Clinical Follow-up Analysis Of Mother To Child Transmission Of Hepatitis B

[Objective](1)To evaluate the maternal and child blocking of different types of he patitis B pregnant women,and strengthen the management of hepatitis B pregn ant women,standardize the clinical follow-up process of the interruption of mo ther to child transmission(MTCT)of HBV.(2)We evaluated and compared the efficacy of antiviral therapy with telbivudine(LDT)and Tenofovir(TDF)in HBeAg positive pregnant women with high viral load for preventing MTC T.[Methods](1)HBsAg pregnant women were followed prospectively observed.On t he basis of the HBV DNA,divided into A group(<106IU/ml)and group B(>106IU/ml).According to whether antiviral therapy were given,divided into B1 group(without antiviral treatment)and group B2(antiretroviral therapy).A ssessed for hepatitis B pregnant women at 28 weeks of gestation,parturition a nd postpartum follow-up etc.(2)A prospective study was conducted in HBeA g positive pregnant women with DNA HBV>106 IU/ml.The patients divided i nto the LDT group and TDF group.To prospectively observe the data of virol ogical response,biochemical indicators,and adverse reactions of pregnant wom en during treatment,neonatal growth and development indicators.[Results](1)All of 107 cases of hepatitis B pregnant women in our study,pregn ant women with HBeAg positive was 62.6%,58.9%pregnant women had high viral load.At the time of delivery,HBV DNA levels were 2.70(2.70-4.37),7.68(7.16-7.70),4.24(3.08-5.09)LogioIU/ml in A group,B1 group and B2 gro up,the difference was statistically significant(P<0.05),further comparison between B1 group and B2 group,the difference of virus level was statistically significant(P<0.05).At 28 weeks of gestation,the ALT in group A and g roup B were(14.24±7.865),(25.46±27.434)U/L,and the difference was stati stically significant.There was no significant difference in ALT between group A,group B1 and group B2 At delivery(P>0.05).69.9%pregnant women c hoose natural childbirth;after delivery,70%mothers choose breastfeeding,and the 10%choose mixed feeding.There was 1 cases of congenital cleft palate in B2 group.All infants who had completed the whole course of vaccination were negative for HBsAg and positive for HBsAb.(2)HBV DNA levels wer e significantly lower than before treatment at delivery respectively(P<0.05).The ratio of HBV DNA lower than 103IU/ml were 28.57%and 30.00%in b oth LDT group and TDF group respectively,which had no significant differen ce(P>0.05).In the group of LDT,1 case's ALT and AST increased trans iently after treatment,and decrease when delivering,while other pregnant wo men and those in the TDF group were all among the normal range.No obvio us adverse reaction in both groups was observed.The premature birth rates we re 7.1%and 10%in LDT group and TDF group,the difference was not statis tically significant(P>0.05).All neonatal Apger scores were 9 points.1 cas e of neonatal in LDT group occurred congenital cleft palate,other newborns w ith normal development,weight and height were within the normal range.The baby of 7-12 months were not detected HBsAg positive.[Conclution](1)Pregnant women with different HBV infection status are different in risk of mother to child transmission.Antiviral therapy is recommended for pre gnant women with high viral load to reduce the risk of MTCT;and liver func tion and HBV DNA should be monitored regularly in pregnant women with lo w viral load.Under systematic management and follow-up,pregnant women im proved the awareness of hepatitis B,reduced the human choice of cesarean se ction,reduced the concerns about breastfeeding.After the follow-up of pregnan t women with hepatitis B and the combination of infant immunization,success ful blocking mother to infant transmission.(2)HBeAg positive pregnant wome n with DNA HBV>106 IU/ml treated with LDT and TDF in a short time,sh own no difference between the antiviral efficacy.The virus has not yet reache d the ideal safe range when the pregnant women with high viral load or insuf ficient exposure time of drugs.Given an antiviral treatment in advance to exte nd the duration of drug exposure,the viral load at delivery may fall to a lowe r and safer range.