contribute to China's achievement goal of eliminating the public health threat posed by hepatitis B by 2030. Funding This study was supported by grants from the National Natural Science Foundation of China (Nos. 71874003, 72122001, and 71934002). Conflicts of interest None.

Roles of Toll-like Receptor 3 in Intrauterine Transmission of Hepatitis B Virus in Mothers with High Viral Load

Backgrounds: Despite passive and active immunization, perinatal mother-to-infant transmission (MTIT) of hepatitis B virus (HBV) still occurs in women with high levels of viremia. Thus, understanding the mechanisms of MTIT is essential to prevent MTIT. The aims of this study were to clarify the roles of toll-like receptor 3 (TLR3) in the prevention of hepatitis B transmission in mothers with a high viral load. Methods: Placental samples were collected from 87 HBV-positive pregnant women and 25 normal pregnant women. Choriocarcinoma JEG-3 cell lines were exposed to different HBV viral loads to mimic the trophoblast barrier affected by HBV in the placenta. The mRNA and protein expression levels of TLR3 were analyzed by qRT-PCR and western blotting assays in placenta and JEG-3 cells, respectively. Results: In terms of mRNA and protein expression, the expression of TLR3 in the placenta among the control, low viral load, medium viral load and high viral load groups were significantly different, showing significant upregulation in the medium load and high load groups compared with the control; TLR3 expression in the placenta of the HBeAg-positive group was higher than that in the HBeAg-negative group, and TLR3 expression in the placenta of the infant-infected group was lower than that of the infant-noninfected group. Expression of TLR3 was gradually increased in JEG-3 cells exposed to low HBV viral loads or with shortterm HBV exposure and was decreased in JEG-3 cells exposed to high HBV viral loads or with longterm HBV exposure. Conclusions: TLR3 contribute to HBV intrauterine infection in mothers with a high viral load and, importantly, prevents mother-to-infant transmission.

1144. Prevention of Mother-to-Child Transmission of Hepatitis B at UNC Hospitals

BackgroundHepatitis B virus (HBV) contributes to liver-related morbidity and mortality on a global scale. In mothers with active hepatitis B, up to 100% of mother-to-child-transmission (MTCT) is preventable. Guidelines from the American Association for the Study of Liver Diseases (AASLD) recommend that HBV vaccination and hepatitis B immunoglobulin (HBIG) be given to HBV-exposed infants in a timely manner to prevent up to 90% of MTCT. Additionally, AASLD guidelines recommend that women with high-risk HBV (those with viral load >200,000 IU/mL and/or HBV e antigen [HBeAg] positivity) receive tenofovir prophylaxis to further prevent MTCT. In this chart review, we compared UNC Hospital’s prevention of MTCT measures to standing AASLD guidelines.MethodsThis retrospective chart review included data from all HBV-positive mothers giving birth at UNC Hospitals from April 1, 2014 through December 31, 2019. We investigated the HBV status of mothers, time to neonatal HBV vaccination, time to HBIG administration, maternal HBV viral load, maternal HBeAg status, and whether tenofovir was provided for high-risk mothers. Data was then compared to AASLD guidelines distributed in January 2017.ResultsWe identified 99 HBV-positive pregnant women over a five-year period. The rate of timely administration of HBIG was 99%. The rate of timely hepatitis B vaccination was 97%. The single neonate who did not receive the HBV vaccination within 12 hours was born to a mother whose HBV testing was initially positive but confirmatory testing was negative. Most (65%) women had documented HBV viral load and 75% of women had HBeAg studies. Nine women were identified as high-risk, with only one not receiving tenofovir.ConclusionUNC Hospitals were compliant with AASLD guidelines regarding timely neonatal vaccination, providing nearly 99% of neonates with timely HBIG and all but three neonates with timely HBV vaccine. The majority of high-risk women identified received tenofovir prophylaxis. However, there is room for improvement in laboratory evaluation to identify other high-risk women. While initial data is reassuring, quality improvement measures include improving testing rate to determine risk status for HBV-positive mothers and further investigation of appropriate follow-up testing for both mothers and children.Disclosures All Authors: No reported disclosures

Maternal HBsAg carriers and pregnancy outcomes: a retrospective cohort analysis of 85,190 pregnancies

BackgroundNowadays, a positive HBV carrier status is common among pregnant women, especially in endemic areas (such as China), little is known about the impact of maternal HBV infection on the risk of adverse pregnancy outcomes. Pregnant women with HBV infection often develop obstetric complications, such as pregnancy-induced hypertension (PIH) syndrome, postpartum hemorrhage, and gestational diabetes mellitus (GDM), and their infants often exhibit neonatal complications.MethodsThis study undertook a retrospective cohort analysis to explore the association of HBV carrier status with adverse pregnancy outcomes. A cohort of 85,190 women including 9699 HBsAg-positive and 73,076 HBsAg-negative pregnancies was retrospectively analyzed.ResultsIt’s found that HBsAg-positive pregnancies may result in higher risk of various maternal outcomes such as ICP (OR 3.4,95%CI 2.80 to 4.13), postpartum hemorrhage (OR 1.16,95%CI 1.00 to 1.34). Interestingly, there was a decreased risk of Preeclampsia (OR 0.91,95%CI 0.87 to 0.96), premature rupture of membrane (OR 0.91,95%CI 0.87 to 0.96) and gestational hypertension (OR 0.828,95%CI 0.701 to 0.978). And in vaginal delivery subgroup analysis, It’s found that the HBsAg-positive group had a higher risk of placental abruption (OR, 1.44; 95% CI, 1.16–1.79).ConclusionsThe present results suggest that compared with HBV positive pregnancies were more likely to be ICP and postpartum hemorrhage. HBV-positive pregnant women underwent vaginal delivery were more likely to have placental abruption and premature birth compared with HBV-negative women. Obstetricians should be aware of ICP, postpartum hemorrhage, placental abruption and premature birth in HBV-positive pregnant women.

Cesarean section in reducing mother-to-child HBV transmission: a meta-analysis

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.

Effectiveness of tenofovir or telbivudine in preventing HBV vertical transmission for pregnancy.

To evaluate the efficacy and safety of telbivudine (LdT) and tenofovir (TDF) for preventing hepatitis B virus (HBV) vertical transmission for HBV-positive pregnant women.Pregnant women (n = 145) from January 2013 to June 2017 were enrolled when they met inclusion criteria, which included HBV DNA ≥1.0 × 107 copies/mL and increased alanine aminotransferase (ALT) levels. Groups A (n = 58) and B (n = 51) were treated with LdT and TDF, respectively. Group C (n = 36) received no antiviral treatment. All infants were vaccinated with hepatitis B immunoglobulin and HBV vaccine. Vertical transmission of HBV was indicated by the presence of hepatitis B surface antigen (HBsAg) in infants 6 months and 12 months after birth.There is no difference of clinical characteristics of patients among the 3 groups. Serum HBV DNA levels of the 3 groups were similar at baseline (Group A vs. Group B vs. Group C, 7.88 ± 0.65 vs. 7.91 ± 0.75 vs. 7.69 ± 0.53 P = .25). In addition, the after anti-HBV treatment in Groups A and B were significantly decreased. Also, the serum HBV DNA levels in both Groups A and B were lower than that of Group C (P < .01, both). The HBV infection rate in Group A treated with LdT was not different from Group B treated with TDF. The dynamic changes of serum ALT level were similar. ALT levels were similar among the 3 Groups (P = .171), while there is statistically significant difference between A and C, and between B and C before delivery (P < .01). For the infants, there were no significant differences among body weight, height, head circumference, or Apgar score. However, the HBsAg positivity rates of infants in Groups A, B, C at postpartum 24 weeks and 48 weeks was 0%, 0%, and 11.1%, respectively (P < .001).Administration of LdT or TDF to HBV-infected mothers are effective and safe to block mother-to-infant HBV transmission.

Hepatitis B Infection among Parturient Women in Peri-Urban Ghana.

Global evidence suggests that hepatitis B viral (HBV) infection is endemic in Africa and perinatal transmission remains one of the most important modes of HBV transmission in this area. This cross-sectional survey examined the seroprevalence and knowledge of hepatitis B among pregnant women attending antenatal clinic (ANC) in a mission hospital in Ghana. Systematic sampling technique was used to recruit 196 pregnant women. The level of statistical significance was set at 0.05 alpha level. The hepatitis B prevalence estimate (hepatitis B surface antigen) was 10.2% (N = 20) and all of the participants were aware of HBV infection. Majority cited media (radio) as their main source of information. Approximately 86% of the participants (N = 168) associated HBV infection with a curse and 88.8% (N = 174) indicated witches and wizards as possible causes of the infection. Those with higher level of school education had high hepatitis B knowledge score (P < 0.01). Implementation of a health education program on the route of hepatitis B transmission is required in the study setting. Also, inclusion of hepatitis B education as part of ANC activities will enable HBV-positive pregnant women to appreciate the need for hepatitis B vaccination of their newborns at birth.

Capture-Recapture: Using Existing Data Sources to Improve Perinatal Hepatitis B Surveillance, Philadelphia, 2008-2014.

The objective of this study was to describe the capture-recapture method used by the Philadelphia Department of Public Health to enhance surveillance of perinatal hepatitis B virus (HBV), report on results and limitations of the process, and determine why some HBV-positive mother-infant pairs were not initially identified by Philadelphia's Perinatal Hepatitis B Prevention Program (PHBPP). We performed capture-recapture retrospectively for births in 2008 and 2009 in Philadelphia and prospectively for births from 2010 to 2014 by independently matching annual birth certificate data to PHBPP and HBV surveillance data. We compared the number of HBV-positive mother-infant pairs identified each year to the point estimates and lower-limit estimates calculated by the Centers for Disease Control and Prevention for the Philadelphia PHBPP. Of 156 605 pregnancy outcomes identified between 2008 and 2014, we found 1549 HBV-positive mother-infant pairs. Of 705 pairs that were initially determined, 358 (50.7%) were confirmed to be previously unidentified HBV-positive pairs. Reasons for failing to identify these mother-infant pairs prior to capture-recapture included internal administrative issues (n = 191, 53.4%), HBV testing and reporting issues (n = 92, 25.7%), and being lost to follow-up (n = 75, 20.9%). Each year that capture-recapture was used, the number of pairs identified by the Philadelphia PHBPP exceeded the Centers for Disease Control and Prevention's lower-limit estimates for HBV-positive mother-infant pairs. Capture-recapture was useful for identifying HBV-positive pregnant women for Philadelphia's PHBPP and for highlighting inadequacies in health department protocols and HBV testing during pregnancy. Other health departments with access to similar data sources and staff members with the necessary technical skills can adapt this method.

Management of pregnancy in women with chronic hepatitis B - literature review and the experience of “Prof. Dr. Panait Sîrbu” Clinical Hospital of Obstetrics and Gynecology, Bucharest

The management of hepatitis B virus (HBV) during pregnancy remains a challenge and involves various aspects of maternal-fetal care. Our objective is to provide a comprehensive review of the current knowledge regarding pregnancy and HBV infection, as well as recent efforts to reduce the rate of mother-to-child transmission (MTCT). We also present the 2016 clinical experience with HBV positive patients. We analysed data from 43 HBV positive pregnancies, resulting in 44 live childbirths, in “Panait Sîrbu” Hospital during 2016. A literature review was also conducted examining recent studies devoted to the clinical, therapeutic, and prognostic aspects of HBV infection during pregnancy in order to extrapolate and interpret data that can help physicians in the management of HBV infection in this setting. In our study group, the mean maternal age was 30 (± 7) and the majority were primiparous. Caesarean section was the birth method in 39 (93%) of the cases, with 36 (83.7%) being born at term. In 7 cases (16.2%) spontaneous membrane rupture occurred. All the newborns received active immunoprophylaxis (HBV vaccine) and 38 (88.3%) also received passive immunoprophylaxis consisting in the administration of hepatitis B immune globulin (HBIG). Testing for HBV is recommended in every pregnancy, regardless of previous testing or vaccination. The identification of HBV-positive pregnant women remains the most effective way to prevent HBV transmission to new-borns, combined with passive and active prophylaxis at birth. Breastfeeding is not contraindicated for HBV patients, but it is not recommended for women taking antiviral drugs. Finally, there is no clear evidence that elective caesarean section reduces the risk of mother-to-child transmission compared to vaginal delivery.

Involvement of viperin in prevention of intrauterine transmission of hepatitis B virus.

The aim of this study was to explore the role of viperin in the prevention of intrauterine infection of hepatitis B virus (HBV). Placental samples were collected from seven HBV-positive pregnant women with their infants infected via intrauterine transmission (infected group), 30 HBV-positive women with non-infected infants (non-infected group), and 30 HBV-negative women (controls). The expression of viperin in placenta was analyzed with immunohistochemistry and Western blotting. The expression of viperin of placental trophoblast cell line Swan71 was determined after exposed to HBV. Viperin was localized to syncytiotrophoblast, and there was a significant difference in placental viperin levels among control, non-infected group and infected group (F = 12.824, p < 0.001). The expression of viperin was significantly higher in non-infected group than in control (p = 0.019) and in infected group (p < 0.001), and viperin expression was significantly lower in infected group than in control (p = 0.001). The exposure to HBV significantly increased the expression of viperin in Swan 71 (p < 0.001). Exposure to HBV up-regulates viperin expression in vivo and in vitro in placental trophoblast, and lack of this up-regulation is associated with intrauterine transmission of HBV.

PTU-115 Hepatitis B in Pregnancy: what Happens to the Infants?

IntroductionAntenatal screening for Hepatitis B (HBV) has been offered to all pregnant women in the UK since 2000. Immunoprophylaxis of infants is essential to reduce the risk of vertical transmission....

The survey about health knowledge condition in HBV-positive pregnant women

Objective To investigate the HBV- positive pregnant women about the knowledge of the route of hepatitis B transmission, hepatitis B hazards, health care during pregnancy, announcements of child- care to explore targeted and effective health education model with self- designed question-naires. Methods Nurses in obstetrics department carried out this questionnaire investigation in the outpa-tients of HBV- positive pregnant women, after that the results underwent statistic analysis. Results The overall knowledge of HBV- positive pregnant women in announcements of child- care, health care during pregnancy and hepatitis B hazards was not very well, and the announcements of child- care was the lowest, followed by health care during pregnancy and hepatitis B hazards. The route of hepatitis B transmission was better, but still not satisfactory. The education should highlight these areas. Well- educated women were better than those who lack education. The age between 20 to 30 years old was better. Conclusions The HBV-positive pregnant women is lack of heath knowledge, so we should gave health intervention in a multi- level, multi- stage standardized and a variety of ways. Key words: HBV; Pregnant women; Health requirement; Health education; Health investigation