A Real-world Study Of Mother-to-child Transmission Of Hepatitis B And Building Up Mobile Health Management Platform

BACKGROUND AND AIM:The World Health Organization has set the target to eliminate the threaten of viral hepatitis by 2030.Hepatitis B surface antigen(HBsAg)positive rate among pregnant women is around 6%.In China,mother-to-child transmission is the main route of hepatitis B virus(HBV)transmission.Previously,national and international guidelines on the management of chronic hepatitis B recommended administering hepatitis B vaccine and hepatitis B immunoglobulin(HBIG)to infants and antiviral drugs for pregnant women with high viral load in late pregnancy.In recent years,with the rapid development of mobile health technology,the efficiency of doctor-patient communication and management has been greatly improved.This study established a management platform through mobile health technology to follow up and manage pregnant women with hepatitis B and their infants under standardized algorithm,and observed mother-to-child transmission of HBV and the clinical characteristics of chronic HBV infection in pregnant women.METHODS:One thousand and eight HBsAg-positive pregnant women were enrolled in China.Immunoprophylaxis(including hepatitis B infant immunization and HBIG administered within 24 hours after birth)was routinely administered to infants.In addition,most mothers with an HBV DNA level of more than 2×106 IU/mL were advised to initiate antiviral therapy at gestational week 24-28.All enrolled pregnant women and their infants were followed up to postpartum 28-48 weeks.A mobile health application called SHIELD was designed and used to manage the study.RESULTS:1.Nine hundred and five of enrolled mothers with 924 infants completed the follow-up,including 561 mothers who were hepatitis e antigen(HBeAg)positive and 499 mothers who had an HBV DNA level of more than 2×106 IU/mL.2.There were 446 mothers who received antiviral therapy,including 72.3%of the mothers with an HBV DNA level of more than 2×106 IU/mL and 21.0%of the mothers with an HBV DNA level of less than 2×106 IU/mL.Among the three nucleot(s)ide analogues,telbivudine was the most frequently used nucleot(s)ide analogues(76.8%),followed by tenofovir(19.9%),and lamivudine(3.3%).3.The coverage of the birth dose of hepatitis B vaccine and HBIG was 99.8%and 99.9%,respectively.The timely birth dose rate of hepatitis B was 98.3%within 12 hours after birth.The timely birth dose rate of HBIG was 99.2%within 12 hours after birth.4.Eight infants became infected with HBV.The overall rate of MTCT was 0.9%.(8/905)(95%confidence interval,0.4%to 1.7%).5.There were no significant differences in rates of mode of delivery,weight,height,head circumference,Apgar score,the rate of birth defect and adverse event between infants whose mothers received antiviral therapy during pregnancy and those whose mothers did not receive antiviral therapy.(P>0.05)CONCLUSIONS:In real-world practice,the rate of mother-to-child transmission of hepatitis B could be further decreased to 0.9%with standardized management using a mobile health application,which achieved the World Health Organization target of reducing the mother-to-child transmission.