| OBJECTIVE: ①To explore the route that the HBsAg positive pregnant women's cell entered fetal circulation,and to study the mechanism of HBV intrauterine transmission that the cell transported HBV to fetus and infected fetus. ②To study the risk factors of HBV intrauterine infection and HBV infection and replication in PBMC. METHODS: 123 pregnant women and 123 newborns were collected between December,2001 and October,2003 in Taiyuan infectious hospital,the epidemiological base line data involving gestation and postpartum were also collected,maternal elbow vein blood and femoral vein blood from newborns not only within 24 hours but also before infecting hepatitis B immuno-globulin(HBIG)were also collected at the same time. Following studies were performed:HBsAg,HBeAg,HBV DNA in gravidas' serum and HBsAg,HBV DNA in newborns' serum were determined by ELISA and nested-PCR(nPCR)； HBV DNA in gravidas ' and newborns' serum and PBMC were detected by selective-PCR(sPCR)；TH01 polymorphism in gravidas,maternal specific alleles,maternal DNA in newborns' peripheral blood were determined by PCR-STR,allele-specific PCR(AS-PCR) and heminested PCR(hemi-nPCR)；risk factors were analyzed by nested case-control study,the interaction among risk factors were also analyzed. All of the data was analyzed by the statistical packages Visual Fox Por 6.0 ,SPSS 10.0 for windows and EPI Info 2000.RESULTS:1. HBV intrauterine infection rate was 40.65%(50/123)in sum,and 38.64%(17/44)in HBsAg and HBeAg both positive mothers. 2. There was no association between PBMC HBV infection in pregnant women whose serum HBV DNA were negative and HBV intrauterine infection(χ2 =3.62,P﹥0.05), but there was significantly association between PBMC HBV infection in pregnant women whose serum HBV DNA were positive and HBV intrauterine infection(χ2 =8.77,P﹤0.01). 3. The TH01 polymorphism in mother-baby could not be used to define the maternal specific alleles.4. Regarding GSTM1,ACE as maternal specific alleles:42 mother-baby pairs were recruited from hemocyte specimens as informative cases,then examining 26(61.90%) newborns'blood cell out of 42 informative cases had maternal cell DNA；by the same token,the detection rate were respectively 73.81%(31/42) and 72.22%(26/36) from blood clotting and serum specimens.5. Nested case-control study analysis showed that risk factors of HBV intrauterine infection were PBMC HBV infection in pregnant women (OR=8.78, 1.23-62.69) and the cell transportion from mother to baby (OR=8.40, 1.42-49.74). There was no interaction between the two factors. The exposure rate of other factors did not reveal the difference in two groups. 6. Nested case-control study analysis showed that risk factors of HBV infection in neonatal PBMC were PBMC HBV rcDNA positive in pregnant women(OR=8.44, 1.37-51.83) and the cell tansportion from mother to baby(OR=11.96, 2.08-68.81), there was no interaction between the two factors; Risk factors of HBV replication in neonatal PBMC was PBMC HBV replication in pregnant women(OR=16.94, 1.71-167.68). CONCLUSIONS: 1. HBV intrauterine infection rate was 40.65% for HBsAg and/or HBV DNA and/or PBMC HBV DNA in neonatal serum of HBsAg positive mothers.2. There is association between PBMC HBV infection in pregnant women and HBV intrauterine infection. 3. The detection of maternal DNA in newborns'peripheral blood whose mothers were HBsAg positive. And the cell transportion from mother to baby had something to do with HBV intrauterine infection and PBMC HBV DNA in newborns,but it had nothing to do with the cell transportion from baby to mother. This revealed the vertical transmission of HBV,that is the transportation of HBV in cell (PBMC)resulted in HBV intrauterine infection.4. Risk factors for HBV intrauterine infection were PBMC HBV infection in pregnant women and the cell transportion from mother to baby. There was no interaction between the two factors；Risk factors of HBV infection in neonatal PBMC were PBMC HBV rcDNA positive...
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