Mother-to-child transmission (MTCT) risk for hepatitis B virus (HBV) is not increased by amniocentesis among infants receiving a standardized immunoprophylaxis schedule, according to a recent study published in the American Journal of Obstetrics & Gynecology.
Takeaways
- The study suggests that amniocentesis, a common prenatal diagnostic procedure, does not increase the risk of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) when infants receive standard immunoprophylaxis.
- Efforts to combat HBV transmission align with the Global Health Sector Strategy on Viral Hepatitis, aiming to reduce HBV infections in children under 5 to 0.1% by 2030.
- Despite vaccination and immunoglobulin administration, HBV infection in children under 5 remains a challenge, with failure rates ranging from 1% to 14%.
- The study was a retrospective cohort study involving HBsAg-positive pregnant women who underwent amniocentesis or noninvasive prenatal testing. Infants included in the study received standard immunoprophylaxis.
- The analysis showed similar MTCT rates of HBV between the amniocentesis group and the control group. Even among pregnant women with HBeAg positivity or high viral loads, the MTCT rates were not significantly different between the groups.
HBV is present in approximately 296 million individuals, according to the World Health Organization. The Global Health Sector Strategy on Viral Hepatitis 2016–2021, aiming to eliminate the public health threat of viral hepatitis by 2030, has received endorsement from the World Health Assembly.
The strategy includes the goal of reducing HV infection in children aged 5 years to 0.1%. Many HBV infections in children aged under 5 years are caused by MTCT, and efforts such as vaccination and hepatitis B immunoglobulin (HBIG) have failed to prevent infection in 1% to 14% of children.
Amniocentesis is the most common invasive prenatal diagnostic method, but it is unclear if this method increases MTCT HBV infection risk. To determine whether amniocentesis increases the MTCT rate of HBV in infants given standard prophylaxis, investigators conducted a single-center retrospective cohort study.
Participants included hepatitis B surface antigen (HBsAg)-positive pregnant women receiving amniocentesis or noninvasive prenatal testing at West China Second University Hospital, Sichuan University in 2019. Patients had a negative hepatitis B surface antibody (HBsAb) and regular monitoring for HBV serologic markers, HBV DNA load, and liver function.
Eligibility criteria for infants included receiving a standardized HBIG and HBV vaccine active–passive immunoprophylaxis schedule and having 1 or more serologic test for HBV markers 1 to 6 months following the latest vaccination.
Exclusion criteria included coinfection with HIV, syphilis, hepatitis A virus, and hepatitis C virus, miscarriage, pregnancy termination, or stillbirth, twin or multiple pregnancy, infant death within 6 months of birth, and loss of follow-up data. Electronic medical records, paper medical documentation, and telephone follow-ups were assessed for participant data.
Data collected included maternity history, HPV status of husband and previous child, age, pregnancy complications, and placental location. HBV serological markers assessed in the first, second, and third trimester 3 times include HBsAg, HBsAb, hepatitis B e antigen (HBeAg), hepatitis B e antibody, and hepatitis B core antibody.
Monthly measurements of aspartate aminotransferase levels, alanine transaminase, and HBV DNA were also performed. Offspring data included birth length, weight, sex, feeding method, mode of delivery, and immunization schedule.
There were 846 women in the amniocentesis group and 918 in the control group included in the final analysis, with mean ages of 32.05±5.92 years and 29.73±4.354 years, respectively. HBeAg was reported in 13.1% of the amniocentesis group and a relatively high viral load in 9.2%. These rates were 22.8% and 11.7%, respectively, in the control group.
Antiviral therapy during pregnancy was given to 13.4% of the amniocentesis group and 16.8% of the control group. Premature birth was reported in 7.1% and 4.4% of these groups, respectively. However, fetal hypoxia, cesarean delivery rates, sex, birth weight, and feeding methods were similar between both groups.
HBV infection was reported in 5 of 846 infants in the amniocentesis group and 4 of 918 in the control group, indicating similar infection rates. These results did not significantly change when comparing MTCT rates among pregnant women who did not receive antiviral drugs during pregnancy.
Comparisons were also made among women who were HBeAg-positive or had a high viral load. The MTCT rates among HBeAg-positive participants were 2 of 111 in the amniocentesis group and 2 of 209 in the control group.
The difference between these rates was not statistically significant. Similar results were reported among patients with high viral load, at 1 of 78 and 1 of 107, respectively.
These results indicated MTCT HBV risk is not increased among patients receiving amniocentesis unless abnormal amniotic fluid is observed during amniocentesis. This is true even among pregnant women who are HBeAg-positive or have a high viral load.
Reference
Du X, Zhang L, Liu Z, et al. Risk of mother-to-child transmission after amniocentesis in pregnant women with hepatitis B virus: a retrospective cohort study. Am J Obstet Gynecol. 2024;230:249.e1-8. doi:10.1016/j.ajog.2023.07.032
