Study On Main Measures And Effect To Prevent HBV Transmission From Mother To Child During Pregnancy

ObjectivesTo explore the influential factors of choosing the blocking measures and the effects ofmain interventions. To evaluate the costs and effects of different blocking measures ofmother-to-child transmission of hepatitis B by the economic evaluation method, so as toselect the best intervention to prevent mother to child transmission of hepatitis B andprovide scientific evidence to the government and related departments to make reasonabledecisions.MethodsThe HBsAg-positive pregnant women and their children were taken out as studyobjects, who accepted prenatal care in district Maternal and Child Health Hospital ofWuhan City, from Jan 1st, 2004. Investigators who received strict training madeface-to-face or telephone interviews to these women with uniform questionnaires based ona voluntary and confidential principle. SPSS10.0 software was used to do data analysis,including descriptive analysis, t test. Chi-square test, nonparametric test, single factor andmulti-factor non-conditional logistic regression.Results1. Blocking measures and effectThe HBsAg positive rate among the pregnant women was 8.67%. 232 pregnant women (71.83%) were injected HBIG during pregnancy, and 90.00% of them began toinject in the third trimester of pregnancy. 90.00% of the pairs injected three needles. 293children were injected HBIG after birth, 94.20% of them accepted 1 needles. In the 323pregnant women, 258 (79.88%) had cesarean section, of which, 29.84% had cesareansection due to hepatitis B factors. 153 pregnant women (47.37%) developed artificialfeeding, 81.70% of which were owing to hepatitis B factors.The incidence of premature rupture of membranes, cesarean section and artificialfeeding of HBsAg positive pregnant women were higher than those of normal pregnantwomen, with statistically significant difference (P＜0.05).Among the 323 pairs of mothers and children, there were 23 pairs (7.12%) thatpregnant women without their children were injected HBIG during pregnancy. 84 pairs(26.00%) children alone were injected HBIG at birth and after birth (active and passiveimmunization). 209 pairs (64.71%) both pregnant women and their children were injectedHBIG (united maternal and child immunization). 7 pairs (2.17%) neither pregnant womennor their children were injected HBIG.Of the 323 infants, 22 (6.81%) infants suffered from intrauterine infection, 10 of themchanged to HBsAg negative after the full vaccination. 15 had HBsAg-positive at 6 monthsold (6.05%), 10 of them had been intrauterine infection. 154 (47.68%) infants hadHBsAb-positive at 6 months old.2. HBeAg and mother-to-child transmission of hepatitis B63 cases (19.51%) of HBsAg-positive pregnant women had HBeAg positive. In thesingle-positive group (only HBsAg-positive), the rate of cesarean section was 77.31%,20.40% of which were for the purpose to prevent HBV infection. And the rate of artificialfeeding was 38.46%, 73.00% of which were for the purpose to prevent HBV infection. Theintrauterine infection rate of newborns was 25.40%. The chronic HBV rate of children was14.29%. Among the double-positive group (HBsAg-positive and HBeAg-positive), the rateof cesarean section was 90.48%, 63.16% of which were for the purpose to prevent HBV infection. And the rate of artificial feeding was 84.13%, 98. 11% of which were for thepurpose to prevent HBV infection. The intrauterine infection rate of newborns was 2.31%.The chronic HBV rate of children was 2.31%. Comparing with the single-positive group,the double-positive group have significantly higher rate not only the caesarean section andthe artificial feeding (χ~2=38.7788, P＜0.0001;χ~2=42.4181, P＜0.0001), but also theintrauterine infection and the chronic HBV infection of children (χ~2=42.5934, P＜0.0001;χ~2=16.4303, P＜0.001).3. Factors of blocking measures and effectResults of single factor analysis indicated that some factors correlated to the methodsand times of blocking measures, including maternal age, perinatal occupation, educationlevel, family per capita monthly income, occupation and education level of husband, theinitial time and place of prenatal care, delivery time and location. And the effect of blockingmeasures was correlated with HBV infection status of pregnant women, injected HBIGduring pregnancy or not, birth age, the initial time of prenatal care, infant HBIG injectionfrequency, times of breast-feeding and birth year.After multi-factor analysis, we presumed that pregnancy HBIG injection was primarilyaffected by maternal age (OR=2.205), education level (OR=3.275), family per capitamonthly income (OR=1.693), birth year (OR=0.380), length of stay in hospital (OR=0.543)and husband occupation was staff occupational category (staff, business services staff,workers, migrant workers) (OR=2.205). If infants received more needles of HBIG injection(OR=3.873) and much longer breast-feeding (OR=9.815), they would be prone to haveHBsAb-positive at 6 months old.5. Economic evaluationThe cost effectiveness ratio (CER) of mother-infant combine blocking to decrease theintrauterine infection was lower than only pregnancy blocking. Comparing with the onlyinfant blocking, the total CER of mother-infant combine blocking to decrease the chronicHBV infection of children was lower, and the direct CER was higher. The CER of mother-infant combine blocking to increase the antibody protection ratio surpassed the onlypregnancy blocking and only infant blocking. Mother-infant combine blocking wasoptimization among the three measures when being evaluated by cost-utility analysis,sensitivity analysis and incremental cost effectiveness analysis.Conclusions1. Pregnant women carrying rate of hepatitis B virus showed an upward trend overall,in Wuhan City in recent years.2. Mother with HBeAg-positive is a high risk factor to the mother-to-childtransmission of HBV. However it was not given enough reconstruction by HBsAg-positivepregnant women.3. HBsAg-positive pregnant women, in particular the mergers of HBeAg-positive, tendto choose cesarean section and artificial feeding. And in this study, the effect of cesareansection and artificial feeding on preventing mother-to-child transmission of hepatitis B hadno significantly difference. Cesarean section and artificial feeding are not the necessaryconditions to prevent mother-to-child transmission of hepatitis B.4. The selection and effect of preventing mother-to-child transmission of hepatitis Bwill be affected not only by the individual, family factors, but also by the medicalenvironment.5. Comparison from an economic point of view, the measure that mothers inject HBIGduring pregnancy and their children inject HBIG and hepatitis B vaccine after birth couldreduce major rate of intrauterine infection and chronic HBV infection of children, restoremore DALY, and could more effectively improve the rate of infants` antibody protection atthe same cost. Therefore, it is superior to other measures on preventing mother-to-childtransmission of hepatitis B in Wuhan City in recent years and should be recommended.