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Z Gastroenterol 2022; 60(02): 241-244
DOI: 10.1055/a-1742-4795
DOI: 10.1055/a-1742-4795
Mitteilungen der DGVS
Stellungnahme der DGVS und der DGIM zum Zeitpunkt des Screenings auf Hepatitis B gemäß Mutterschafts-Richtlinien (Mu-RL)
In Deutschland wurde 1994 ein generelles HBsAg-Screening in die Mutterschafts-Richtlinien (Mu-RL) aufgenommen. Diese sieht derzeit vor, bei allen Schwangeren nach der 32. Schwangerschaftswoche (SSW) bzw. möglichst nahe am Geburtstermin das Blut auf HBsAG zu untersuchen. Bereits im Juni 2019 hatte die DGVS in einer initiativen Stellungnahme den GBA aufgefordert den Zeitpunkt des Screenings zu überprüfen, da inzwischen antivirale Therapien für infizierte Mütter zur Verfügung stehen. Aufgrund des Screenings auf HBsAg nach der 32. SSW werden Mütter mit einer Indikation für eine antivirale Therapie jedoch viel zu spät diagnostiziert. Durch eine Bestimmung des HBsAG zu Beginn der Schwangerschaft (oder spätestens in der 12. SSW) kann die infizierte Mutter rechtzeitig einem Experten zugewiesen, therapiert und eine Infektion des Neugeborenen verhindert werden.
Publication History
Article published online:
11 February 2022
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Literatur
- 1 Brown RS, McMahon BJ, Lok ASF. et al. Antiviral therapy in chronic hepatitis B viral infection during pregnancy: A systematic review and meta-analysis. Hepatology 2016; 63: 319-333 DOI: 10.1002/hep.28302.
- 2 Li W, Jia L, Zhao X. et al. Efficacy and safety of tenofovir in preventing mother-to-infant transmission of hepatitis B virus: A meta-analysis based on 6 studies from China and 3 studies from other countries. BMC Gastroenterology 2018; 18 DOI: 10.1186/s12876-018-0847-2.
- 3 Hyun MH, Lee YS, Kim JH. et al. Systematic review with meta-analysis: the efficacy and safety of tenofovir to prevent mother-to-child transmission of hepatitis B virus. Alimentary Pharmacology and Therapeutics 2017; 45: 1493-505 DOI: 10.1111/apt.14068.
- 4 Pan CQ, Duan Z, Dai E. et al. Tenofovir to prevent hepatitis B transmission in mothers with high viral load. New England Journal of Medicine 2016; 374: 2324-2334 DOI: 10.1056/NEJMoa1508660.
- 5 European Association for the Study of the Liver (EASL). EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. Journal of Hepatology 2017; 67: 370-398 DOI: 10.1016/j.jhep.2017.03.021.
- 6 Terrault NA, Bzowej NH, Chang K-M. et al. AASLD Guidelines for Treatment of Chronic Hepatitis B. Hepatology 2016; 63: 261-283 DOI: 10.1002/hep.28156/suppinfo.
- 7 World Health Organization. Prevention of mother-to-child transmission of hepatitis B virus: Guidelines on antiviral prophylaxis in pregnancy. Geneva: World Health Organization; 2020 Licence: CC BY-NC-SA 3.0 IGO
- 8 Marcellin P, Heathcote EJ, Buti M. et al. Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B. N Engl J Med 2008; 359: 2442-2455 DOI: 10.1056/NEJMoa0802878.
- 9 Ständige Impfkommission: Empfehlungen der Ständigen Impfkommission (STIKO) beim Robert Koch-Institut 2021. Epid Bull 2021; 34: 3-63 DOI: 10.25646/8824.
- 10 Lin Y, Liu Y, Ding G. et al. Efficacy of tenofovir in preventing perinatal transmission of HBV infection in pregnant women with high viral loads. Scientific Reports 2018; 8 DOI: 10.1038/s41598-018-33833-w.
- 11 Chen JZJQ, Liao ZW, Huang FL. et al. Efficacy and safety of tenofovir disoproxil fumarate in preventing vertical transmission of hepatitis B in pregnancies with high viral load. Scientific Reports 2017; 7 DOI: 10.1038/s41598-017-04479-x.
- 12 Jourdain G, Ngo-Giang-Huong N, Harrison L. et al. Tenofovir versus Placebo to Prevent Perinatal Transmission of Hepatitis B. New England Journal of Medicine 2018; 378: 911-923 DOI: 10.1056/nejmoa1708131.
- 13 Yang M, Qin Q, Fang Q. et al. Cesarean section to prevent mother-to-child transmission of hepatitis B virus in China: A meta-analysis. BMC Pregnancy and Childbirth 2017; 17: 303 DOI: 10.1186/s12884-017-1487-1.
- 14 Chen HL, Cai JY, Song YP. et al. Vaginal delivery and HBV mother to child transmission risk after immunoprophylaxis: A systematic review and a meta-analysis. Midwifery 2019; 74: 116-125 DOI: 10.1016/j.midw.2019.03.024.
- 15 Pan CQ, Zou HB, Chen Y. et al. Cesarean section reduces perinatal transmission of hepatitis B virus infection from hepatitis b surface antigen-positive women to their infants. Clinical Gastroenterology and Hepatology 2013; 11: 1349-1355 DOI: 10.1016/j.cgh.2013.04.026.
- 16 Hou J, Wang G, Wang F. et al. Guideline of Prevention and Treatment for Chronic Hepatitis B (2015 Update). Journal of Clinical and Translational Hepatology 2017; 5: 297-318 DOI: 10.14218/JCTH.2016.00019.
- 17 Hou J, Cui F, Ding Y. et al. Management Algorithm for Interrupting Mother-to-Child Transmission of Hepatitis B Virus. Clinical Gastroenterology and Hepatology 2019; 17: 1929-1936.e1 DOI: 10.1016/j.cgh.2018.10.007.
- 18 Ehrhardt S, Xie C, Guo N. et al. Breastfeeding while taking lamivudine or tenofovir disoproxil fumarate: A review of the evidence. Clinical Infectious Diseases 2015; 60: 275-278 DOI: 10.1093/cid/ciu798.
- 19 Hu X, Wang L, Xu F. Guides concerning tenofovir exposure via breastfeeding: A comparison of drug dosages by developmental stage. International Journal of Infectious Diseases 2019; 87: 8-12 DOI: 10.1016/j.ijid.2019.07.023.
- 20 Mofenson LM, Baggaley RC, Mameletzis I. Tenofovir disoproxil fumarate safety for women and their infants during pregnancy and breastfeeding. Aids 2017; 31: 213-232 DOI: 10.1097/QAD.0000000000001313.
- 21 Mugwanya KK, John-Stewart G, Baeten J. Safety of oral tenofovir disoproxil fumarate-based HIV pre-exposure prophylaxis use in lactating HIV-uninfected women. Expert Opinion on Drug Safety 2017; 16: 867-871 DOI: 10.1080/14740338.2017.1338271.
- 22 Wen W-H, Chen H-L, Shih TT-F. et al. Long-term growth and bone development in children of HBV-infected mothers with and without fetal exposure to tenofovir disoproxil fumarate. J Hepatol 2020; 72: 1082-1087 DOI: 10.1016/j.jhep.2020.01.021.
- 23 Wang M, Bian Q, Zhu Y. et al. Real-world study of tenofovir disoproxil fumarate to prevent hepatitis B transmission in mothers with high viral load. Alimentary Pharmacology and Therapeutics 2019; 49: 211-217 DOI: 10.1111/apt.15064.