Skip to main content
Erschienen in: Current Hepatology Reports 4/2018

08.11.2018 | Hepatitis B (J Lim, Section Editor)

Update in the Management of Chronic Hepatitis B in Pregnancy

verfasst von: Kalyan Ram Bhamidimarri, Calvin Q. Pan

Erschienen in: Current Hepatology Reports | Ausgabe 4/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Vertical transmission accounts for almost half of the chronic hepatitis B infections worldwide. Therefore, management of HBV in pregnancy presents a unique opportunity for intervention, so that vertical transmission and overall HBV could be reduced. There is limited data on outcomes of acute HBV. There were several observational and prospective studies on effects of chronic HBV during pregnancy, modes of mother to child transmission (MTCT), role of obstetric interventions, indications for antiviral therapy during pregnancy which demonstrated variable findings. Our purpose is to summarize and update the data published in the recent years on the topic.

Recent Findings

Pregnant women with acute HBV had fewer symptoms but were prone to become chronic HBV carriers compared to non-pregnant women with acute HBV infection. HBV transmission could occur at any time during pregnancy via germ cell, intra-uterine, or peri-natal transmission. Avoidance of invasive procedures during pregnancy and elective Cesarean section have shown evidence in minimizing the risk of MTCT. Antiviral therapy during third trimester at 30–32 weeks of gestation in pregnant mothers with high viremia > 200,000 IU/mL was associated with significantly lowered risk of MTCT. Among lamivudine, telbivudine, and tenofovir that are considered safe during pregnancy, tenofovir is the preferred drug of choice due to higher resistance barrier and efficacy. Immuno-prophylaxis with HBIG and HBV vaccine is recommended within 12 hours after birth to all neonates born to HBV infected mothers.

Summary

The large global burden of chronic HBV could be reduced with judicious implementation of various steps and strategies during pregnancy. The review provides an update in the management of HBV infection during pregnancy that have demonstrated improved maternal and fetal outcomes. The endemicity rates are variable across various geographic regions, the highest seen in China and South East Asia where the HBV prevalence rate is 10–20% in women of child-bearing age in contrast to 0.4% in USA. Global elimination of HBV by 2030 has been taken up a target goal by several countries in the world and the crucial step is to reduce MTCT by implementing screening and treatment strategies in pregnant mothers. Current research is focused to eliminate cccDNA to achieve true viral cure of HBV.
Literatur
1.
Zurück zum Zitat Sirilert S, Traisrisilp K, Sirivatanapa P, Tongsong T. Pregnancy outcomes among chronic carriers of hepatitis B virus. Int J Gynaecol Obstet. 2014;126(2):106–10.PubMed Sirilert S, Traisrisilp K, Sirivatanapa P, Tongsong T. Pregnancy outcomes among chronic carriers of hepatitis B virus. Int J Gynaecol Obstet. 2014;126(2):106–10.PubMed
2.
Zurück zum Zitat Beasley RP, Trepo C, Stevens CE, Szmuness W. The e antigen and vertical transmission of hepatitis B surface antigen. Am J Epidemiol. 1977;105(2):94–8.PubMed Beasley RP, Trepo C, Stevens CE, Szmuness W. The e antigen and vertical transmission of hepatitis B surface antigen. Am J Epidemiol. 1977;105(2):94–8.PubMed
3.
Zurück zum Zitat Lee C, Gong Y, Brok J, Boxall EH, Gluud C. Hepatitis B immunisation for newborn infants of hepatitis B surface antigen-positive mothers. Cochrane Database Syst Rev. 2006;2:CD004790. Lee C, Gong Y, Brok J, Boxall EH, Gluud C. Hepatitis B immunisation for newborn infants of hepatitis B surface antigen-positive mothers. Cochrane Database Syst Rev. 2006;2:CD004790.
4.
Zurück zum Zitat Geneva. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection, 2015. Geneva. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection, 2015.
5.
Zurück zum Zitat Mast EE, Weinbaum CM, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep. 2006;55(RR-16):1–33 quiz CE31–34.PubMed Mast EE, Weinbaum CM, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep. 2006;55(RR-16):1–33 quiz CE31–34.PubMed
6.
Zurück zum Zitat • Brown RS Jr, McMahon BJ, Lok AS, et al. Antiviral therapy in chronic hepatitis B viral infection during pregnancy: a systematic review and meta-analysis. Hepatology. 2016;63(1):319–33 The review summarizes the pregnancy interventions especially in regards to antiviral therapy to prevent the risk of MTCT. PubMed • Brown RS Jr, McMahon BJ, Lok AS, et al. Antiviral therapy in chronic hepatitis B viral infection during pregnancy: a systematic review and meta-analysis. Hepatology. 2016;63(1):319–33 The review summarizes the pregnancy interventions especially in regards to antiviral therapy to prevent the risk of MTCT. PubMed
7.
Zurück zum Zitat European Association For The Study Of The L. EASL clinical practice guidelines: management of chronic hepatitis B virus infection. J Hepatol. 2012;57(1):167–85. European Association For The Study Of The L. EASL clinical practice guidelines: management of chronic hepatitis B virus infection. J Hepatol. 2012;57(1):167–85.
8.
Zurück zum Zitat •• Woodring J, Ishikawa N, Nagai M, et al. Integrating HIV, hepatitis B and syphilis screening and treatment through the maternal, newborn and child health platform to reach global elimination targets. West Pac Surveill Response J. 2017;8(4):1–5 The paper emphasizes the importance of screening for HBV in pregnant mothers. This is the first stept to identify and intervene in order to achieve global eradication of HBV in the future. •• Woodring J, Ishikawa N, Nagai M, et al. Integrating HIV, hepatitis B and syphilis screening and treatment through the maternal, newborn and child health platform to reach global elimination targets. West Pac Surveill Response J. 2017;8(4):1–5 The paper emphasizes the importance of screening for HBV in pregnant mothers. This is the first stept to identify and intervene in order to achieve global eradication of HBV in the future.
9.
Zurück zum Zitat Nayagam S, Thursz M, Sicuri E, Conteh L, Wiktor S, Low-Beer D, et al. Requirements for global elimination of hepatitis B: a modelling study. Lancet Infect Dis. 2016;16(12):1399–408.PubMed Nayagam S, Thursz M, Sicuri E, Conteh L, Wiktor S, Low-Beer D, et al. Requirements for global elimination of hepatitis B: a modelling study. Lancet Infect Dis. 2016;16(12):1399–408.PubMed
10.
Zurück zum Zitat Centers for Disease C, Prevention. Progress in hepatitis B prevention through universal infant vaccination--China, 1997-2006. MMWR Morb Mortal Wkly Rep. 2007;56(18):441–5. Centers for Disease C, Prevention. Progress in hepatitis B prevention through universal infant vaccination--China, 1997-2006. MMWR Morb Mortal Wkly Rep. 2007;56(18):441–5.
11.
Zurück zum Zitat Lu FM, Zhuang H. Management of hepatitis B in China. Chin Med J. 2009;122(1):3–4.PubMed Lu FM, Zhuang H. Management of hepatitis B in China. Chin Med J. 2009;122(1):3–4.PubMed
12.
Zurück zum Zitat Roberts H, Kruszon-Moran D, Ly KN, Hughes E, Iqbal K, Jiles RB, et al. Prevalence of chronic hepatitis B virus (HBV) infection in U.S. households: National Health and Nutrition Examination Survey (NHANES), 1988-2012. Hepatology. 2016;63(2):388–97.PubMed Roberts H, Kruszon-Moran D, Ly KN, Hughes E, Iqbal K, Jiles RB, et al. Prevalence of chronic hepatitis B virus (HBV) infection in U.S. households: National Health and Nutrition Examination Survey (NHANES), 1988-2012. Hepatology. 2016;63(2):388–97.PubMed
13.
Zurück zum Zitat Schillie S, Vellozzi C, Reingold A, Harris A, Haber P, Ward JW, et al. Prevention of hepatitis B virus infection in the United States: recommendations of the advisory committee on immunization practices. MMWR Recomm Rep. 2018;67(1):1–31.PubMedPubMedCentral Schillie S, Vellozzi C, Reingold A, Harris A, Haber P, Ward JW, et al. Prevention of hepatitis B virus infection in the United States: recommendations of the advisory committee on immunization practices. MMWR Recomm Rep. 2018;67(1):1–31.PubMedPubMedCentral
14.
Zurück zum Zitat Wasley A, Kruszon-Moran D, Kuhnert W, Simard EP, Finelli L, McQuillan G, et al. The prevalence of hepatitis B virus infection in the United States in the era of vaccination. J Infect Dis. 2010;202(2):192–201.PubMed Wasley A, Kruszon-Moran D, Kuhnert W, Simard EP, Finelli L, McQuillan G, et al. The prevalence of hepatitis B virus infection in the United States in the era of vaccination. J Infect Dis. 2010;202(2):192–201.PubMed
15.
Zurück zum Zitat Zibbell JE, Asher AK, Patel RC, Kupronis B, Iqbal K, Ward JW, et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am J Public Health. 2018;108(2):175–81.PubMedPubMedCentral Zibbell JE, Asher AK, Patel RC, Kupronis B, Iqbal K, Ward JW, et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am J Public Health. 2018;108(2):175–81.PubMedPubMedCentral
16.
Zurück zum Zitat Smith EA, Jacques-Carroll L, Walker TY, Sirotkin B, Murphy TV. The national perinatal hepatitis B prevention program, 1994-2008. Pediatrics. 2012;129(4):609–16.PubMed Smith EA, Jacques-Carroll L, Walker TY, Sirotkin B, Murphy TV. The national perinatal hepatitis B prevention program, 1994-2008. Pediatrics. 2012;129(4):609–16.PubMed
17.
Zurück zum Zitat Perumalswami PV, Factor SH, Kapelusznik L, Friedman SL, Pan CQ, Chang C, et al. Hepatitis outreach network: a practical strategy for hepatitis screening with linkage to care in foreign-born communities. J Hepatol. 2013;58(5):890–7.PubMed Perumalswami PV, Factor SH, Kapelusznik L, Friedman SL, Pan CQ, Chang C, et al. Hepatitis outreach network: a practical strategy for hepatitis screening with linkage to care in foreign-born communities. J Hepatol. 2013;58(5):890–7.PubMed
18.
Zurück zum Zitat Alter MJ. Epidemiology of hepatitis B in Europe and worldwide. J Hepatol. 2003;39(Suppl 1):S64–9.PubMed Alter MJ. Epidemiology of hepatitis B in Europe and worldwide. J Hepatol. 2003;39(Suppl 1):S64–9.PubMed
19.
Zurück zum Zitat Publicover J, Gaggar A, Nishimura S, van Horn CM, Goodsell A, Muench MO, et al. Age-dependent hepatic lymphoid organization directs successful immunity to hepatitis B. J Clin Invest. 2013;123(9):3728–39.PubMedPubMedCentral Publicover J, Gaggar A, Nishimura S, van Horn CM, Goodsell A, Muench MO, et al. Age-dependent hepatic lymphoid organization directs successful immunity to hepatitis B. J Clin Invest. 2013;123(9):3728–39.PubMedPubMedCentral
20.
Zurück zum Zitat Hadchouel M, Scotto J, Huret JL, Molinie C, Villa E, Degos F, et al. Presence of HBV DNA in spermatozoa: a possible vertical transmission of HBV via the germ line. J Med Virol. 1985;16(1):61–6.PubMed Hadchouel M, Scotto J, Huret JL, Molinie C, Villa E, Degos F, et al. Presence of HBV DNA in spermatozoa: a possible vertical transmission of HBV via the germ line. J Med Virol. 1985;16(1):61–6.PubMed
21.
Zurück zum Zitat Nie R, Jin L, Zhang H, Xu B, Chen W, Zhu G. Presence of hepatitis B virus in oocytes and embryos: a risk of hepatitis B virus transmission during in vitro fertilization. Fertil Steril. 2011;95(5):1667–71.PubMed Nie R, Jin L, Zhang H, Xu B, Chen W, Zhu G. Presence of hepatitis B virus in oocytes and embryos: a risk of hepatitis B virus transmission during in vitro fertilization. Fertil Steril. 2011;95(5):1667–71.PubMed
22.
Zurück zum Zitat Zhang RL, Chen QY, Xie JX, et al. Risk factors for paternal vertical transmission of hepatitis B virus. Zhonghua Fu Chan Ke Za Zhi. 2009;44(11):805–8.PubMed Zhang RL, Chen QY, Xie JX, et al. Risk factors for paternal vertical transmission of hepatitis B virus. Zhonghua Fu Chan Ke Za Zhi. 2009;44(11):805–8.PubMed
23.
Zurück zum Zitat Zhang SL, Yue YF, Bai GQ, Shi L, Jiang H. Mechanism of intrauterine infection of hepatitis B virus. World J Gastroenterol. 2004;10(3):437–8.PubMedPubMedCentral Zhang SL, Yue YF, Bai GQ, Shi L, Jiang H. Mechanism of intrauterine infection of hepatitis B virus. World J Gastroenterol. 2004;10(3):437–8.PubMedPubMedCentral
24.
Zurück zum Zitat Xu DZ, Yan YP, Choi BC, et al. Risk factors and mechanism of transplacental transmission of hepatitis B virus: a case-control study. J Med Virol. 2002;67(1):20–6.PubMed Xu DZ, Yan YP, Choi BC, et al. Risk factors and mechanism of transplacental transmission of hepatitis B virus: a case-control study. J Med Virol. 2002;67(1):20–6.PubMed
25.
Zurück zum Zitat Dienstag JL. Immunopathogenesis of the extrahepatic manifestations of hepatitis B virus infection. Springer Semin Immunopathol. 1981;3(4):461–72.PubMed Dienstag JL. Immunopathogenesis of the extrahepatic manifestations of hepatitis B virus infection. Springer Semin Immunopathol. 1981;3(4):461–72.PubMed
26.
Zurück zum Zitat Hyams KC. Risks of chronicity following acute hepatitis B virus infection: a review. Clin Infect Dis. 1995;20(4):992–1000.PubMed Hyams KC. Risks of chronicity following acute hepatitis B virus infection: a review. Clin Infect Dis. 1995;20(4):992–1000.PubMed
27.
Zurück zum Zitat Han YT, Sun C, Liu CX, Xie SS, Xiao D, Liu L, et al. Clinical features and outcome of acute hepatitis B in pregnancy. BMC Infect Dis. 2014;14:368.PubMedPubMedCentral Han YT, Sun C, Liu CX, Xie SS, Xiao D, Liu L, et al. Clinical features and outcome of acute hepatitis B in pregnancy. BMC Infect Dis. 2014;14:368.PubMedPubMedCentral
28.
Zurück zum Zitat Mohite BJ, Rath S, Bal V, Kamat SA, Marathe SN, Zuckerman AJ, et al. Mechanisms of liver cell damage in acute hepatitis B. J Med Virol. 1987;22(3):199–210.PubMed Mohite BJ, Rath S, Bal V, Kamat SA, Marathe SN, Zuckerman AJ, et al. Mechanisms of liver cell damage in acute hepatitis B. J Med Virol. 1987;22(3):199–210.PubMed
29.
Zurück zum Zitat Spencer SJ, Mouihate A, Galic MA, Pittman QJ. Central and peripheral neuroimmune responses: hyporesponsiveness during pregnancy. J Physiol. 2008;586(2):399–406.PubMed Spencer SJ, Mouihate A, Galic MA, Pittman QJ. Central and peripheral neuroimmune responses: hyporesponsiveness during pregnancy. J Physiol. 2008;586(2):399–406.PubMed
30.
Zurück zum Zitat European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L. EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370–98. European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L. EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370–98.
31.
Zurück zum Zitat • Tong MJ, Pan CQ, Han SB, et al. An expert consensus for the management of chronic hepatitis B in Asian Americans. Aliment Pharmacol Ther. 2018;47(11):1542–43 The expert consenus paper reports on various aspects of HBV in general population and also in specific populations including pregnant mothers. • Tong MJ, Pan CQ, Han SB, et al. An expert consensus for the management of chronic hepatitis B in Asian Americans. Aliment Pharmacol Ther. 2018;47(11):1542–43 The expert consenus paper reports on various aspects of HBV in general population and also in specific populations including pregnant mothers.
32.
Zurück zum Zitat • Afdhal NH, Bacon BR, Patel K, et al. Accuracy of fibroscan, compared with histology, in analysis of liver fibrosis in patients with hepatitis B or C: a United States multicenter study. Clin Gastroenterol Hepatol. 2015;13(4):772–9 e771-773. Assessment of liver fibrosis in HBV infected individuals is important and the paper reports the accuracy of fibroscan in liver fibrosis assessment in HBV and HCV infected subjects. PubMed • Afdhal NH, Bacon BR, Patel K, et al. Accuracy of fibroscan, compared with histology, in analysis of liver fibrosis in patients with hepatitis B or C: a United States multicenter study. Clin Gastroenterol Hepatol. 2015;13(4):772–9 e771-773. Assessment of liver fibrosis in HBV infected individuals is important and the paper reports the accuracy of fibroscan in liver fibrosis assessment in HBV and HCV infected subjects. PubMed
33.
Zurück zum Zitat Yi W, Pan CQ, Hao J, Hu Y, Liu M, Li L, et al. Risk of vertical transmission of hepatitis B after amniocentesis in HBs antigen-positive mothers. J Hepatol. 2014;60(3):523–9.PubMed Yi W, Pan CQ, Hao J, Hu Y, Liu M, Li L, et al. Risk of vertical transmission of hepatitis B after amniocentesis in HBs antigen-positive mothers. J Hepatol. 2014;60(3):523–9.PubMed
34.
Zurück zum Zitat •• Ghi T, Sotiriadis A, Calda P, et al. ISUOG practice guidelines: invasive procedures for prenatal diagnosis. Ultrasound Obstet Gynecol. 2016;48(2):256–68 Invasive procedures like amniocentesis, chorionic villous sampling could increase the risk of intra-uterine HBV transmission. The paper lists the risks of MTCT of HBV with obstetric practices. PubMed •• Ghi T, Sotiriadis A, Calda P, et al. ISUOG practice guidelines: invasive procedures for prenatal diagnosis. Ultrasound Obstet Gynecol. 2016;48(2):256–68 Invasive procedures like amniocentesis, chorionic villous sampling could increase the risk of intra-uterine HBV transmission. The paper lists the risks of MTCT of HBV with obstetric practices. PubMed
35.
Zurück zum Zitat Pan CQ, Duan ZP, Bhamidimarri KR, et al. An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clin Gastroenterol Hepatol. 2012;10(5):452–9.PubMed Pan CQ, Duan ZP, Bhamidimarri KR, et al. An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clin Gastroenterol Hepatol. 2012;10(5):452–9.PubMed
36.
Zurück zum Zitat Liu CP, Zeng YL, Zhou M, et al. Factors associated with mother-to-child transmission of hepatitis B virus despite immunoprophylaxis. Intern Med (Tokyo, Japan). 2015;54(7):711–6. Liu CP, Zeng YL, Zhou M, et al. Factors associated with mother-to-child transmission of hepatitis B virus despite immunoprophylaxis. Intern Med (Tokyo, Japan). 2015;54(7):711–6.
37.
Zurück zum Zitat Pan CQ, Zou H-B, Chen Y, Zhang X, Zhang H, Li J, et al. Cesarean section reduces perinatal transmission of hepatitis B virus infection from hepatitis B surface antigen–positive women to their infants. Clin Gastroenterol Hepatol. 2013;11(10):1349–55.PubMed Pan CQ, Zou H-B, Chen Y, Zhang X, Zhang H, Li J, et al. Cesarean section reduces perinatal transmission of hepatitis B virus infection from hepatitis B surface antigen–positive women to their infants. Clin Gastroenterol Hepatol. 2013;11(10):1349–55.PubMed
38.
Zurück zum Zitat Yang J, Zeng XM, Men YL, Zhao LS. Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus--a systematic review. Virol J. 2008;5:100.PubMedPubMedCentral Yang J, Zeng XM, Men YL, Zhao LS. Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus--a systematic review. Virol J. 2008;5:100.PubMedPubMedCentral
39.
Zurück zum Zitat Chang MS, Gavini S, Andrade PC, McNabb-Baltar J. Caesarean section to prevent transmission of hepatitis B: a meta-analysis. Can J Gastroenterol Hepatol. 2014;28(8):439–44.PubMedPubMedCentral Chang MS, Gavini S, Andrade PC, McNabb-Baltar J. Caesarean section to prevent transmission of hepatitis B: a meta-analysis. Can J Gastroenterol Hepatol. 2014;28(8):439–44.PubMedPubMedCentral
40.
Zurück zum Zitat • Liu J, Zhang S, Liu M, Wang Q, Shen H, Zhang Y. Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth: a population-based cohort study. Lancet Glob Health. 2017;5(6):e624–32 This large population cohort study of 489,965 patients demonstrated the risk of pre-term delivery in mothers infected with HBV vs those without HBV. PubMed • Liu J, Zhang S, Liu M, Wang Q, Shen H, Zhang Y. Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth: a population-based cohort study. Lancet Glob Health. 2017;5(6):e624–32 This large population cohort study of 489,965 patients demonstrated the risk of pre-term delivery in mothers infected with HBV vs those without HBV. PubMed
41.
Zurück zum Zitat Lao TT, Chan BC, Leung WC, Ho LF, Tse KY. Maternal hepatitis B infection and gestational diabetes mellitus. J Hepatol. 2007;47(1):46–50.PubMed Lao TT, Chan BC, Leung WC, Ho LF, Tse KY. Maternal hepatitis B infection and gestational diabetes mellitus. J Hepatol. 2007;47(1):46–50.PubMed
42.
Zurück zum Zitat • Tan J, Mao X, Zhang G, et al. Hepatitis B surface antigen positivity during pregnancy and risk of gestational diabetes mellitus: a systematic review and meta-analysis. J Viral Hepat. 2018;25(11):1372–83 The meta-anaysis reports the risk of GDM and pregnancy outcomes in HBsAg mothers. • Tan J, Mao X, Zhang G, et al. Hepatitis B surface antigen positivity during pregnancy and risk of gestational diabetes mellitus: a systematic review and meta-analysis. J Viral Hepat. 2018;25(11):1372–83 The meta-anaysis reports the risk of GDM and pregnancy outcomes in HBsAg mothers.
43.
Zurück zum Zitat Beasley RP, Hwang LY, Lee GC, et al. Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immune globulin and hepatitis B vaccine. Lancet. 1983;2(8359):1099–102.PubMed Beasley RP, Hwang LY, Lee GC, et al. Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immune globulin and hepatitis B vaccine. Lancet. 1983;2(8359):1099–102.PubMed
44.
Zurück zum Zitat Hu YH, Liu M, Yi W, Cao YJ, Cai HD. Tenofovir rescue therapy in pregnant females with chronic hepatitis B. World J Gastroenterol. 2015;21(8):2504–9.PubMedPubMedCentral Hu YH, Liu M, Yi W, Cao YJ, Cai HD. Tenofovir rescue therapy in pregnant females with chronic hepatitis B. World J Gastroenterol. 2015;21(8):2504–9.PubMedPubMedCentral
45.
Zurück zum Zitat Pan CQ, Han G, Wang Y. Prevention of peripartum hepatitis B transmission. N Engl J Med. 2016;375(15):1497–8.PubMed Pan CQ, Han G, Wang Y. Prevention of peripartum hepatitis B transmission. N Engl J Med. 2016;375(15):1497–8.PubMed
46.
Zurück zum Zitat • Park JS, Pan CQ. Viral factors for HBV mother-to-child transmission. Hepatol Int. 2017;11(6):476–80 The review identifies viral factors and particularly HBV DNA > 200,000 IU/mL as an important predictor for MTCT. PubMed • Park JS, Pan CQ. Viral factors for HBV mother-to-child transmission. Hepatol Int. 2017;11(6):476–80 The review identifies viral factors and particularly HBV DNA > 200,000 IU/mL as an important predictor for MTCT. PubMed
47.
Zurück zum Zitat Wen WH, Chang MH, Zhao LL, Ni YH, Hsu HY, Wu JF, et al. Mother-to-infant transmission of hepatitis B virus infection: significance of maternal viral load and strategies for intervention. J Hepatol. 2013;59(1):24–30.PubMed Wen WH, Chang MH, Zhao LL, Ni YH, Hsu HY, Wu JF, et al. Mother-to-infant transmission of hepatitis B virus infection: significance of maternal viral load and strategies for intervention. J Hepatol. 2013;59(1):24–30.PubMed
48.
Zurück zum Zitat Jackson S, Lentino J, Kopp J, Murray L, Ellison W, Rhee M, et al. Immunogenicity of a two-dose investigational hepatitis B vaccine, HBsAg-1018, using a toll-like receptor 9 agonist adjuvant compared with a licensed hepatitis B vaccine in adults. Vaccine. 2018;36(5):668–74.PubMed Jackson S, Lentino J, Kopp J, Murray L, Ellison W, Rhee M, et al. Immunogenicity of a two-dose investigational hepatitis B vaccine, HBsAg-1018, using a toll-like receptor 9 agonist adjuvant compared with a licensed hepatitis B vaccine in adults. Vaccine. 2018;36(5):668–74.PubMed
49.
Zurück zum Zitat • Hyer R, McGuire DK, Xing B, Jackson S, Janssen R. Safety of a two-dose investigational hepatitis B vaccine, HBsAg-1018, using a toll-like receptor 9 agonist adjuvant in adults. Vaccine. 2018;36(19):2604–11 The availability of two dose HBV vaccine administered 1 month apart could increase the vaccine adherence rates and thereby increase herd immunity in the population. PubMed • Hyer R, McGuire DK, Xing B, Jackson S, Janssen R. Safety of a two-dose investigational hepatitis B vaccine, HBsAg-1018, using a toll-like receptor 9 agonist adjuvant in adults. Vaccine. 2018;36(19):2604–11 The availability of two dose HBV vaccine administered 1 month apart could increase the vaccine adherence rates and thereby increase herd immunity in the population. PubMed
50.
Zurück zum Zitat Cheung KW, Seto MT, Lee CP. Mother-to-infant transmission of hepatitis B virus infection: significance of maternal viral load and strategies for intervention. J Hepatol. 2013;59(2):400.PubMed Cheung KW, Seto MT, Lee CP. Mother-to-infant transmission of hepatitis B virus infection: significance of maternal viral load and strategies for intervention. J Hepatol. 2013;59(2):400.PubMed
51.
Zurück zum Zitat Wiseman E, Fraser MA, Holden S, et al. Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust. 2009;190(9):489–92.PubMed Wiseman E, Fraser MA, Holden S, et al. Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust. 2009;190(9):489–92.PubMed
52.
Zurück zum Zitat Kubo A, Shlager L, Marks AR, Lakritz D, Beaumont C, Gabellini K, et al. Prevention of vertical transmission of hepatitis B: an observational study. Ann Intern Med. 2014;160(12):828–35.PubMedPubMedCentral Kubo A, Shlager L, Marks AR, Lakritz D, Beaumont C, Gabellini K, et al. Prevention of vertical transmission of hepatitis B: an observational study. Ann Intern Med. 2014;160(12):828–35.PubMedPubMedCentral
53.
Zurück zum Zitat Lu Y, Zhu FC, Liu JX, Zhai XJ, Chang ZJ, Yan L, et al. The maternal viral threshold for antiviral prophylaxis of perinatal hepatitis B virus transmission in settings with limited resources: a large prospective cohort study in China. Vaccine. 2017;35(48 Pt B):6627–33.PubMed Lu Y, Zhu FC, Liu JX, Zhai XJ, Chang ZJ, Yan L, et al. The maternal viral threshold for antiviral prophylaxis of perinatal hepatitis B virus transmission in settings with limited resources: a large prospective cohort study in China. Vaccine. 2017;35(48 Pt B):6627–33.PubMed
54.
Zurück zum Zitat Zou H, Chen Y, Duan Z, Zhang H, Pan C. Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg-positive mothers. J Viral Hepat. 2012;19(2):e18–25.PubMed Zou H, Chen Y, Duan Z, Zhang H, Pan C. Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg-positive mothers. J Viral Hepat. 2012;19(2):e18–25.PubMed
55.
Zurück zum Zitat •• Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560–99 This is an update from the AASLD HBV guidelines that is available on the AASLD website. The document provides practice guidelines for management of HBV in pregnancy. PubMedPubMedCentral •• Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560–99 This is an update from the AASLD HBV guidelines that is available on the AASLD website. The document provides practice guidelines for management of HBV in pregnancy. PubMedPubMedCentral
56.
Zurück zum Zitat Chan HL, Thompson A, Martinot-Peignoux M, et al. Hepatitis B surface antigen quantification: why and how to use it in 2011 - a core group report. J Hepatol. 2011;55(5):1121–31.PubMed Chan HL, Thompson A, Martinot-Peignoux M, et al. Hepatitis B surface antigen quantification: why and how to use it in 2011 - a core group report. J Hepatol. 2011;55(5):1121–31.PubMed
57.
Zurück zum Zitat Nguyen T, Thompson AJ, Bowden S, et al. Hepatitis B surface antigen levels during the natural history of chronic hepatitis B: a perspective on Asia. J Hepatol. 2010;52(4):508–13.PubMed Nguyen T, Thompson AJ, Bowden S, et al. Hepatitis B surface antigen levels during the natural history of chronic hepatitis B: a perspective on Asia. J Hepatol. 2010;52(4):508–13.PubMed
58.
Zurück zum Zitat • Belopolskaya M, Avrutin V, Firsov S, Yakovlev A. HBsAg level and hepatitis B viral load correlation with focus on pregnancy. Ann Gastroenterol. 2015;28(3):379–84 HBsAg titers are not widely used in practice but may help in identifying subjects with active disease despite low viremia levels. PubMedPubMedCentral • Belopolskaya M, Avrutin V, Firsov S, Yakovlev A. HBsAg level and hepatitis B viral load correlation with focus on pregnancy. Ann Gastroenterol. 2015;28(3):379–84 HBsAg titers are not widely used in practice but may help in identifying subjects with active disease despite low viremia levels. PubMedPubMedCentral
59.
Zurück zum Zitat •• The Antiretroviral Pregnancy Registry Interim Report, 2018. This updated report shows the current number of mothers exposed to lamivudine, adefovir, entecavir, telbivudine and tenofovir and the materno-fetal outcomes. In general although it is not robust data, the current knowledge is that the antiviral therapies do not pose significant threat to pregnancy outcomes. •• The Antiretroviral Pregnancy Registry Interim Report, 2018. This updated report shows the current number of mothers exposed to lamivudine, adefovir, entecavir, telbivudine and tenofovir and the materno-fetal outcomes. In general although it is not robust data, the current knowledge is that the antiviral therapies do not pose significant threat to pregnancy outcomes.
60.
Zurück zum Zitat Xu WM, Cui YT, Wang L, Yang H, Liang ZQ, Li XM, et al. Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study. J Viral Hepat. 2009;16(2):94–103.PubMed Xu WM, Cui YT, Wang L, Yang H, Liang ZQ, Li XM, et al. Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study. J Viral Hepat. 2009;16(2):94–103.PubMed
61.
Zurück zum Zitat Han GR, Jiang HX, Yue X, Ding Y, Wang CM, Wang GJ, et al. Efficacy and safety of telbivudine treatment: an open-label, prospective study in pregnant women for the prevention of perinatal transmission of hepatitis B virus infection. J Viral Hepat. 2015;22(9):754–62.PubMed Han GR, Jiang HX, Yue X, Ding Y, Wang CM, Wang GJ, et al. Efficacy and safety of telbivudine treatment: an open-label, prospective study in pregnant women for the prevention of perinatal transmission of hepatitis B virus infection. J Viral Hepat. 2015;22(9):754–62.PubMed
62.
Zurück zum Zitat •• Sheng Q, Ding Y, Li B, et al. Efficacy and safety of nucleos(t)ide analogues to prevent hepatitis B virus mother-to-child transmission in pregnant women with high viremia: real life practice from China. Int J Med Sci. 2018;15(8):796–801 In this real life study from China, talbivudine was used during pregnancy to prevent MTCT. However, two mothers had < 2 logs IU/mL decline after starting LdT and therefore had to be switched to TDF which shows the real life limitation of LdT resistance in the population. PubMedPubMedCentral •• Sheng Q, Ding Y, Li B, et al. Efficacy and safety of nucleos(t)ide analogues to prevent hepatitis B virus mother-to-child transmission in pregnant women with high viremia: real life practice from China. Int J Med Sci. 2018;15(8):796–801 In this real life study from China, talbivudine was used during pregnancy to prevent MTCT. However, two mothers had < 2 logs IU/mL decline after starting LdT and therefore had to be switched to TDF which shows the real life limitation of LdT resistance in the population. PubMedPubMedCentral
63.
Zurück zum Zitat Fontana RJ. Side effects of long-term oral antiviral therapy for hepatitis B. Hepatology. 2009;49(5 Suppl):S185–95.PubMed Fontana RJ. Side effects of long-term oral antiviral therapy for hepatitis B. Hepatology. 2009;49(5 Suppl):S185–95.PubMed
64.
Zurück zum Zitat •• Pan CQ, Duan Z, Dai E, et al. Tenofovir to prevent hepatitis B transmission in mothers with high viral load. N Engl J Med. 2016;374(24):2324–34 This is a large trial of 200 patients who were randomly assigned 1:1 to receive TDF vs no antiviral therapy and the rate of MTCT was significantly lower at 5% vs 18% as per ITT and 0% vs 7% as per-protocol analysis. Viremia threshold of 200,000 IU/mL was chosen as an indication to consider antiviral therapy in the third trimester to prevent MTCT. PubMed •• Pan CQ, Duan Z, Dai E, et al. Tenofovir to prevent hepatitis B transmission in mothers with high viral load. N Engl J Med. 2016;374(24):2324–34 This is a large trial of 200 patients who were randomly assigned 1:1 to receive TDF vs no antiviral therapy and the rate of MTCT was significantly lower at 5% vs 18% as per ITT and 0% vs 7% as per-protocol analysis. Viremia threshold of 200,000 IU/mL was chosen as an indication to consider antiviral therapy in the third trimester to prevent MTCT. PubMed
65.
Zurück zum Zitat Marcellin P, Heathcote EJ, Buti M, Gane E, de Man RA, Krastev Z, et al. Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B. N Engl J Med. 2008;359(23):2442–55.PubMed Marcellin P, Heathcote EJ, Buti M, Gane E, de Man RA, Krastev Z, et al. Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B. N Engl J Med. 2008;359(23):2442–55.PubMed
66.
Zurück zum Zitat Sarin SK, Kumar M, Lau GK, Abbas Z, Chan HLY, Chen CJ, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int. 2016;10(1):1–98.PubMed Sarin SK, Kumar M, Lau GK, Abbas Z, Chan HLY, Chen CJ, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int. 2016;10(1):1–98.PubMed
67.
Zurück zum Zitat Chen HL, Lee CN, Chang CH, Ni YH, Shyu MK, Chen SM, et al. Efficacy of maternal tenofovir disoproxil fumarate in interrupting mother-to-infant transmission of hepatitis B virus. Hepatology. 2015;62(2):375–86.PubMed Chen HL, Lee CN, Chang CH, Ni YH, Shyu MK, Chen SM, et al. Efficacy of maternal tenofovir disoproxil fumarate in interrupting mother-to-infant transmission of hepatitis B virus. Hepatology. 2015;62(2):375–86.PubMed
68.
Zurück zum Zitat •• Yi W, Pan CQ, Li MH, et al. The characteristics and predictors of postpartum hepatitis flares in women with chronic hepatitis B. Am J Gastroenterol. 2018;113(5):686–93 This is a large study that enrolled 4236 patients that evaluated predictors of post-partum hepatic flares. Those with elevated ALT during pregnancy and HBV DNA levels > 5 logs IU/mL were reported as predictors associated with flares. •• Yi W, Pan CQ, Li MH, et al. The characteristics and predictors of postpartum hepatitis flares in women with chronic hepatitis B. Am J Gastroenterol. 2018;113(5):686–93 This is a large study that enrolled 4236 patients that evaluated predictors of post-partum hepatic flares. Those with elevated ALT during pregnancy and HBV DNA levels > 5 logs IU/mL were reported as predictors associated with flares.
69.
Zurück zum Zitat •• Liu J, Wang J, Jin D, et al. Hepatic flare after telbivudine withdrawal and efficacy of postpartum antiviral therapy for pregnancies with chronic hepatitis B virus. J Gastroenterol Hepatol. 2017;32(1):177–83 The study that enrolled 241 subjects and 34.4% exhibited hepatic flare after telbivudine was discontinued after 12 weeks post-partum. Mothers with elevated ALT during pregnancy were particularly at higher risk for flare compared to those with normal ALT. PubMed •• Liu J, Wang J, Jin D, et al. Hepatic flare after telbivudine withdrawal and efficacy of postpartum antiviral therapy for pregnancies with chronic hepatitis B virus. J Gastroenterol Hepatol. 2017;32(1):177–83 The study that enrolled 241 subjects and 34.4% exhibited hepatic flare after telbivudine was discontinued after 12 weeks post-partum. Mothers with elevated ALT during pregnancy were particularly at higher risk for flare compared to those with normal ALT. PubMed
70.
Zurück zum Zitat Ehrhardt S, Xie C, Guo N, Nelson K, Thio CL. Breastfeeding while taking lamivudine or tenofovir disoproxil fumarate: a review of the evidence. Clin Infect Dis. 2015;60(2):275–8.PubMed Ehrhardt S, Xie C, Guo N, Nelson K, Thio CL. Breastfeeding while taking lamivudine or tenofovir disoproxil fumarate: a review of the evidence. Clin Infect Dis. 2015;60(2):275–8.PubMed
71.
Zurück zum Zitat •• Siberry GK, Jacobson DL, Kalkwarf HJ, et al. Lower newborn bone mineral content associated with maternal use of tenofovir disoproxil fumarate during pregnancy. Clin Infect Dis. 2015;61(6):996–1003 The study compared the bone mineral content in 74 TDF exposed infants and 69 TDF unexposed infants. Bone mineral content was 12% lower in TDF exposed infants vs those who were not exposed to TDF. PubMedPubMedCentral •• Siberry GK, Jacobson DL, Kalkwarf HJ, et al. Lower newborn bone mineral content associated with maternal use of tenofovir disoproxil fumarate during pregnancy. Clin Infect Dis. 2015;61(6):996–1003 The study compared the bone mineral content in 74 TDF exposed infants and 69 TDF unexposed infants. Bone mineral content was 12% lower in TDF exposed infants vs those who were not exposed to TDF. PubMedPubMedCentral
72.
Zurück zum Zitat •• Jao J, Abrams EJ, Phillips T, Petro G, Zerbe A, Myer L. In utero tenofovir exposure is not associated with fetal long bone growth. Clin Infect Dis. 2016;62(12):1604–9 Results from study of 646 mother-fetus dyads in HIV infected mothers showed TDF exposure even in early trimester did not result in impairment of fetal long bone growth. TDF exposure was compared in three arms < 10 weeks, 10–24 weeks and > 25 weeks and there was no association between the duration of TDF exposure in utero and fetal bone health. •• Jao J, Abrams EJ, Phillips T, Petro G, Zerbe A, Myer L. In utero tenofovir exposure is not associated with fetal long bone growth. Clin Infect Dis. 2016;62(12):1604–9 Results from study of 646 mother-fetus dyads in HIV infected mothers showed TDF exposure even in early trimester did not result in impairment of fetal long bone growth. TDF exposure was compared in three arms < 10 weeks, 10–24 weeks and > 25 weeks and there was no association between the duration of TDF exposure in utero and fetal bone health.
73.
Zurück zum Zitat Greenup AJ, Tan PK, Nguyen V, Glass A, Davison S, Chatterjee U, et al. Efficacy and safety of tenofovir disoproxil fumarate in pregnancy to prevent perinatal transmission of hepatitis B virus. J Hepatol. 2014;61(3):502–7.PubMed Greenup AJ, Tan PK, Nguyen V, Glass A, Davison S, Chatterjee U, et al. Efficacy and safety of tenofovir disoproxil fumarate in pregnancy to prevent perinatal transmission of hepatitis B virus. J Hepatol. 2014;61(3):502–7.PubMed
Metadaten
Titel
Update in the Management of Chronic Hepatitis B in Pregnancy
verfasst von
Kalyan Ram Bhamidimarri
Calvin Q. Pan
Publikationsdatum
08.11.2018
Verlag
Springer US
Erschienen in
Current Hepatology Reports / Ausgabe 4/2018
Elektronische ISSN: 2195-9595
DOI
https://doi.org/10.1007/s11901-018-0437-3

Weitere Artikel der Ausgabe 4/2018

Current Hepatology Reports 4/2018 Zur Ausgabe

Hepatic Cancer (A Singal and A Mufti, Section Editors)

Management of Combined Hepatocellular Carcinoma-Cholangiocarcinoma

Hepatic Cancer (A Singal and A Mufti, Section Editors)

Stereotactic Ablative Radiotherapy (SABR/SBRT) for Hepatocellular Carcinoma

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.