title: Risk of vertical transmission of hepatitis B after amniocentesis in HBs antigen-positive mothers.
abstract: OBJECTIVE
  Despite appropriate immunoprophylaxis, HBV vertical transmission (VT) occurs in 5-10% of infants born to HBs-antigen (HBsAg)+ mothers. We investigated whether amniocentesis increases the risk of transmission.
  
  
  METHODS
  We performed a case-control study on infants who were born to HBsAg+ mothers without antiviral exposure and completed appropriate immunization. Infants born to mothers with amniocentesis were compared to those without amniocentesis to assess VT rates, which were defined by the percentage of infants with HBsAg positivity when they were 7-12 months old.
  
  
  RESULTS
  Of the 642 consecutive infants enrolled, 63 infants with amniocentesis were compared with 198 matched infants selected from the remaining 579 infants without amniocentesis. There was a higher VT rate in infants with amniocentesis than in those without amniocentesis (6.35% vs. 2.53%; p=0.226). Maternal HBV DNA levels before amniocentesis were further stratified to <500 copies/ml, 500-6.99 log10 copies/ml, and ⩾ 7 log10 copies/ml for subset analyses. There were no significant differences in the VT rates between the amniocentesis group and the control group if the maternal HBV DNA levels were <6.99 log10 copies/ml. However, a significantly higher VT rate was observed in the amniocentesis group vs. the control group if the maternal HBV DNA levels were ⩾ 7 log10 copies/ml (50% vs. 4.5%, respectively, p=0.006). According to baseline value risk analyses, performing amniocentesis on highly viremic mothers was a risk factor for HBV transmission (OR=21.3, 95% CI: 2.960-153.775).
  
  
  CONCLUSIONS
  Amniocentesis performed on HBsAg+ mothers with HBV DNA ⩾ 7 log10 copies/ml significantly increased the frequency of VT. HBsAg+ women who plan to have amniocentesis should be evaluated for the risk of VT and stratified according to their HBV DNA levels. Further prospective studies are warranted to verify our findings.
authors.affiliation: Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Yi
authors.affiliation: Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA. Electronic address: cpan11355@yahoo.com.
authors.forename: Calvin Q
authors.initials: CQ
authors.lastname: Pan
authors.affiliation: Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
authors.forename: Jianzhen
authors.initials: J
authors.lastname: Hao
authors.affiliation: Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
authors.forename: Yuhong
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
authors.forename: Min
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
authors.forename: Dongzhu
authors.initials: D
authors.lastname: Liang
mesh_terms: D000293:Adolescent; D000328:Adult; D000649:Amniocentesis / Q000009:adverse effects*; D016022:Case-Control Studies; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006509:Hepatitis B / Q000209:etiology / Q000635:transmission*; D006514:Hepatitis B Surface Antigens / Q000032:analysis*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D012306:Risk
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens
keywords: ALT; Alanine Aminotransferase; Amniocentesis; CHB; HBIg; HBV; HBV fetal infection; HBeAg; HBsAg; Immunoprophylaxis; MTMC; Mother-to-child transmission; Prevention; ULN; chronic hepatitis B; hepatitis B e antigen; hepatitis B immune globulin; hepatitis B surface antigen; hepatitis B virus; mother to child transmission; upper limit of normal