剖宫产分娩对HBV母婴传播较少见

StephenW

Mother-to-child HBV transmission less common with cesarean section delivery
Pan CQ. Clin Gastroenterol Hepatol. 2013;11:1349-1355.

  

    September 26, 2013

Infants born to mothers with hepatitis B were less likely to contract the infection when delivered via cesarean section in a recent study.
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Researchers performed a retrospective analysis of data collected from 673 infants born by vaginal delivery (VD), 496 through elective cesarean section (ECS) and 240 through urgent cesarean section (UCS) to 1,401 hepatitis B surface antigen-positive (HBsAg) mothers. All infants received HBV immunization and were tested for HBsAg when aged 7 to 12 months. Among the mothers, 54.5% also were hepatitis B e antigen-positive (HBeAg) and 61.5% had detectable HBV DNA.

The mother-to-child transmission (MTCT) rate for chronic HBV across the entire cohort was 2.8%. No maternal or infant mortality occurred during the study.

All infants who developed infection were born to mothers who tested positive for HBsAg and HBeAg, and had HBV DNA levels of 6 log10 copies/mL before delivery.

Fewer infants in the ECS group (1.4%) developed HBV than in the VD (3.4%; P<.032 for comparison) or UCS groups (4.2%; P<.02). When the VD and UCS groups were combined for analysis, they displayed a greater rate of HBV than the ECS group (3.6% vs. 1.4%; P=.017).

Multivariate analysis indicated that delivery via VD or UCS was independently associated with increased MTCT risk (OR=4.29; 95% CI, 1.87-9.84). Subanalysis of infants born to HBeAg-positive mothers (n=365, VD group; n=273, ECS group; n=131, UCS group) also yielded a lower MTCT rate for infants born via ECS (2.6%) than those in the VD (6.3%, P=.027) or UCS groups (7.6%, P=.018), or in the non-ECS groups combined (6.7%; P=.015).

“Our study demonstrated that a significantly lower MTCT rate was observed in infants delivered by ECS when compared with the group of those delivered vaginally or by UCS,” the researchers wrote. “Compared with VD, ECS did not seem to have a higher rate of mortality or major complications during 1-year follow-up in both mothers and infants. We concluded that performing ECS only in highly viremic mothers with pre-delivery HBV DNA levels ≥1,000,000 copies/mL may be advisable.”

Disclosure: The researchers report no relevant financial disclosures.

StephenW

潘CQ 。临床胃肠肝脏病杂志。 2013 ， 11:1349-1355 。

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    2013年9月26日

乙肝母亲所生的婴儿是不太可能感染通过剖宫产，在最近的一项研究。
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研究人员进行了一项回顾性分析收集的数据通过经阴道分娩出生的673名婴儿（ VD ）通过选择性剖宫产（ ECS ） ，496和240紧急剖宫产（ UCS ） 1,401乙肝表面抗原阳性（ HBsAg）的母亲。所有婴儿接受乙肝免疫接种，并， HBsAg的年龄在7至12个月时进行了测试。其中，54.5％的母亲也分别为B型肝炎e抗原阳性（ HBeAg）阳性， 61.5％有可检测到HBV DNA 。

母亲传染给孩子（母婴传播）汇率为慢性HBV在整个队列为2.8％ 。在研究过程中没有发生产妇或婴儿死亡率。

检测HBsAg和HBeAg阳性母亲所生婴儿感染谁开发，分娩前6个log10拷贝/ ml的HBV DNA水平。

精英组的婴儿较少（1.4％）比在VD开发HBV （3.4％ ， P < .032比较）或UCS组（4.2％ ， P <0.02 ） 。当VD和UCS组结合进行分析，他们显示出更大的HBV率比精英组（ 3.6 ％对1.4 ％，P = .017 ） 。

多因素分析表明，送货VD或UCS是独立与母婴传播的风险增加（ OR = 4.29 ，95％CI ， 1.87-9.84 ） 。亚组分析婴儿出生HBeAg阳性的母亲（ N = 365， VD组，n = 273 ，精英组， UCS组N = 131 ）也产生了通过ECS （2.6％）比那些在婴儿出生的母婴传播率较低VD （6.3％ ，P = 0.027 ）或UCS组（7.6％ ，P = 0.018 ） ，或者在非ECS组组合（6.7 ％，P = 0.015 ） 。

“我们的研究表明，显着降低母婴传播率，观察组阴道分娩或通过UCS ECS婴儿相比， ”研究人员写道。 “与VD相比， ECS没有似乎在母亲和婴儿1年随访期间死亡或重大并发症率也较高。我们得出的结论是执行ECS只有在发货前HBV DNA水平≥ 100万拷贝/ ml可能是可取的高度病毒血症的母亲。 “

披露：研究人员报告没有相关财务披露。

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