Source Division of Liver Diseases, The Mount Sinai Medical Center, Mount Sinai School of Medicine, New York, NY, USA.
BACKGROUND & AIMS: Despite immunoprophylaxis, mother to child transmission (MTCT) of hepatitis B virus (HBV) still occurs in infants born to HB surface antigen (HBsAg)+ mothers. We analyzed methods of risk assessment and interventions for MTCT.
METHOD: We reviewed 63 articles and abstracts published from 1975 to 2011 that were relevant to MTCT; articles were identified using the PubMed bibliographic database.
RESULTS: Administration of HB immunoglobulin (HBIg) and HB vaccine to the infants at birth (within 12 hours), followed by 2 additional doses of vaccines within 6 -12 months, prevented approximately 95% of transmission from HBsAg-positive mothers to their infants. However, HBV was still transmitted from 8-30% of mothers with high levels of viremia. It is important to assess risk for MTCT and identify mothers that are the best candidates for intervention. The most important risk factor is maternal level of HBV DNA > 200,000 IU (10(6) copies)/mL; other factors include a positive test result for HB e antigen (HBeAg), pregnancy complications such as threatened preterm labor or prolonged labor, and prior failure of immunoprophylaxis in sibling(s). Antiviral therapy during late stages of pregnancy is the most effective method to reduce transmission from mothers with high levels of viremia, but elective cesarean section might also be effective. Antepartum administration of HBIg, giving infants a double dose of HB vaccine, or avoiding breast feeding had no impact on MTCT.
CONCLUSIONS: HBsAg-positive mothers should be assessed for risk of MTCT and infants should receive immunoprophylaxis. Pregnant women with levels of HBV DNA > 200,000 IU/mL should be considered for strategies to reduce the risk for MTCT; we propose an algorithm for risk assessment and patient management, based on a review of the literature and the opinion of a panel of physicians with expertise in preventing MTCT.