The Study And Meta-analysis Of The Influence Of The Delivery And Feeding Mode On The Blocking Mother-to-child Transmission Of HBV

According to the World Health Organization,about 2 billion people worldwide are infected with hepatitis B virus,350 million are carriers of chronic hepatitis B virus,and 240 million are chronically infected.Hepatitis B virus(HBV)infection is one of the major public health burdens worldwide.China is a high epidemic area of HBV.HBV infection mainly occurs in perinatal period and infants,and mother-to-child transmission is the most important modes of transmission.By taking measures to block in the prenatal,intrapartum and postpartum stages,especially after the combination of active and passive immunization in the postpartum stage,the mother-to-child transmission rate of HBV has been significantly reduced,but for high-risk infants whose mothers are HBsAg and HBeAg positive,there is still a risk of immunoprophylaxis failure,thus exploring the risk factors leading to the failure is of great significance for achieving zero transmission of HBV.Objective:To explore the factors that may affect the infant immunoprophylaxis failure of HBsAg and HBeAg positive mothers.Considering the low immunoprophylaxis failure rate and low test efficacy,meta-analysis was used to synthesize the results of various studies,focusing on the impact of delivery mode and feeding mode on the blocking of mother-to-child transmission of HBV.Methods:(1)Pregnant women who were both positive for serum HBsAg and HBeAg and did not receive antiviral treatment during pregnancy were recruited from the First Hospital of Jilin University,Jiangsu Maternal and Child Health Care Centers and Henan Maternal and Child Health Care Center between August 2009 and June 2015.All infants were administered injections of 100IU or 200IU HBIG and 10?g or 20?g HepB after birth,followed by administration of the same dose of HepB at the ages of1 month and 6 months.Venous blood samples were collected from infants and detected for HBsAg at 7 months of age.Relevant information was obtained through questionnaires and telephone follow-up.Logarithmic binomial distribution model analysis was used to analyze risk factors.(2)A systematic literature search was performed of the PubMed,Embase,the Cochrane databases,China Biological Medicine Database,China National Knowledge Infrastructure,and Wanfang Chinese databases.Retrieval strategy was“HBV”(or“hepatitis b”or“hepatitis b virus”)and“mother-to-infant transmission”(or“vertical transmission”).Studies in which pregnant women did not receive antiviral therapy during pregnancy were screened according to inclusion and exclusion criteria and data included in the study were extracted.Statistical analyses were conducted with Stata12.0.The risk ratios(RR)with 95%confidence interval(CI)was used as a measure to assess the risk.Heterogeneity among studies was assessed by I~2 test.Publication bias was evaluated by funnel plot and Egger's regression test.Result:(1)A total of 852 mothers with HBsAg and HBeAg antigen positive and 857newborns were enrolled in the study.At the age of 7 months,41 infants were positive for HBsAg,and the infection rate was 4.78%.Logarithmic binomial distribution model showed that mothers with higher HBV DNA levels(>10~8IU/mL;RR=2.95,95%C:1.37-6.35)were associated with an increased risk for immunoprophylaxis failure.Although cesarean section(RR=0.56,95%CI:0.29-1.09)and non-breastfeeding(RR=0.91,95%CI:0.48-1.71)showed a tendency to reduce the risk of infection,there was no statistical significance.(2)A total of 5294 literatures were identified through search terms,and 17literatures were included after evaluating,of which 10 were included in the study of delivery mode and 11 were included in the study of feeding mode.In the study of delivery mode,the infection rate of hepatitis B was 11.50%in vaginal delivery group and 6.49%in cesarean section group.The risk of HBV infection in cesarean section group was lower than that in vaginal delivery group(RR=0.60,95%CI:0.47-0.76).In the study of feeding mode,the infection rate of HBV in breast-feeding group was8.33%,and that in non-breastfeeding was 6.79%.Compared with breastfeeding group,the risk of HBV infection in non-breastfeeding group was significantly lower(RR=0.74,95%CI:0.56-0.98).Conclusion:For mothers with both HBsAg and HBeAg positivity who did not receive antivirals during pregnancy,high viral load increased the risk of immunoprophylaxis failure in their infants.Cesarean section and non-breastfeeding reduced the risk of HBV blocking failure in infants with HBsAg and HBeAg positive mothers who did not receive antiviral therapy during pregnancy.