title: Measures to reduce mother-to-child transmission of Hepatitis B virus in China: a meta-analysis.
abstract: BACKGROUND
  Mother-to-child transmission (MTCT) is the main mode of spread of hepatitis B virus (HBV) in China. We performed a meta-analysis to compare the effects of three measures for prevention of MTCT.
  
  
  METHODS
  A meta-analysis was performed on randomized controlled trials and non-randomized studies comparing the index of MTCT among five groups of pregnant women: hepatitis B immunoglobulin (HBIG) administration, antiviral treatment, placebo, elective caesarean section, and vaginal delivery.
  
  
  RESULTS
  Compared with the control group, the incidence of HBV intrauterine infection (RR = 0.42, 95 % CI 0.27-0.64, P < 0.0001) and the number of chronic hepatitis B (CHB) infants (RR = 0.44, 95 % CI 0.32-0.61, P < 0.00001) were lower in the HBIG administration group. In the antiviral treatment group, serum HBV DNA levels were lower (MD = -4.01, 95 % CI -5.07 to -2.94, P < 0.00001) at the time of delivery, and normalization of ALT levels was better (RR = 1.11, 95 % CI 1.06-1.17, P < 0.0001). Infant serum HBsAg positivity (RR = 0.45, 95 % CI 0.22-0.91, P = 0.03) and incidence of infant HBV transmission RR = 0.06, 95 % CI 0.01-0.24, P < 0.0001) were reduced in antiviral the treatment group. Infant serum anti-HBs positivity at birth (RR = 1.24, 95 % CI 0.89-1.74, P = 0.2) or at 6-7 months (RR = 0.98, 95 % CI 0.86-1.11, P = 0.73) was not significantly different between the caesarean section and vaginal delivery groups. The incidence of infant CHB infection may have been higher in the vaginal delivery group (RR = 2.20, 95 % CI 1.02-4.74, P = 0.04).
  
  
  CONCLUSIONS
  Administration of HBIG or antiviral therapy to HBV carrier mothers during pregnancy is effective in reducing MTCT.
authors.affiliation: The Second College of Clinical Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lingjiang Road, Central District, Chongqing, 400010, China, xuhua0605@126.com.
authors.forename: Hua
authors.initials: H
authors.lastname: Xu
authors.forename: Teng
authors.initials: T
authors.lastname: Zeng
authors.forename: Jun-Ying
authors.initials: JY
authors.lastname: Liu
authors.forename: Yu
authors.initials: Y
authors.lastname: Lei
authors.forename: Shan
authors.initials: S
authors.lastname: Zhong
authors.forename: Yun-Jian
authors.initials: YJ
authors.lastname: Sheng
authors.forename: Zhi
authors.initials: Z
authors.lastname: Zhou
authors.forename: Hong
authors.initials: H
authors.lastname: Ren
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D002585:Cesarean Section; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D017558:Elective Surgical Procedures; D005260:Female; D017325:Hepatitis B Vaccines / Q000627:therapeutic use*; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D015994:Incidence; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D016017:Odds Ratio; D011247:Pregnancy; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin