| BACKGROUD: Hepatitis B virus is a widely spreaded infectious disease. It was estimated up to 20,000,000 million people all round world that have been infected or is suffering from HBV. About 12,000,000 developed into chronic carrier status in mainland of China. China is a prevalent area of HBV, and positive rate of HBsAg in normal population is up to 10 percent. Long term of carrier status may also have serious consequences: most of them terminate in unrteatable liver cancer. or hepatic cirrhosis. Worldwide deaths caused by HBV infection exceed one million per year. Hepatitis B seriously threatened the public health. It has been proved that high proportion of neonates infected with HBV in uterine would developed into liver cancer or hepatic cirrhosis. In a word, seeking risk factors that affecting HBV infection in uterine will be helpful inprevention of hepatitis B prevalence.AIM: to find out risk factors that affecting HBV infection in uterine.METHODS:(1) To obtain studies eligible for meta-analysis, China biological medicine discs and MEDLINE citations were surveyed with'intrauterine transmission, risk factor, hepatitis B' . Mother HBV DNA or HBeAg positivity, neonate HBeAg positivity, mode of delivery, threatened abortion and threatened premature labor were processed with Meta analysis. Odd ratio was calculated and summarized by fixed effect model or random-effects model using RevMan software. The heterogeneity of the group of ORs was assessed using an x2 test. The significance of the pooled OR was determined by the Z-test. The strength of association was assessed using the odds ratio (OR).(2) Pregnant women with HBsAg were selected as subjects, information on medical events before pregnancy, during pregnancy, or perinatal medical events were collected. Peripheral serum samples both from HBsAg positive mothers and their neonates and, neonatal gastric aspirate of neonates were collected. HBV markers in peripheral serum samples and gastric aspirate samples were detected with enzyme-linked immunoabsorbent assay. The association of information collected with HBV infection in uterine were analyzed with case-control study.RESULTS:(1) Maternal HBV DNA or HBeAg positivity and neonate HBeAg positivity, mode of delivery, threatened abortion and threatened premature labor were processed with META analysis. With META analysis of all factors concerned, a significant association was found between the positivity of HBeAg in mother and in neonate, HBV DNA in mother peripheral serum, and HBV vertical transmission, with OR 19.43(95% confidence interval (CI) equal to 8.77-43.06), 7.98(95%CI=2.44-26.06), and 27.01(95%CI=8.65-85.32) respectively. Mode of delivery, threatened abortion and threatened premature labor proved not to be of risk factors on intrauterine transmission of Hepatitis B Virus.(2) Associations of mother's positivity for HBV DNA and HBsAg with HBV infection in uterine: Univariate analysis indicated that mother's positivity for HBV DNA and HBsAg were associated with occurrence of HBV intrauterine transmission with odd ratios 5.96(1.61-22.12) and 12.09(2.97-40.17) respectively. Mother's PQsitivity for HBV DNA was sequently affirmed by multiple logistic regression analysis.(3 ) Associations of sex contact with HBV infection in uterine: Sex contact in the first trimester or in the third trimester was not associated with HBV infection in uterine, whereas in the second trimester of pregnancy sex contact was found to be a risk factor for HBV intrauterine transmission with OR 9.15(1.10-76.28). Thestrength of association increased with frequency of sexual contact. Interaction analysis suggested that there was synergistic interaction between positivity for mother HBeAg or for mother HBV DNA and sexual contact in the second trimester.(4) Pretective effect of HBIG adminstration during pregnancy: Four hundred and two pregnant women who were not given HBIG for prevention of HBV intrauterine transmission during pregnancy were considered as controls; Two hundred and ten two pregnant women who were given HBIG for prevention of HBV infection in uterine during pregnancy were considered as cases. Based on the same diagnostic standard, 15 and 10 neonates were diagnosed, as occurrence of HBV intrauterine transmission, and the differnce was not significant which indicated that pretective effect of HBIG adminstration was limited.(5) Associations of neonate's positivity for HBeAg with HBV intrauterine transmission: Fifteen of fifty-eight consecutively collected sera samples from HBsAg positive mothers at the beginning of research were detected as HBeAg positive. Eleven of 58 neonates were detected as HBeAg positive who were all born to HBeAg positive mothers. Among 58 neonates, 3 were diagnosed as HBV intrauterine transmission and, interestingly all the 3 neonates were born to HBeAg positive mothers. Fisher's exact test indicated that associations of neonatal positivity for HBeAg with HBV intrauterine transmission were significantly. One hundred and thirty... |
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