Effect Of HBV Infection On Mother And Infant In Pregnancy And The Economic Evaluation Of Main Intervention

Objective: To approach the effect on pregnant women and newborn babies when the pregnant women accompany with HBV infection. To study the cost, effectiveness, utility and benefit of main intervention for interrupting HBV transmission from mother to infant. Therefore provide scientific basis for maternal and infant care and the best intervention of preventing HBV mother-infant transmission.Methods: 1. Effect of HBV infection on mother and infant in pregnancy: Adopt the retrospective method to collect pregnant women with HBV infection (including ever infected) among pregnant women who had adopted systemic prenatal check-up in Jiang'an District Wuhan city from Jan 1st, 2004 to Dec.31th, 2006. 564 pregnant women were divided into infection group and recovery group according to the HBsAg whether it was positive or not. Meanwhile, randomly select homeochronous 603 normal pregnant women (including anti-HBs(+) and negative of markers) as control group. To analysis and compare the conditions of duration of pregnancy and delivery, and the conditions of birth and feeding of newborn.2. The economic evaluation of main intervention: On the basis of voluntary, adopt the method of cluster sampling and the way of face to face or phone interview to carry out questionnaire investigation to mothers who carried HBV in pregnancy from Jan 1st, 2004 to Dec.31th in Jiang'an District Wuhan city. Choose the main intervention, and adopt the method of cost-effectiveness, cost-utility, cost-benefit to carry out economic evaluation.Results: 1. Effect of HBV infection on mother and infant in pregnancy: (1) The duration of pregnancy and intrapartum complication: incidence rate of PIH (infection group 8.45%, recovery group 7.66%, normal group 3.48%), incidence rate of fetal distress (infection group 11.83%, recovery group 8.13%, normal group 6.63%), incidence rate of premature rupture of membrane (infection group 13.24%, recovery group 11.96%, normal group 8.13%), the differences all had statistical significance (P<0.01). (2) Abnormal occurrence of newborn: incidence rate of low birth weight infant (infection group 4.23%, recovery group 2.39%, normal group 1.33%), incidence rate of premature infant (infection group 5.92%, recovery group 5.74%, normal group 2.65%), incidence rate of neonatal asphyxia (infection group 9.01%, recovery group 5.74%, normal group 4.81%), the differences all had statistical significance (P<0.05). (3) Feeding: the rate of artificial feeding in infection group was 41.69%, obviously higher than recovery group (8.61%) and normal group (6.14%). The difference had statistical significance (P<0.0001).2. The economic evaluation of main intervention: 124 (78.48%) objects adopted the method of mother-infant combined immunization, that was injecting mother and infant with HBIG in the third trimester (28,32,36W) and at birth and the HB vaccine was inoculated as usual. Threw into cost 102456.00 Yuan would reduce one cirrhosis patient, four chronic B hepatitis and fourteen HBV carriers. The estimated disease burden that was retrieved was 65.91 DALY. The cost per DALY was 1554.48 Yuan. The anticipated total benefit was 847298.62 Yuan. The net benefit obtained was 744842.62 Yuan. The BCR was 8.27:1.Conclusions: Pregnancy with HBsAg positive may raise the incidences of PIH, premature rupture of membrane, fetal distress, low birth weight, premature infant and neonatal asphyxia. It has much more effects on mother and infant. Adopt the method of mother-infant combined immunization to interrupt HBV transmission from mother to infant can obtain better effectiveness and produce greater utility and benefit.