Lamivudine in late pregnancy to interrupt in utero transmission of hepatitis B virus: a systematic review and meta-analysis.
OBJECTIVE
To evaluate efficacy of lamivudine in reducing in utero transmission of hepatitis B virus (HBV).


METHODS
A database was constructed from Medline, EMBASE, Cochrane Library, National Science Digital Library, China Biological Medicine Database, and through contact with experts in the field from January 1990 to October 2009.


METHODS
We used the Jadad score and Cochrane Collaboration's tool for assessing risk of bias.


RESULTS
We abstracted data regarding HBV intrauterine infection, mother-to-child transmission, maternal HBV DNA level, treatment methods, and adverse effects. All newborns followed joint immune prophylaxis schedule of hepatitis B vaccine and hepatitis B immunoglobulin after delivery. The Mantel-Haenszel random-effects model was employed for all analyses using odds ratio (OR) and 95% confidence interval. Compared with the no-treatment group or placebo group, newborns in the lamivudine group had a 10.7–23.7% lower incidence of intrauterine infection, indicated by newborn hepatitis B surface antigen (0.38,0.15–0.94, six randomized controlled trials [RCTs], P5.04) and HBV DNA (0.22, 0.12–0.40, four RCTs, P,.001) seropositivity, and a 12.7–33.2% lower mother-to child transmission rate at 9–12 months, indicated by infant hepatitis B surface antigen (0.31, 0.15–0.63, five RCTs, P,.01) and HBV DNA (0.20, 0.10–0.39, two RCTs,P,.001) seropositivity [corrected].No significant higher adverse effects or complications in pregnancy were observed.


CONCLUSIONS
Lamivudine in HBV carrier-mothers with high degree of infectiousness in late pregnancy effectively prevented HBV intrauterine infection and mother-to-child transmission.
Shi
Zhongjie
Z
From the Department of Chemistry and Biology, Temple University, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; and Health Science Center, Temple University, Philadelphia, Pennsylvania.
Yang
Yuebo
Y
Ma
Lin
L
Li
Xiaomao
X
Schreiber
Ann
A
D002353:Carrier State; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control* / Q000635:transmission; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000235:genetics; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019259:Lamivudine / Q000627:therapeutic use*; D008962:Models, Theoretical; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*
D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine