Research On The Status Of Antiviral Therapy And Effect Of Mother-to-child Transmission Interruption Of HBsAg Positive Pregnant Women During Pregnancy Based On Hospital

Objective:The study aims to understand HBeAg,HBV-DNA distribution characteristics of HBsAg positive pregnant women and status of antiviral treatment in pregnant women after hepatitis B antiviral drugs were included in medical insurance,analyze the effect of mother to child transmission and potential influence factors of babies accepted active passive immunity born to high HBV-DNA level pregnant women who accepted antiviral treatment during pregnancy.To provide a basis for proposing and popularizing comprehensive preventing measures and eliminating mother-to-child transmission.Methods:A typical investigation was adopted.Information including demography,antiviral treatment,serum HBV markers during pregnancy and before delivery of HBsAg positive pregnant woman who established record in Beijing Ditan hospital affiliated to capital medical university was collected from hospital information management system to describe HBV-DNA distribution and HBeAg positive state during pregnancy and before delivery as well as antiviral treatment state.Basic information such as weight,body length and Apgar score and follow-up results of preventing of mother-to-child transmission at 7 months-2 years old after HepB immunization of babies born to HBsAg positive pregnant woman were collected to analyze the preventing effect of anti-viral drugs intervention group and non-intervention group in pregnant women,and multivariate logistic regression was used to analyze the factors affecting the effect of preventing of mother-to-child transmission.Results:1.The HBeAg positive rate of HBsAg positive pregnant women during pregnancy and before delivery was 46.86%and 46.90%,respectively.HBV-DNA(IU/mL)<1.0×104,1.O×104?2.0×106,and?2.0×106 during pregnancy and before delivery accounted for 54.46%,9.47%,36.14%and 68.49%,21.64%,9.86%,respectively.HBV-DNA(IU/mL)of High viral level pregnant women in antiviral treatment group and no-antiviral treatment group during pregnancy in 2.0×106?1.0×107,1.0×107?1.0×108,?1.0×108 accounted for 6.69%,25.54%,68.07%and 6.56%,27.57%,and 65.86%,respectively.The proportion of HBV-DNA<2.0×106IU/mL before delivery was 99.13%and 9.26%,respectively.2.The antiviral treatment rate of HBsAg positive pregnant women was 27.16%,and the antiviral treatment rate of pregnant women with high viral load was 75.10%.Pregnant women using LdT,TDF and LAM for antiviral treatment accounted for 64.18%,34.60%and 1.22%,respectively.The utilization rate of TDF increased year by year(?2=760.34,P<0.001).77.13%and 20.30%of patients started antiviral therapy in the second and third trimester.The antiviral treatment rate of pregnant women with high viral load using medical insurance,new rural cooperative medical system(NCMS)and out-of-pocket payment were 77.49%,68.75%and 70.48%,respectively.The rates of antiviral therapy for pregnant women using medical insurance were higher than those of NCMS and out-of-pocket(?2=6.43,P=0.011;?2=8.15,P=0.004).Median antiviral therapy time for pregnant women with high viral load was 11 weeks,after antiviral treatment,the median decline was 1.0×104IU/mL3.There was no statistical difference in the gender,length,weight,Apgar score and birth defect rate of babies born in HBsAg positive pregnant women's antiviral treatment group and non-antiviral treatment group.The failure rate of preventing mother-to-child transmission was 0.24%,0.59%,0.50%,0.60%,5.00%,and 7.01%,respectively,for babies born to pregnant women with HBV-DNA(IU/mL)<1.0×102,1.0×103?1.0×104?,1.0×105?,1.O×107 and ?1.0×108IU/mL before delivery.The failure rate of preventing mother-to-child transmission in antiviral treatment group and no-antiviral treatment group with high viral load during pregnancy was 0.70%and 6.67%,respectively(?2=26.69,P<0.0001).4.Compared with HBV-DNA negative pregnant women,the OR value of failure of mother-to-child transmission of babies born to pregnant women with HBV-DNA?2.0×106IU/mL was 13.54(95%CI:2.50-73.37).No statistical significance has been found between HBV-DNA<2.O×106IU/mL and failure to block mother-to-child transmission?Conclusion:1.The management of HBsAg positive pregnant women during pregnancy should focus on high viral load women,especially whose HBV-DNA is more than 1.0×107IU/mL.HBV-DNA of pregnant women with high viral load accepted antiviral treatment mostly falls below 2.O×106IU/mL before delivery.HBV-DNA load and HBeAg titer decreased with age during pregnancy and before delivery.HBV-DNA load increased with HBeAg titer during pregnancy.2.HBsAg positive pregnant women were mainly treated with TDF and LdT,and the utilization rate of TDF increased year by year.The beginning time of antiviral treatment mainly ranged from 24 to 28 weeks.The use of medical insurance payments can increase the rate of antiviral therapy in pregnant women.3.Antiviral therapy during pregnancy can significantly reduce the HBV-DNA level of pregnant women,combining with HepB and HBIG,and thereby reduce the failure rate of preventing mother-to-child transmission of babies born to HBsAg positive pregnant women,and has no adverse effects on fetal growth and development.Antiviral therapy has little effect on HBeAg positive rate of HBsAg positive pregnant women4.HBV-DNA load is an important factor affecting mother-to-child transmission interruption.The failure rate of mother-to-child transmission interruption increases with HBV-DNA load before delivery in pregnant women.The HBeAg status during pregnancy is also worthy of concern.