剖宫产和非母乳喂养在预防HBsAg和HBeAg阳性母亲的乙肝病毒母

StephenW

J Viral Hepat. 2020 May 3. doi: 10.1111/jvh.13314. [Epub ahead of print]
The role of cesarean section and non-breastfeeding in preventing mother-to-child transmission of hepatitis B virus in HBsAg and HBeAg positive mothers: results from a prospective cohort study and a meta-analysis.
Pan YC1, Jia ZF1, Wang YQ1, Yang N1, Liu JX2, Zhai XJ3, Song Y1, Wang C4, Li J5, Jiang J1.
Author information

1
    Division of Clinical Research, First Hospital of Jilin University, Changchun, China.
2
    Zhengzhou Municipal Center for Disease Control and Prevention, Zhengzhou, 450053, China.
3
    Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China.
4
    Department of Hepatology, First Hospital of Jilin University, Changchun, China.
5
    Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.

Abstract

The study aimed to assess whether cesarean section and non-breastfeeding can prevent mother-to-child transmission (MTCT) in HBsAg and HBeAg positive mothers via a cohort study and a meta-analysis. (1) Pregnant women who were positive for HBsAg and HBeAg and didn't receive antiviral treatment during pregnancy were recruited from the First Hospital of Jilin University, Maternal and Child Health Care Center of Jiangsu and Henan from August 2009 to June 2015. Infants received active and passive immunity. (2) In addition, a systematic literature search was performed in the PubMed, Embase, Cochrane, China National Knowledge Infrastructure, and Wanfang Chinese databases. The retrieval strategy was [("HBV" or "hepatitis b" or "hepatitis b virus") and ("mother-to-infant transmission" or "vertical transmission")]. Studies were screened and data were extracted. The fixed-effect model was used to analyse the studies. A total of 852 mothers and 857 newborns were enrolled. At the age of 7 months, 41 infants (4.78%) were positive for HBsAg. Multivariate analysis showed that mothers with higher HBV DNA levels (>108 IU/mL; RR=3.03, 95%CI: 1.41-6.52) were associated with an increased risk of infection. Although there was no statistical significance, cesarean section (RR=0.61) and non-breastfeeding (RR=0.88) showed a tendency to reduce the risk of infection. (2) A total of 5726 studies were identified. Together with our study, 13 were included in the analysis of delivery mode, and 12 were included in the analysis of feeding mode. The risk of infection in the cesarean section group was lower than that in the vaginal delivery group (RR=0.58, 95%CI: 0.46-0.74). In the analysis of feeding mode, the risk in the non-breastfeeding group was significantly lower (RR=0.74, 95%CI: 0.56-0.98). In conclusion, cesarean section and non-breastfeeding reduced the risk of MTCT in infants of HBsAg and HBeAg positive mothers who did not receive antiviral therapy during pregnancy.

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KEYWORDS:

Hepatitis B virus; delivery mode; feeding mode; mother-to-infant transmission

PMID:
    32362050
DOI:
    10.1111/jvh.13314

StephenW

J病毒性肝炎。 2020年5月3日。doi：10.1111 / jvh.13314。 [Epub提前发布]
剖宫产和非母乳喂养在预防HBsAg和HBeAg阳性母亲的乙肝病毒母婴传播中的作用：一项前瞻性队列研究和荟萃分析的结果。
潘YC1，贾ZF1，王YQ1，杨N1，刘JX2，翟XJ3，宋Y1，王C4，李J5，姜J1。
作者信息

1个
    吉林大学第一医院临床研究室，长春
2
    郑州市疾病预防控制中心，郑州450053
3
    江苏省疾病预防控制中心，江苏南京210009
4
    吉林大学第一医院肝病科，长春
5
    北京大学健康科学中心基础医学学院微生物学教研室，传染病中心，北京。

抽象

该研究旨在通过队列研究和荟萃分析评估剖宫产和不母乳喂养是否可以预防HBsAg和HBeAg阳性母亲的母婴传播（MTCT）。 （1）于2009年8月至2015年6月在吉林大学第一医院，江苏省和河南省妇幼保健中心接受HBsAg和HBeAg阳性且未接受抗病毒治疗的孕妇。主动和被动免疫。 （2）此外，在PubMed，Embase，Cochrane，中国国家知识基础设施和Wanfang中国数据库中进行了系统的文献检索。检索策略为[（“ HBV”或“ b肝炎”或“ b肝炎病毒”）和（“母婴传播”或“垂直传播”）。筛选研究并提取数据。固定效应模型用于分析研究。共有852名母亲和857名新生儿参加。在7个月大时，有41例婴儿（4.78％）的HBsAg阳性。多变量分析表明，HBV DNA水平较高（> 108 IU / mL； RR = 3.03，95％CI：1.41-6.52）的母亲感染风险增加。尽管无统计学意义，但剖宫产（RR = 0.61）和非母乳喂养（RR = 0.88）表现出降低感染风险的趋势。 （2）总共鉴定了5726项研究。与我们的研究一起，在分娩方式的分析中包括了13个，在进食方式的分析中包括了12个。剖宫产组的感染风险低于阴道分娩组（RR = 0.58，95％CI：0.46-0.74）。在喂养方式分析中，非母乳喂养组的风险显着降低（RR = 0.74，95％CI：0.56-0.98）。总之，剖宫产和非母乳喂养降低了在怀孕期间未接受抗病毒治疗的HBsAg和HBeAg阳性母亲的婴儿中MTCT的风险。

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关键字：

乙型肝炎病毒;投放方式；进料方式母婴传播

PMID：
    32362050
DOI：
    10.1111 / jvh.13314