Measures to reduce mother-to-child transmission of Hepatitis B virus in China: a meta-analysis

Abstract

Background: Mother-to-child transmission (MTCT) is the main mode of spread of hepatitis B virus (HBV) in China. We performed a meta-analysis to compare the effects of three measures for prevention of MTCT.

Methods: A meta-analysis was performed on randomized controlled trials and non-randomized studies comparing the index of MTCT among five groups of pregnant women: hepatitis B immunoglobulin (HBIG) administration, antiviral treatment, placebo, elective caesarean section, and vaginal delivery.

Results: Compared with the control group, the incidence of HBV intrauterine infection (RR = 0.42, 95 % CI 0.27-0.64, P < 0.0001) and the number of chronic hepatitis B (CHB) infants (RR = 0.44, 95 % CI 0.32-0.61, P < 0.00001) were lower in the HBIG administration group. In the antiviral treatment group, serum HBV DNA levels were lower (MD = -4.01, 95 % CI -5.07 to -2.94, P < 0.00001) at the time of delivery, and normalization of ALT levels was better (RR = 1.11, 95 % CI 1.06-1.17, P < 0.0001). Infant serum HBsAg positivity (RR = 0.45, 95 % CI 0.22-0.91, P = 0.03) and incidence of infant HBV transmission RR = 0.06, 95 % CI 0.01-0.24, P < 0.0001) were reduced in antiviral the treatment group. Infant serum anti-HBs positivity at birth (RR = 1.24, 95 % CI 0.89-1.74, P = 0.2) or at 6-7 months (RR = 0.98, 95 % CI 0.86-1.11, P = 0.73) was not significantly different between the caesarean section and vaginal delivery groups. The incidence of infant CHB infection may have been higher in the vaginal delivery group (RR = 2.20, 95 % CI 1.02-4.74, P = 0.04).

Conclusions: Administration of HBIG or antiviral therapy to HBV carrier mothers during pregnancy is effective in reducing MTCT.