| BackgroundHepatitis B is a contagious and liver-damaging disease caused by infection with the hepatitis B virus(HBV),which poses a major health risk to humans.The main routes of transmission of hepatitis B include sexual transmission,blood transmission and mother-to-child transmission.Prevention of mother-to-child transmission of hepatitis B virus is an important means of reducing the incidence of HBV infection and the prevalence of chronic hepatitis B.The main measure is co-immunisation of hepatitis B-exposed infants,which can block 90% of mother-to-child transmission of hepatitis B.Studies in the last decade have shown that the incidence of mother-to-child transmission of HBV can be further reduced through standardised antiviral treatment during pregnancy in pregnant women with a high viral load of hepatitis B,and the incidence of mother-to-child transmission of hepatitis B can be gradually eliminated.The study has shown that the incidence of mother-to-child transmission of HBV can be further reduced and mother-to-child transmission of hepatitis B gradually eliminated through standardised antiviral treatment during pregnancy.Much of the data from previous antiviral treatment studies are from randomised controlled clinical studies with strict inclusion and exclusion criteria,whereas in the real world there are various reasons and factors that can affect the implementation of antiviral treatment.The risk of mother-to-child transmission of HBV is increased if pregnant women with high viral load hepatitis B infection are not treated with timely antiviral treatment.The aim of this study was to investigate the current status of antiviral treatment in real-world pregnant women with high viral load of hepatitis B infection and to analyse the relevant factors affecting their antiviral treatment to provide a real-world basis for developing strategies to improve antiviral treatment rates in pregnant women with hepatitis B infection,to further interrupt mother-to-child transmission of HBV and to promote the elimination of mother-to-child transmission of HBV.MethodsA total of 378 pregnant women with hepatitis B virus DNA(HBV DNA)load≥2×105 IU/m L during pregnancy who attended the outpatient clinic of Guangdong Maternal and Child Health Hospital from January 1,2020 to September 30,2022 were retrospectively collected medical record information(including basic information,pregnancy information,antiviral treatment status and mother-infant outcome information)and followed up,and relevant surveys were completed The questionnaires were completed.The cut-off point for follow-up was confirmation of the hepatitis B status of the infants born to mothers who had completed the combined immunisation programme.The antiviral group was used as the study group and the non-antiviral group was used as the control group to compare antiviral treatment,pregnancy complication rates,pregnancy outcomes and maternal-infant interruption effects and influencing factors between the two groups,and the data were collated and statistically analysed using SPSS 26.0 software.Results1.Current status of antiviral treatment: Among 378 pregnant women with high viral load of hepatitis B infection,313 had antiviral treatment and 65 did not,with an antiviral treatment rate of 82.8%.2.Factors affecting antiviral treatment: The results of the univariate analysis showed statistically significant differences between the antiviral treatment group and the non-antiviral treatment group in terms of the number of pregnancies,knowledge of the disease,regularity of follow-up appointments,time between follow-up appointments,and affordability of medical care(all P < 0.1).The five variables with P<0.1 in the univariate analysis were included in a multi-factor logistic regression model,which showed that knowledge of hepatitis B disease(OR=0.043,95% CI:0.014-0.133,P<0.001),regular physician for follow-up visits(OR=0.162,95% CI:0.045-0.577,P=0.005),and Affordability of health care costs(OR=0.175,95% CI:0.064-0.475,P=0.001)were the main factors influencing whether pregnant women with high viral load hepatitis B infection underwent antiviral therapy.3.Effect of antiviral treatment on the incidence of pregnancy complications and pregnancy outcomes: both univariate and multifactorial analyses showed no statistical difference between the antiviral treatment and non-antiviral treatment groups in the incidence of placental abnormalities(15.7% vs 13.8%),amniotic fluid abnormalities(22.4% vs 21.5%),intrahepatic cholestasis during pregnancy(6.1% vs3.1%),transaminase abnormalities at delivery(8.0% vs 6.2%)There was no statistical difference in the incidence of abnormal abdominal ultrasound(8.9% vs7.7%)and preterm labour(7.7% vs 9.2%)(all p > 0.1).4.Comparison of viral load reduction between the antiviral treatment group and the non-antiviral treatment group: Among the 378 pregnant women with high viral load of hepatitis B infection,there was a statistically significant difference between the antiviral treatment group and the non-antiviral treatment group in the proportion of viral reduction below the detection standard and the viral load reduction ≥2log(p < 0.1).5.Comparison of the effectiveness of mother-to-child transmission interruption between the antiviral treatment group and the non-antiviral treatment group: the rate of mother-to-child transmission was 2.24% in the antiviral treatment group and4.62% in the non-antiviral treatment group.Numerically,the mother-to-child transmission rate was significantly lower in the antiviral group than in the non-antiviral group,but the statistical difference between the two groups was not statistically significant(p > 0.1).6.Major factors influencing the effectiveness of maternal-infant interruption in the antiviral treatment group: Among the 313 pregnant women who were routinely treated with antiviral therapy,the results of the univariate analysis showed that the three factors of mode of delivery,period of initiation of antiviral treatment during pregnancy and number of weeks of antiviral treatment were the major factors influencing the effectiveness of maternal-infant interruption in the antiviral treatment group(all P<0.1).These 3 variables with P<0.1 in the univariate analysis were included in a multi-factor logistic regression model,which showed that the number of weeks of antiviral treatment dosing(OR=6.809,95% CI: 1.017-45.596,P=0.048)was the main factor influencing the effectiveness of mother-to-child interruption in the antiviral treatment group,and the number of weeks of antiviral treatment dosing for pregnant women with high viral load hepatitis B infection The risk of mother-to-child transmission was 6.809 times higher in pregnant women with high viral load hepatitis B infection who had been on antiviral therapy for less than 10 weeks than in those who had been on antiviral therapy for greater than or equal to 10 weeks.Conclusions1.The antiviral treatment rate for pregnant women with high viral load hepatitis B infection in this particular institution is high,exceeding 80%.However,there are still some pregnant women who are not on antiviral treatment,mainly due to lack of knowledge of hepatitis B disease among pregnant women,lack of regular physicians for follow-up consultations,and unaffordable costs of antiviral treatment.2.In the real world antiviral treatment during pregnancy in pregnant women with high viral load hepatitis B infection does not increase the incidence of complications during pregnancy or the incidence of adverse pregnancy outcomes compared to those who are not on antiviral treatment.Antiviral therapy during pregnancy is safe.3.The results of this study showed that antiviral treatment reduced the level of HBV DNA in hepatitis B viral load and antiviral treatment reduced the rate of mother-to-child transmission in pregnant women with high viral load of hepatitis B.The rate of mother-to-child transmission in the antiviral treatment group of pregnant women with high viral load of hepatitis B infection was numerically significantly lower than that in the non-antiviral treatment group,but there was no statistically significant difference between the two groups.The main reasons for this were that the results were biased due to insufficient sample size and that the shorter duration of medication for some pregnant women in the antiviral treatment group affected the effect of mother-to-child transmission in the antiviral group.It is recommended that the standardization of antiviral medication and follow-up management during the antiviral period for pregnant women with high viral load hepatitis B infection should be strengthened to ensure the effectiveness of antiviral medication. |
PDF Full Text Request