Serological Characteristics And The Value Of Umbilical Blood And Peripheral Blood For Diagnosis Of Mother To Child Transmission

Background and Objective:Three modes were considered as possible ways of mother to infanttrans mission of hepatitis B virus:intrauterine,parturient and postpartum trans missions.After the implementation of passive-active immunization for infants from HBeAg-positive mothers,most studies suggested that intrauterine infectionwas occurred for the children who had immunoprophylaxis failure.Some scholars use theHBV-M in neonates to analyze the mother-to-child transmission.Some studies believe that umbilical blood is safe,easy to operate,and easy for family members to accept,so they use HBV-M in cord blood to analyze mother-to-child transmission.Some considered that the venous blood of infants at birth was the more accurate diagnostic marker for HBV infection than umbilical cord blood because the umbilical cord blood can be contaminated by maternal blood easily.Inour study,we collectedboth umbilical blood and peripheral blood of neonatesand focused on the analysis of HBV characteristics of neonates in which born HBsAg-positive pregnant women.At the same time,we conducted quantitative detection and comparative analysis of HBV serological markers of peripheral blood and cord blood from neonatal,which may provide an important value for the early diagnosis of HBV mother-to-child transmissionMethods:750 neonates and pregnant women from pregnant womendelivered at Shenzhen Third People's Hospital between 2011 and 2016 were enrolled.386 peripheral blood from HBsAg-positive pregnant women and their neonatal umbilical cord blood were collected,and newborn infants were followed up at their 7th-12th months.The viral loads and hepatitis B virus markers of peripartum pregnant women(using peripheral blood,pb),follow-up children(pb)and neonates(using umbilical blood,ub and pb)was evaluated.In our study,HBV DNA was detected by fluorescence-based quantitative real-time PCR,and the titers of HBsAg,HBsAb,HBeAg,HBeAb and HBcAbwere quantitatively detected by chemiluminescenceResults:(1)In our study,750 neonates and pregnant women from pregnant women were HBsAg positive delivering at Shenzhen Third People's Hospital between 2011 and 2016 were enrolled.High viral load(more than 2×105 IU/mL)accounted for 30.5%(229/750)in pregnant womenof HBsAg positive.207 newborn infants were followed up at their 1th-12th months.For the rule-outsubjects,62 of them had detected HBV virus titers in other hospitals and refused to back,95 of them were out of Shenzhen,22 of them could not be contacted.(2)Additionally,28.1%,39.2%,98.5%and6.2%of the umbilical cord(UC)of neonates were found to be positive for HBsAg,HBeAg,HBcAb and HBV-DNA,respectively,whereas for neonatal femoral venous blood(FV),the percentages were 14.2%,37.3%,98.8%and 2.3%,respectively.(3)Motherswith high HBV DNA loads or HBeAg-positiveproduced offspring with significant increases in HBV positivity rates(P<0.05).Imunoprophylaxis failed in five infants:the children were all born to HBeAg-positivemothers withhigh HBV DNA levels.(4)The difference of median HBV DNA titers in UC blood for infants with HBV MTCT and without HBV MTCT(P<0.05).There was no significant difference in HBV DNA titers between UC blood and in peripheral blood of infants with HBV MTCT(P>0.05).Conclusions:The characteristics of HBV-M in umbilical bloodbears resemblance to those in peripheral blood while they also have obvious distinctions.The rate and amount of HBV transmission through the placenta are related to the titer of HBV mother.HBsAg and HBV DNA negative at birth rules out the occurrence of mother-to-child transmission.However,HBsAg and HBV DNA positive at birth cannot diagnose mother-to-child transmission.HBVDNA titers in UC is a good predictor for predictive value for HBV MTCT.