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Measures to Reduce Mother-to-Child Transmission of Hepatitis B Virus in China: A Meta-Analysis

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Abstract

Background

Mother-to-child transmission (MTCT) is the main mode of spread of hepatitis B virus (HBV) in China. We performed a meta-analysis to compare the effects of three measures for prevention of MTCT.

Methods

A meta-analysis was performed on randomized controlled trials and non-randomized studies comparing the index of MTCT among five groups of pregnant women: hepatitis B immunoglobulin (HBIG) administration, antiviral treatment, placebo, elective caesarean section, and vaginal delivery.

Results

Compared with the control group, the incidence of HBV intrauterine infection (RR = 0.42, 95 % CI 0.27–0.64, P < 0.0001) and the number of chronic hepatitis B (CHB) infants (RR = 0.44, 95 % CI 0.32–0.61, P < 0.00001) were lower in the HBIG administration group. In the antiviral treatment group, serum HBV DNA levels were lower (MD = −4.01, 95 % CI −5.07 to −2.94, P < 0.00001) at the time of delivery, and normalization of ALT levels was better (RR = 1.11, 95 % CI 1.06–1.17, P < 0.0001). Infant serum HBsAg positivity (RR = 0.45, 95 % CI 0.22–0.91, P = 0.03) and incidence of infant HBV transmission RR = 0.06, 95 % CI 0.01–0.24, P < 0.0001) were reduced in antiviral the treatment group. Infant serum anti-HBs positivity at birth (RR = 1.24, 95 % CI 0.89–1.74, P = 0.2) or at 6–7 months (RR = 0.98, 95 % CI 0.86–1.11, P = 0.73) was not significantly different between the caesarean section and vaginal delivery groups. The incidence of infant CHB infection may have been higher in the vaginal delivery group (RR = 2.20, 95 % CI 1.02–4.74, P = 0.04).

Conclusions

Administration of HBIG or antiviral therapy to HBV carrier mothers during pregnancy is effective in reducing MTCT.

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Acknowledgments

Zhi Zhou conceived the study, provided funding support, and revised the manuscript critically for important intellectual content. Hua Xu made substantial contributions to the design of the study and to acquisition, analysis, and interpretation of the data. Teng Zeng, Jun-Ying Liu, Yu Lei, Shan Zhong, Yun-Jian Sheng, and Hong Ren participated in the design of the study and in acquisition, analysis, and interpretation of data. All authors read and approved the final manuscript. This work was supported by National Nature Science Foundation of China (grant numbers 81171563 and 31000397).

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Authors and Affiliations

  1. The Second College of Clinical Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lingjiang Road, Central District, Chongqing, 400010, China

    Hua Xu, Teng Zeng, Jun-Ying Liu, Yu Lei, Shan Zhong, Yun-Jian Sheng, Zhi Zhou & Hong Ren

  2. Department of Infectious Diseases, Institute for Viral Hepatitis, Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Teng Zeng, Yu Lei, Shan Zhong, Yun-Jian Sheng, Zhi Zhou & Hong Ren

  3. Department of the Digestive System, Zhou Kou Central Hospital, Zhoukou, China

    Jun-Ying Liu

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  1. Hua Xu
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Correspondence to Zhi Zhou.

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Xu, H., Zeng, T., Liu, JY. et al. Measures to Reduce Mother-to-Child Transmission of Hepatitis B Virus in China: A Meta-Analysis. Dig Dis Sci 59, 242–258 (2014). https://doi.org/10.1007/s10620-013-2918-0

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