Antiviral Mother-to-child Block In HBV Infection And Study On Maternal Safety After Drug Withdrawal

Objectives:Through retrospective analysis of clinical and laboratory data of pregnant women with HBV infection treated with tenofovir and Tibivudine for preventing mother-to-child transmission of hepatitis B virus,the efficacy and fetal safety of the two drugs for preventing mother-to-child transmission of hepatitis B were studied,the safety of the mothers after drug withdrawal was evaluated,and the related predictive factors of the onset of postpartum hepatitis were discussed.Methods:Data of newly treated patients with chronic hepatitis B during pregnancy and their newborns who visited the outpatient or inpatient department of Infection Department of Sichuan People’s Hospital from January 2018 to December 2021 were collected.A total of 302 cases were included,including 289 patients who stopped taking drugs after delivery,24 patients who repeated antiviral drugs after delivery,and 13patients who continued antiviral drugs after delivery.According to the type of antiviral drugs,265 patients who did not revirus after drug withdrawal were divided into tenofovir group and Tibivudine group.The viral response,liver function,pregnancy complications and the growth and development indexes of the newborns were analyzed at different treatment time points.To evaluate the antiviral effect of mother-to-child block of hepatitis B,the safety of pregnant women’s fetuses and whether there are differences between different drugs;The change trend and abnormal situation of ALT in 289 patients after drug withdrawal during delivery were analyzed,and the predictive factors affecting the abnormal postpartum ALT were discussed.Results:(1)Virus response:(1)Comparison between groups:there were no significant differences in HBV DNA levels between the two groups at different time points after antiviral therapy(p>0.05);There was no significant difference in the number of HBV DNA<10~3IU/mL and HBeAg turning negative during delivery.(2)Intra-group comparison:HBV DNA load in both groups decreased from antiviral therapy to delivery,and rebounded immediately after postpartum drug withdrawal.HBV DNA level in tenofovir group and Tibivudine group reached the baseline level at 6 and 3 months postpartum,respectively(p>0.05).(2)Liver function:(1)Comparison between groups:There was no statistical difference in ALT level between the two groups at 4 weeks,8weeks after antiviral treatment,at the time of delivery and 1 month after delivery(all p>0,05),but there were statistical differences in ALT level between the two groups at 3months and 6 months after delivery(p<0.05),and ALT level in Tenofovir group was higher than that in Tibivudine group at 3 months and 6 months after delivery.There was no significant difference in the number of patients with abnormal ALT in 1 month,3months and 6 months postpartum between the two groups.(2)Change trend of ALT in the two groups:ALT level in the two groups increased from 1 to 3 months postpartum,reached the peak in 1 month postpartum,began to decline from 3 months postpartum,and recovered to the baseline level in 6 months.(3)Mother-to-child blocking effect and fetal safety:No HBV infection occurred in the fetus during delivery,and the mother-to-child blocking rate was 100%.There was no statistical difference between the two groups in the number of pregnant women with gestational diabetes mellitus,gestational cholestasis,anemia and fetal dysplasia.There was statistical difference in the number of premature births between the two groups.A few pregnant women showed mild increase in DBi L and CK,as well as mild digestive tract symptoms,which could be improved after symptomatic treatment.There was no statistical difference in body length,body weight and Apgar score between the two groups.(4)The results of univariate and multivariate Logistic regression analysis showed that baseline HBV DNA level and baseline ALT level were both risk factors for postpartum abnormal ALT.The ROC curves of baseline HBV DNA level and baseline ALT level to predict postpartum ALT abnormalities showed that the AUC was 0.624 and 0.632,respectively,with p values<0.001,the cutoff value of baseline HBV DNA level was 7.935lg IU/mL,and the cutoff value of baseline ALT level was 34.5U/L.Conclusions:(1)In pregnant women with high HBV viral load for the purpose of mother-to-child block of hepatitis B,tenofovir or Tibivudine starting in the second and third trimester of pregnancy can effectively block mother-to-child transmission of hepatitis B,and promote the recovery of liver function while significantly reducing the level of HBV DNA.(2)After drug withdrawal,viral load rebounded to baseline in March or June;ALT level increased from 1 month to 3 months postpartum and returned to baseline level within 6 months.(3)It is safe for pregnant women and infants to stop taking antiviral therapy after delivery for the purpose of mother-to-child block of hepatitis B.(4)Baseline HBV DNA level and baseline ALT level were both risk factors for postpartum abnormal ALT,and their predicted cutoff values were 7.935lg IU/mL and 34.5U/L,respectively.