Study On The Effect And Influencing Factors Of Antiviral Therapy In Pregnant Women With HBV Infection

BackgroundChronic Hepatitis B has become a public health problem worldwide.Mother-to-child transmission is its main mode of transmission.At present,antiviral therapy during pregnancy is recommended for pregnant women with high HBV DNA level.However,there is still some controversies.In addition,recognition of the optimal and suboptimal virological response,provides a reference direction for personalized treatment.MethodsProspective analysis of clinical data of HBsAg-positive pregnant women undergoing antiviral treatment in our outpatient clinic.Patients who started antiviral treatment during the second and third trimester were divided into the second trimester(13-27 weeks of pregnancy)group and the third trimester(28 weeks of pregnancy and After)group,and observe HBV DNA of patients in the two groups from beginning to stopping antiviral treatment,and neonatal HBsAg,and further explore the impact on mother factors related to short-term and the whole viral response.Select the appropriate statistical methods depending on the data types and study design.ResultFrom July 2015 to December 2019,331 pregnant women accepted antiviral treatment for preventing mother-to-child transmission of hepatitis B virus at Zhujiang Hospital,including 90 and 41 patients initiated antiviral therapy from the second or third trimesters,respectively.HBsAg was negative in 69 neonates,and the mother-to-child transmission rate of hepatitis B was 0.There was no statistically significant difference in HBV DNA levels and the rate of<2×105 IU/mL of pregnant women who received antiviral therapy from the second trimester and the third at the 4th、8th、12th week after antiviral treatment,at delivery and 6th to 8th after delivery.(P≥0.05)Taking the decrease from the baseline level to delivery in serum HBV DNA of pregnant womentrimester as the evaluation index of the virological response during the whole antiviral treatment.Our analysis found that the influencing factors are HBV DNA load before antiviral treatment(P<0.001)and types of antiviral drugs(LdT or TDF)(TDF for reference,B value=-0.255,P=0.013).Subgroup analysis was conducted by HBV DNA before treatment with≥6 log10IU/mL,which were statistically different(P=0.001).Taking the decrease of HBV DNA from baseline level to the 4th week of antiviral treatment as the evaluation index of early virological response of antiviral treatment.Our analysis found that the influencing factors are HBV DNA load before antiviral treatment(P<0.001),HBeAg positive(P=0.006),ALT level(P=0.003)and AST level(P=0.008).HBV DNA of the two groups was analyzed at the subgroup of 6 log10IU/mL,which was statistically different(P=0.002).Conclusion1.All newborns were negative for HBsAg.The mother-to-child transmission rate of hepatitis B was 0,and the mother-to-child transmission of hepatitis B was blocked.2.Antiviral treatment from the second and the third trimester can significantly reduce HBV DNA levels of pregnant women and the effect of blocking mother-to-child transmission is similar.3.The virological response during the whole antiviral treatment is related to the HBV DNA before antiviral treatment and the type of antiviral drugs.Pregnant women with HBV DNA ≥6 log10 IU/mL and using TDF(compared with LdT)for antiviral treatment,the HBV DNA response in the whole antiviral treatment during pregnancy is better.4.The early virological response of antiviral treatment is related to HBV DNA before treatment、HBeAg、ALT and AST.HBV DNA≥6 log10IU/mL,low ALT,high AST and HBeAg negative pregnant women,HBV DNA can rapidly decline after the 4th weeks of treatment.