Different Measures To Reduce Mother-to-child Transmission Of HBV: A Network Meta-analysis

Object: Mother-to-child transmission (MTCT) is the main mode of spread ofhepatitis B virus (HBV) in China, and this paper performed a NetworkMeta-Analysis(NMA) to quantitatively summarize the effects of seven measures forprevention of MTCT.Method: Medline/PubMed, Embase, Google, the Cochrane Library, Web ofKnowledge, and the China Biological Medicine Database, Wangfang database, andVip Database were searched for all relevant cohort studies up to January2014,without language limitation. Meantime this paper also performed a full manual searchand Literature retroactive methods to identify additional studies, only abstract andunpublished articles should not be considered. The retrieved documents werescreened and included based on the inclusion and exclusion criteria of this researchrequirement, and to assess the quality of the literature according to Jadad qualityassessment criteria. The present study used R software, Stata11.0and Winbugs1.4.3software to do the data processing and analysis. The first step was to build a Networkdiagram；the second step was to conduct a traditional head to head meta-analysis；Thethird step was to do a comprehensive analysis conducted by the networkmeta-analysis; the fourth step was to evaluate network meta-analysis heterogeneous;the fifth step was to test the posterior rank probabilities by network meta-analysis andthe last step was to evaluate the consistency of network meta-analysis.Results: There were54relevant studies including7interventions and10518patients were involved in the meta-analysis. All the included studies had been dividedinto2groups based on the HBsAg states of pregnant mothers (HBsAg positivemothers group and mothers with both HBsAg and HBeAg positive group) to analysisthe block effect of HBV spread in12months and24hours. The results showed thatthe inconsistencies did not exist in all groups of this network meta-analysis. Theresults of HBsAg-positive rate within24hours after were born (HBsAg positivemothers group) showed: Interventions C (pregnant women injected HBIG+babiesinjected (HBIG+HBVac)) and D (taking lamivudine during pregnancy+babies injected HBVac) compared to A (babies injection HBVac) might reduce the risk ofinfants HBsAg-positive occurrence. Interventions C(pregnant woman injected HBIG+babies injected (HBIG+HBVac)), E (mothers taking Telbivudine during pregnancy+Infants injection (HBIG+HBVac)), F(mothers taking lamivudine during pregnancy+Infants injection HBVac), and G (pregnant mothers injected (HBIG+HBVac)+babies injected (HBIG+HBVac)) compared to B(Infants injected HBVac and HBIG)may reduce the risk of infants HBsAg positive happened, and A (Infants injectedHBVac) and B (Infants injected HBVac and HBIG) compared with no significantdifference. The interventions posterior probability showed interventions F might bethe best intervention compared to others.The results of HBsAg-positive rate within24hours after the babies were born(mothers with both HBsAg and HBeAg positive group) showed: Interventions C(pregnant woman injected HBIG+babies injected (HBIG+HBVac)) compared to B(Infants injected ac and HBIG) might reduce the risk of infants HBsAg-positiveoccurrence. There was significant different between the effect of Interventions D(taking lamivudine during pregnancy+babies injected HBVac) and E(mothers takingTelbivudine during pregnancy+Infants injection (HBIG+HBVac)). The networkmeta-analysis results were similar to the results of HBsAg-positive rate within24hours after the babies were born (HBsAg positive mothers group), and theinterventions posterior probability also showed interventions F might be the bestintervention compared to others.The results of HBsAg-positive rate within12months after the babies was bornto (HBsAg positive mothers group) showed: the effects between interventions B andA,C and A,C and B,D and B, E and B,F and A by head to head meta-analysis.Intervention D and E did not show significant different. And the interventionsposterior probability also showed interventions E might be the best interventioncompared to others in this groups. The results of HBsAg-positive rate within12months after the babies were born (mothers with both HBsAg and HBeAg positivegroups) were the same as the results of HBsAg-positive rate within12months afterthe babies were born (HBsAg positive mothers group).Conclusion: According to the results showed that the use of antiviral drugs and HBIG injected during pregnancy could reduce the risk of HBV MTCT occurred. Andthe results of Network meta-analysis showed that use of antiviral drugs might betterto block the spread of HBV compared to others.