在怀孕管理乙肝病毒

StephenW

Management of HBV in Pregnancy

    Erin Kelly, Marion G. Peters


Abstract

Hepatitis B in pregnancy must include diagnosis and management of the pregnant woman as well as modalities to decrease mother to child transmission (MTCT). MTCT remains the most important mode of hepatitis B virus (HBV) transmission, although effective strategies exist to reduce this risk. Universal screening for HBV can identify women with previously unrecognized infection and allow for targeted therapy to prevent MTCT. All children of HBV-infected mothers should receive passive active immunoprophylaxis with hepatitis B immune globulin (HBIG) and HBV vaccination within 12 h of birth. With such measures, the risk of transmission can be decreased to less than 1 % in women with low viral loads. Immunoprophylaxis failures occur in as many as 15 % of children born to mothers with high viral loads at the time of delivery (>6 log copies/ml or >200,000 IU/ml), and therefore, additional treatment in the third trimester is warranted in this group. Antiviral therapy with lamivudine, tenofovir, or telbivudine in the third trimester can decrease MTCT to less than 5 % and should be used in women with high viral loads in the third trimester. Postpartum flares of liver disease are common, and therefore, careful monitoring is warranted in women who stop therapy. The decision to breastfeed while on antiviral therapy should be individualized, but current evidence suggests that it is safe.
Keywords
Hepatitis B Pregnancy Breastfeeding

StephenW

乙肝病毒在怀孕管理

    艾琳·凯利，马里昂G.彼得斯


抽象的

在怀孕乙肝必须包括诊断孕妇和管理，以及模式，以降低母婴传播（母婴传播）。母婴传播仍然乙型肝炎病毒（HBV）传输的最重要的模式，虽然有效策略存在降低感染的风险。乙肝病毒普遍筛查可以识别妇女先前未确认的感染，并允许进行有针对性的治疗，以防止母婴传播。 HBV感染母亲的孩子应该接受出生12小时内与乙肝免疫球蛋白（HBIG）和乙肝疫苗被动主动免疫预防。通过这样的措施，传播的风险可以被减小到小于1％的妇女与低病毒载量。免疫预防故障发生在多达15％的生与高病毒载量的母亲的儿童在交货时间（> 6日志拷贝/ ml或> 200000国际单位/毫升），所以，在孕晚期附加治疗是必要的这一组。抗病毒治疗拉米夫定，替诺福韦，替比夫定或在孕晚期可以减少母婴传播至小于5％，应该在妇女与在孕晚期高病毒载量被使用。肝病产后耀斑是常见的，因此，仔细监测是必要的谁停止治疗的妇女。母乳喂养，而在抗病毒治疗的决定应个体化，但目前的证据表明，它是安全的。
关键词
乙肝妊娠哺乳