| BackgroundIt is estimated that 400 million people are chronic carriers of hepatitis B virus worldwidely, with a remarkably high prevalence in China, etc. Vertical transmission is the main route of HBV transmission, than the blood products, body fluids, medical, etc. Without Immunoprophylaxis,85～90% of children born to mothers both HBsAg-positive and HBeAg-positive will get infected with HBV,90% of which will develop into chronic hepatitis B virus carriers. With just more than 30 years of history assisted reproductive technology need more follow-up studies and observation of the children’s health problems and HBV infection status. Recently with rapid development of assisted reproductive technology, more and more HBV carriers suffering from infertility demand invitro-fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and embryo transplantation. The risk of maternal or paternal HBV transmission through assisted reproduction technology is still uncertain. Some studies have considered that cryopreservation of sperm, sperm washing, etc can reduce the HBV infection rate of offspring. While other studies have found that male infected with HBV obtain a poorer sperm quality, lower rate of fertilization, embryo implantation, pregnancy, gestational weeks, etc.ObjectiveThe investigation aims to collect and analyse data from hepatitis B virus carriers, mainly including the ART implementation, maternal pregnancy complications, health of their offspring and HBV immune prevention situation, comparing with the domestic and foreign data from HBV carriers of spontaneous pregnancy. We hope it may provide reference for the future work of assisted reproduction.MethodsHepatitis B virus carriers receiving ART treatment in Women’s Hospital Zhejiang University School of Medicine in 2010 are studied, totally 265 couples. A registration form named "ART implementation status and maternal and infant health status of HBV carriers" is established to record the general information, ART implementation, status in pregnancy, childbirth and postpartum, neonatal conditions, immuneprophylaxis implementation. The spontaneous pregnancy data of HBV carriers and infection-free infertility patients after ART were selected as control. SPSS 20 statistical software is used to analyze and compare the results of this survey.Results1. Pregnancy period and delivery conditions:1.1 General situation:216 pairs of all hepatitis B carrier couples have successful parturition (81.51%); 59 cases are premature delivery (27.31%); 186 cases choose caesarean section (86.11%); 12 cases are ectopic pregnancy (4.91%),36 cases are spontaneous abortion (13.58%). A total of 282 offspring are followed, of which 151 were singleton,64 were twins,1 was triplet, including 141 boys and 141 girls. The ratio of male to female was 100:100. Comparing the successful delivery rate, premature delivery rate, cesarean section rate, ectopic pregnancy rate, abortion rate, single pregnancy rate, twinning rates and the proportion of men and women between HBV carriers and non-HBV carriers after ART showed no significant difference (P>0.05). According to the epidemiological data the cesarean section rate and twinning rate in HBV carriers after ART is higher than that of natural pregnancy data (35-45%). No significant difference of multiple birth rate was observed between IVF fertilization method (30.87%) and ICSI fertilization method (28.36%) (P>0.05). Cesarean section rate (86.11%) and premature birth rate (23.61%) of HBV carriers after ART are not significantly different from cesarean delivery rate (83.8%) and preterm birth rate (19.97%) of non-HBV carriers after ART (P>0.05), but which was numerically higher than natural pregnancy data of HBV carriers (cesarean section rate 44-54%, premature rate 11.91%).81.40% pregnant women with only HBsAg-positive underwent cesarean section,72.22% of both HBsAg and HBeAg-positive pregnant women underwent cesarean section, and there is not significant difference between them (P>0.05).1.2 Pregnancy complications of HBV carriers after ART were summarized as follows:the incidence of OHSS is 5.12%; Threatened abortion rate in early pregnancy period is 9.28%; hyperemesis gravidarum rate is 1.03%; anemia rate is 11.34%; pregnancy Induced hypertension (PIH) rate is 5.15%; Pregnancy gestational diabetes mellitus (GDM) rate is 6.67%; Intrahepatic cholestasis in pregnancy (ICP) rate is 6.19%; Liver function damage rate is 4.64%; Placenta previa rate is 1.03%; Placental abruption rate is 1.55%; rate of premature rupture of fetal membranes is 6.19%; oligohydramnios rate is 5.67%; amniotic fluid fate is 1.55%; rate of symphysis pubis separation is 0.52%; umbilical cord around neck rate is 8.76%; intrauterine distress rate is 9.28%. The oligoamnios and polyhydramnios is numerically higher than that in natural pregnancy epidemiological data of HBV carriers; The incidence rate of anemia, liver function damage, premature rupture of fetal membranes and umbilical cord around the neck is numerically lower than the natural pregnancy data of HBV carriers; The incidence rate of PIH and placenta previa is lower than epidemiological data of non-HBV carriers after ART. The incidence rate of other complications in pregnancy was consistent with the epidemiological data.2. Health of offspring:2.1 HBV infection in children:Totally 251 Children of HBV carriers (except other infection status) after ART in our hospital were born in 2010, and 49 of which was not followed up,11 of which were infected with HBV at birth by examination of "3 system of hepatitis B " or HBV DNA test. The infection rate of children of carriers (only the woman) and that of carriers (only man) were not remarkably different (P>0.05); But the offspring infection rate of both HBsAg and HBeAg positive carriers after ART (17.1%) was significantly higher than that of the only HBsAg positive carriers (3.37%) (P=0.023). There was no significant difference in the rate of infection after ICSI (4/69) and HBV carriers after IVF (7/161) (P>0.05). There was no significant difference of offspring infection rate observed between HBsAg positive or HBsAg+HBeAg positive carriers taking cesarean delivery (2.13%,12.5%) and natural labour(12.5%,16.67%) (P> 0.05). HBV infection rate (3.51%) in offspring was no significant difference between low birth weight infants and non-low birth weight infants (P> 0.05). The infection rate of children with neonatal asphyxia (14.29%) was not remarkably different from that without neonatal asphyxia (4.15%) (P> 0.05).2.2 Birth defects and neonatal diseases:The birth defects rate of HBV carriers after ICSI (5/69) in our hospital was significantly higher than those after IVF (2/161) (P=0.044). The offspring average birth weight of HBV carriers after ART was 2887.7±614.67g, singleton average birth weight (3257.5±504.911g) significantly higher than twins average birth weight (2460.2±423.62g) (P< 0.01). Rate of low birth weight infants was 22.7%, rate of very low birth weight infants was 1.77%. The proportion of low birth weight in multiple infants (60/131) was significantly higher than that in singleton infants (5/151) (P< 0.01). Neonatal asphyxia rate (16.88%) in preterm infants was significantly higher than that in term infants (0.65%) (P< 0.01). The incidence of neonatal respiratory distress syndrome NRDs in offspring of HBV carriers (0.87%) was lower than natural pregnancy data of HBV carriers, jaundice incidence (10.39%) was higher than the data, neonatal infectious diseases incidence (3.46%) and the data were matched, congenital malformations rate (3.03%) was lower than the data.3. HBV immune prevention situation:61.54% of both HBsAg and HBeAg-positive carriers in pregnancy after ART take HBIG injection,55.17% of only HBsAg-positive carriers take HBIG injection. HBIG injection group has no significant difference in the infection rate of offspring with non-HBIG injection group (P>0.05). There is no significant difference of infection rate in offspring between HBsAg positive or HBsAg+HBAg positive carriers after HBIG-block (0%,13.33%) and those without HBIG block (7.69%,14.29%) (P> 0.05).Conclusion1. Hepatitis B virus carried or not does not affect the success rate of birth, premature birth rate, ectopic pregnancy rate, abortion rate, the rate of cesarean section rate and the proportion of male and female ratio of ART.2. HBV carrier taking ART does not significantly increase the incidence of pregnancy complications.3. The risk of HBV infection in children of HBsAg+HBeAg positive carriers was higher than that of only HBsAg positive carriers, and which has no significant correlation with method of fertilization (IVF or ICSI).4. The female HBV carriers taking HBIG injection can not significantly reduce the HBV infection rate of offspring.5. Vaginal delivery, low birth weight, neonatal asphyxia were not significantly related to the HBV infection in offspring of HBV carriers after ART.6. HBV carriers taking ART would not significantly increase the birth defects rate in offspring, but risk of birth defects after ICSI was remarkbly higher than that after IVF.7. Multiple pregnancy may increase the risk of low birth weight infants.8. The neonatal asphyxia risk in premature infants was significantly higher than that of full-term infants. |
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