title: Antiviral therapy in chronic hepatitis B viral infection during pregnancy: A systematic review and meta-analysis.
abstract: Perinatal or mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains the major risk factor for chronic HBV infection worldwide. In addition to hepatitis B immune globulin and vaccination, oral antiviral therapies in highly viremic mothers can further decrease MTCT of HBV. We conducted a systematic review and meta-analysis to synthesize the evidence on the efficacy and maternal and fetal safety of antiviral therapy during pregnancy. A protocol was developed by the American Association for the Study of Liver Diseases guideline writing committee. We searched multiple databases for controlled studies that enrolled pregnant women with chronic HBV infection treated with antiviral therapy. Outcomes of interest were reduction of MTCT and adverse outcomes to mothers and newborns. Study selection and data extraction were done by pairs of independent reviewers. We included 26 studies that enrolled 3622 pregnant women. Antiviral therapy reduced MTCT, as defined by infant hepatitis B surface antigen seropositivity (risk ratio = 0.3, 95% confidence interval 0.2-0.4) or infant HBV DNA seropositivity (risk ratio = 0.3, 95% confidence interval 0.2-0.5) at 6-12 months. No significant differences were found in the congenital malformation rate, prematurity rate, and Apgar scores. Compared to control, lamivudine or telbivudine improved maternal HBV DNA suppression at delivery and during 4-8 weeks' postpartum follow-up. Tenofovir showed improvement in HBV DNA suppression at delivery. No significant differences were found in postpartum hemorrhage, cesarean section, and elevated creatinine kinase rates.
  
  
  CONCLUSIONS
  Antiviral therapy improves HBV suppression and reduces MTCT in women with chronic HBV infection with high viral load compared to the use of hepatitis B immunoglobulin and vaccination alone; the use of telbivudine, lamivudine, and tenofovir appears to be safe in pregnancy with no increased adverse maternal or fetal outcome.
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
authors.affiliation: Liver Diseases and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: McMahon
authors.affiliation: Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI.
authors.forename: Anna S F
authors.initials: AS
authors.lastname: Lok
authors.affiliation: Division of Clinical Decision Making, Tufts Medical Center, Boston, MA.
authors.forename: John B
authors.initials: JB
authors.lastname: Wong
authors.affiliation: Evidence-Based Practice Research Program.|Center for the Science of Health Care Delivery.
authors.forename: Ahmed T
authors.initials: AT
authors.lastname: Ahmed
authors.affiliation: Division of Hospital Internal Medicine.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Mouchli
authors.affiliation: Evidence-Based Practice Research Program.|Center for the Science of Health Care Delivery.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Library Public Services.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.affiliation: Evidence-Based Practice Research Program.|Center for the Science of Health Care Delivery.|Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Evidence-Based Practice Research Program.|Center for the Science of Health Care Delivery.|Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Khaled
authors.initials: K
authors.lastname: Mohammed
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011256:Pregnancy Outcome
chemical_list: D000998:Antiviral Agents