Prevention of Vertical Hepatitis B Transmission by Hepatitis B Immunoglobulin in the Third Trimester of Pregnancy

Abstract

Passive-active immunoprophylaxis with hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine provides a high level of protection against vertical transmission of hepatitis B virus (HBV). Nevertheless, 1 in 10 children of HBV carriers have chronic hepatitis B early in their lives despite immunoprophylaxis because they were infected in utero. This study of 469 pregnant women testing positive for hepatitis B surface antigen (HbsAg) was conducted to learn whether giving HBIG to HBV carriers in the third trimester can prevent vertical transmission of the virus. Of the women entered into the study, all of whom were asymptomatic, 126 (group 1) tested positive for hepatitis B e antigen (HbeAg), while 343 (group 2) did not. HBIG was given intramuscularly in a dose of 200 IU at 28, 32, and 36 weeks of pregnancy. All newborn infants received 100 IU of HBIG within 12 hours of birth as well as the first of 3 doses of hepatitis B vaccine (the subsequent doses were given at ages 1 and 6 months).In group 1, 16% of infants whose mothers received HBIG in the third trimester tested positive for HbsAg at birth and 7% at age 6 months. The respective figures for infants whose mothers were not treated were significantly higher at 39% and 23%. No such treatment-related difference was observed in group 2 infants. At age 6 months, rates of protective levels of anti-Hbs antibody were 32% in group 1 infants whose mothers were HbeAg-positive and 56% in group 2 infants when the mothers had not received HBIG while pregnant. The respective figures for infants whose mothers were treated in the third trimester were 76% and 89%. Neither mothers nor their infants experienced adverse effects related to the administration of HBIG or hepatitis B vaccine.The investigators conclude that, if all HbsAg-positive pregnant women, regardless of HbeAg status, were to receive HBIG in the last weeks of pregnancy, their infants would be better protected against chronic HBV infection. ABSTRACTFetal karyotyping of cells obtained by amniocentesis may take as long as 3 weeks, and many pregnant women experience anxiety during the interval. This randomized, controlled study evaluated 2 tactics for lessening anxiety: issuing karyotyping results on a prespecified date rather than when they become available and presenting early results Preconception and Prenatal Care 495 496 Obstetrical and Gynecological Survey ABSTRACTAbout 1 in 4 primary cesarean deliveries take place during the second stage of labor. Not only is second-stage surgery technically more difficult, but the fetus is at risk of hypoxia-related morbidity. This prospective observational study of primary cesarean deliveries was carried out at 13 university centers that make up the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Of 11,981 primary cesarean deliveries, 9265 were done in the first and 2716 in the second stage of labor. Women in the latter group were likely to be older, nulliparous, and white, and they had a smaller body mass index at the time of del...

The Follow-up of HBsAg Carrier Pregnant Women and Their Infants: Evaluation of the Clinical Results of a “Patient follow-up and Treatment Algorithm”

“…Pek çok çalışmada immünopro-filaksi başarısızlığı için en önemli risk faktörleri, annenin HBeAg pozitifliği ve yüksek HBV DNA düzeyi olarak bulunmuştur (4,12,13,15,(17)(18)(19)21,26,31) . Wang ve ark.…”

“…Gebelik döneminde HBV DNA seviyeleri yüksek gebelerde nükleozid analogları (NA) kullanılmasının viral yükü azaltarak etkili olabileceği ve doğumda aşı ve HBIG uygulamasına ek olarak gebeliğin son trimesterinde lamivudin ve telbivudin tedavisinin güven-li olduğu ve intrauterin geçişi azalttığı saptanmıştır (12,13,22,31,34) . Perinatal bulaşın en önemli bulaş yollarından biri olduğu ülkemizde HBsAg taşı-yıcı gebelerin ve çocuklarının takipleriyle ilgili halen genel bir görüş ve yeterli bir çalışma olmadığından çeşitli aksaklıklar yaşanmaktadır.…”

Evaluation of Hepatitis B virus infection in pregnant women

“…The differences with other studies may be due to sample size, methods used and prevalence of HBV in that region. The world was divided into three separate groups regarding the prevalence of HBV [10] and our study showed HBsAg + was 5% which is in the moderate prevalence.…”

Treatment of special populations with chronic hepatitis B infection

“…To prevent vertical transmission, passive and active immunization of the neonates immediately after birth with HBIG and anti-HBV vaccine is used, especially in HBeAg + mothers with high viral load [85,86]. In these high viral load pregnant women (HBV-DNA >8log 10 copies/ml), HBIG has been administered monthly in the third trimester of the pregnancy, yielding better results [87,88]. Thus, even intrauterine/ transplacental transmission of HBV can be prevented, which is reported to reach 8% of the cases in women with high viral load and/or preterm labor [89].…”