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Prevention of Maternal to Child Transmission of HBV Infection

Prevention of Maternal to Child Transmission of HBV Infection

20 Aug 2021 10:56 11:08
Janus P Ong Speaker
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Mother-to-child transmission (MTCT) is the primary route of transmission of Hepatitis B in most endemic countries. The prevention of MTCT can thus lead to a decrease in Hepatitis B seroprevalence as well as Hepatitis B-related complications. Immunoprophylaxis with Hepatitis B vaccine and Hepatitis B Immune globulin (HBIG) can decrease perinatal transmission to less than 10%. Virologic factors that can lead to failure of immunoprophylaxis include maternal HBeAg positivity and high viral load. Breakthrough infection or immunoprophylaxis failure has been observed when the the HBeAg is positive or the HBV DNA levels are 200,000 IU/mL or higher. The use of antivirals, initially with lamivudine and telbivudine, in pregnancy have been shown to be effective and safe in preventing MTCT. More recently, tenofovir disoproxil fumarate (TDF) which has replaced the lamivudine and telbivudine as first line antiviral drug for Hepatitis B, has also been shown to be effective and safe in preventing MTCT. Most experts have recommended initiation of antiviral prophylaxis with TDF at around 28 weeks (24-32 weeks) for mothers with HBV DNA levels 200,000 IU/mL and continued until delivery or up to 12 weeks after delivery. Maternal Hepatitis B flares can be observed after discontinuation of antiviral prophylaxis although the risk is not significantly higher compared to those not receiving antiviral prophylaxis and the majority of the flares do not require antiviral therapy. Infant complications of fetal death, preterm birth, and congenital abnormalities were not higher in mothers receiving antiviral prophylaxis. The use of antiviral prophylaxis together with immunoprophylaxis with Hepatitis B vaccine and HBIG is recommended by all the major liver societies and by the WHO. This would contribute to the global efforts towards HBV elimination.

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