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World J Gastroenterol. Sep 14, 2014; 20(34): 12056-12061
Published online Sep 14, 2014. doi: 10.3748/wjg.v20.i34.12056
Individualized management of pregnant women with high hepatitis B virus DNA levels
Zhao Zhang, Chao Chen, Zhe Li, Ying-Hua Wu, Xiao-Min Xiao
Zhao Zhang, Zhe Li, Ying-Hua Wu, Xiao-Min Xiao, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou 510632, Guangdong Province, China
Chao Chen, Zhuhai Entry-Exit Inspection and Quarantine Bureau, Zhuhai 519015, Guangdong Province, China
Author contributions: Zhang Z wrote the manuscript and did part of the literature search; Chen C searched the literature on hepatitis B epidemiology; Li Z searched literature on anti-viral treatment for hepatitis B; Wu YH searched literature on delivery mode of pregnant women with hepatitis B; Xiao XM designed the manuscript topic and reviewed the manuscript.
Correspondence to: Xiao-Min Xiao, MD, Professor, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, No. 613, West Huangpu Avenue, Guangzhou 510632, Guangdong Province, China. xiaoxiaomin55@163.com
Telephone: +86-20-38088660 Fax: +86-20-38688606
Received: October 27, 2013
Revised: January 9, 2014
Accepted: April 1, 2014
Published online: September 14, 2014
Abstract

Hepatitis B is a major health concern in the Asia-Pacific region, and is endemic in China, Southeast Asia, and Africa. Chronic hepatitis B virus (HBV) infection may cause hepatic cirrhosis and liver cancer. It is estimated that there are more than 350 million chronic HBV carriers worldwide, of whom approximately one quarter will die of chronic hepatitis B-related liver diseases. HBV is transmitted horizontally through blood and blood products or by sexual transmission, and vertically from mother to infant. Perinatal infection is the predominant mode of transmission in countries with a high prevalence of hepatitis B surface antigen (HBsAg) carriage, and perinatal transmission leads to high rates of chronic infection. Therefore, it is important to prevent the mother-to-child transmission (MTCT) of HBV. Research has shown that pregnant women with high HBV DNA levels have an increased risk of MTCT. However, most of the obstetrics guidelines do not make a distinction between pregnant women with high HBV DNA levels and those who are HBsAg positive only. This review addresses the management of pregnant women with high levels of HBV viremia, in terms of antiviral therapy, use of hepatitis B immunoglobulin (HBIG), the combined application of hepatitis B vaccine and HBIG, choice of delivery mode and feeding practices.

Keywords: Hepatitis B virus, Hepatitis B virus DNA, High level, Management, Pregnancy

Core tip: Research has shown that pregnant women with high hepatitis B virus (HBV) DNA levels have an increased risk of mother-to-child transmission. However, most of the obstetrics guidelines do not make a distinction between pregnant women with high HBV DNA levels and those who are hepatitis B surface antigen positive only. This review addresses the management of pregnant women with high levels of HBV viremia, in terms of antiviral therapy, use of hepatitis B immunoglobulin (HBIG), the combined application of hepatitis B vaccine and HBIG, choice of delivery mode and feeding practices.