分娩时间，膜破裂不影响HBV垂直传播风险

StephenW

                     Infectious Disease Advisor Contributing Writer              
January 21, 2019    Duration of Labor, Rupture of Membranes Do Not Effect HBV Vertical Transmission Risk                   Share this content:        

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                                  Investigators found that obstetric factors had no effect on the transmission of hepatits B to newborns.        
    The duration of labor and rupture of membranes do not impact the risk of hepatitis B virus vertical transmission in infants after standard hepatitis B vaccinations and hepatitis B virus immunoglobulin administration, according to a study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology.
Researchers in this prospective, multicenter, observational study evaluated the impact of membrane rupture and labor on the risk of hepatitis B vertical transmission between mother and infants born in Hong Kong between 2014 and 2016 (N=641). All women included in the final analysis had been identified as hepatitis B surface antigen (HBsAg) positive at their initial prenatal visit, were not on antiviral therapy, and carried their pregnancies to term.
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Mothers were regularly evaluated until delivery, and by 12 hours after birth, all infants were given 10 μg  of hepatitis B vaccine and 110 IU hepatitis B immunoglobulin, with the same dose of hepatitis B vaccine repeated at months 1 and 6. Durations of labor, rupture of membranes, and mode of delivery were collected, and primary outcome was immunoprophylaxis failure, defined as positive HBsAg status for infants at 9 to 12 months.
No statistically significant difference in duration of labor, duration of rupture of membranes, mode of delivery, gestational age at delivery, preterm rupture of membranes, preterm delivery, birth weight, gravida, or parity were found after the analyses of the 641 pregnancies (P >.05). Immunoprophylaxis failure occurred in only 1% of pregnancies and only in women with viral loads greater than 7 log10 IU/ml and 8 log10 IU/ml, but subgroup analysis still found no significant associations between duration of labor and duration of rupture of membranes and immunoprophylaxis failure.

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Study investigators concluded that “[a]fter standard immunization to newborn, prolonged duration of [rupture of membranes] and labour would not affect the rate of vertical transmission even in HBV women with high viral load.”
Reference
Cheung KW, Seto MTY, So PL, et al. The effect of rupture of membranes and labour on the risk of hepatitis B vertical transmission: prospective multicentre observational study [published online November 23, 2018]. Eur J Obstet Gynecol Reprod Biol. doi: 10.1016/j.ejogrb.2018.11.017

StephenW

传染病顾问特约撰稿人
2019年1月21日
分娩时间，膜破裂不影响HBV垂直传播风险
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研究人员发现，产科因素对新生儿肝脏B的传播没有影响。研究人员发现，产科因素对新生儿肝脏B的传播没有影响。

根据发表在“欧洲妇产科和生殖生物学杂志”上的一项研究，在标准乙型肝炎疫苗接种和乙型肝炎病毒免疫球蛋白给药后，分娩时间和胎膜破裂不会影响婴儿乙型肝炎病毒垂直传播的风险。

这项前瞻性，多中心，观察性研究的研究人员评估了2014年至2016年间，在香港出生的母亲和婴儿之间，膜破裂和分娩对乙型肝炎垂直传播风险的影响（N = 641）。最终分析中包括的所有女性在初次产前检查时均被确定为乙型肝炎表面抗原（HBsAg）阳性，未进行抗病毒治疗，并将其怀孕至足月。

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定期对母亲进行评估直至分娩，并且在出生后12小时，所有婴儿均给予10μg乙型肝炎疫苗和110 IU乙型肝炎免疫球蛋白，并在第1和第6个月重复使用相同剂量的乙型肝炎疫苗。收集膜破裂和分娩方式，主要结果是免疫预防失败，定义为9至12个月婴儿的HBsAg阳性。

在分析641例妊娠后，未发现分娩持续时间，分娩持续时间，分娩方式，分娩时胎龄，早产胎膜早产，出生体重，孕妇或胎次的统计学差异（P） > 0.05）。只有1％的妊娠发生免疫预防失败，仅在病毒载量大于7 log10 IU / ml和8 log10 IU / ml的女性中发生，但亚组分析仍未发现分娩时间与胎膜破裂持续时间和免疫预防之间无显着相关性失败。

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研究调查人员得出结论：“对新生儿进行标准免疫接种，延长[胎膜破裂]和分娩持续时间，即使在病毒载量高的HBV女性中也不会影响垂直传播率。”

参考

Cheung KW，Seto MTY，So PL，et al。膜破裂和分娩对乙型肝炎垂直传播风险的影响：前瞻性多中心观察研究[2018年11月23日在线发表]。 Eur J Obstet Gynecol Reprod Biol。 doi：10.1016 / j.ejogrb.2018.11.017