免疫预防后阴道分娩和HBV母婴传播风险：系统评价和荟萃分

StephenW

Midwifery. 2019 Mar 30;74:116-125. doi: 10.1016/j.midw.2019.03.024. [Epub ahead of print]
Vaginal delivery and HBV mother to child transmission risk after immunoprophylaxis: A systematic review and a meta-analysis.
Chen HL1, Cai JY1, Song YP1, Zha ML1, Qin G2.
Author information

1
    Nantong University, Nantong, Jiangsu, PR China.
2
    Center for Liver Diseases, Nantong Third People's Hospital, Nantong University, Nantong, PR China. Electronic address: [email protected].

Abstract
OBJECTIVE:

HBV mother to child transmission (MTCT) can be prevented by passive and active immunoprophylaxis. In this study, we aim to assess whether vaginal delivery is safe for HBV MTCT after immunoprophylaxis.
MATERIAL AND METHODS:

PubMed and Web of Science were systematically searched. We compared the MTCT incidence of infants at 6 months or older between vaginal delivery and caesarean section. Serological HBV positive incidences for newborns at birth were also compared.
RESULTS:

Eighteen studies with 11,446 mother-child pairs were included in the meta-analysis. The average incidence of serological HBV positive for newborns at birth was 7.2% in the cesarean section group, and 16.6% in the vaginal delivery group. The summary odds ratio (OR) was 0.499 (95% CI 0.364-0.684; Z = 4.33, P < 0.00001) between two groups. However, the average incidences of MTCT were 3.3% and 4.1% for the cesarean section group and the vaginal delivery group, respectively. The summary OR compared between two groups was 0.790 (95% CI 0.614 to 1.016; Z = 1.83, P = 0.067). The funnel plot, Begg's Test (z = -0.55, P = 0.583) and Egger's test (t = -0.29, P = 0.777) suggested there was no publication bias among the included studies. Sensitive analyze showed the ORs were 0.764 (95% CI 0.490 to 1.192; Z = 1.19, P = 0.236), and 0.386 (95% CI 0.132 to 1.125; Z = 1.74, P = 0.0081), respectively.
CONCLUSION:

The vaginal delivery did not increase the HBV MTCT incidence after immunoprophylaxis at 6 months old or more. The existing evidence does not support the conclusion that caesarean section can prevent MTCT in HBsAg-positive mother after immunoprophylaxis. However, this conclusion should be cautious in the HBV mother with high viral load.

Copyright © 2019. Published by Elsevier Ltd.
KEYWORDS:

Caesarean section; Hepatitis B virus; Immunoprophylaxis; Mother-to-child transmission; Vaginal delivery

PMID:
    30953967
DOI:
    10.1016/j.midw.2019.03.024

StephenW

助产。 2019年3月30日; 74：116-125。 doi：10.1016 / j.midw.2019.03.024。 [印刷前的电子版]
免疫预防后阴道分娩和HBV母婴传播风险：系统评价和荟萃分析。
陈HL1，蔡JY1，宋YP1，Zha ML1，秦G2。
作者信息

1
    中国江苏省南通市南通大学。
2
    南通大学南通市第三人民医院肝病中心，中国南通。电子地址：[email protected]。

抽象
目的：

可通过被动和主动免疫预防来预防HBV母婴传播（MTCT）。在本研究中，我们的目的是评估免疫预防后阴道分娩对HBV MTCT是否安全。
材料与方法：

系统地搜索PubMed和Web of Science。我们比较了阴道分娩和剖腹产之间6个月或更大的婴儿的MTCT发病率。还比较了出生时新生儿的血清HBV阳性发病率。
结果：

荟萃分析纳入了18项研究，共有11,446对母子对。剖宫产组新生儿出生时血清HBV阳性率为7.2％，阴道分娩组为16.6％。两组之间的概率比值比（OR）为0.499（95％CI 0.364-0.684; Z = 4.33，P <0.00001）。然而，剖宫产组和阴道分娩组的平均MTCT发生率分别为3.3％和4.1％。两组之间的总结或比较为0.790（95％CI 0.614至1.016; Z = 1.83，P = 0.067）。漏斗图，Begg's Test（z = -0.55，P = 0.583）和Egger's检验（t = -0.29，P = 0.777）表明纳入的研究中没有发表偏倚。敏感性分析显示OR分别为0.764（95％CI 0.490至1.192; Z = 1.19，P = 0.236）和0.386（95％CI 0.132至1.125; Z = 1.74，P = 0.0081）。
结论：

在6个月或更长时间的免疫预防后，阴道分娩不会增加HBV MTCT发病率。现有证据不支持剖宫产术可以预防免疫预防后HBsAg阳性母亲MTCT的结论。然而，这个结论应该在具有高病毒载量的HBV母亲中保持谨慎。

版权所有©2019。由Elsevier Ltd.出版
关键词：

剖腹产;乙型肝炎病毒;免疫预防;母婴传播;阴道分娩

结论：
    30953967
DOI：
    10.1016 / j.midw.2019.03.024