title: Quantitative maternal hepatitis B surface antigen predicts maternally transmitted hepatitis B virus infection.
abstract: Despite immunoprophylaxis, hepatitis B virus (HBV) transmission in highly viremic mothers remains a global health issue. Using quantitative maternal surface antigen (HBsAg) to predict HBV infection in infants has not been investigated. We enrolled 526 mother-infant pairs with positive maternal HBsAg under current immunoprophylaxis. Maternal viral load and quantitative HBsAg were measured in the peripartum period. Infant HBsAg seropositivity for more than 6 months was defined as chronic infection. Rates of chronic infection in infants at various maternal HBsAg levels were estimated using a multivariate logistic regression model. Results showed that maternal HBsAg was positively correlated with maternal viral load (r = 0.69; P < 0.001) and accurately predicted maternal viral load above 6, 7, and 8 log10IU/mL with an area under the receiver operating characteristic curve (AUC) of 0.97, 0.98, and 0.95. Nineteen infants were chronically infected. After adjustment for the other risk factor, maternal HBsAg level was significantly associated with risk of infection (adjusted odds ratio for each log10IU/mL increase, 15.02; 95% confidence interval [CI], 3.89-57.94; P < 0.001). The AUC for predicting infection by quantitative maternal HBsAg was comparable to that by maternal viral load (0.89 vs. 0.87; P = 0.459). Estimated rates of infection at maternal HBsAg levels of 4, 4.5, and 5 log10IU/mL were 2.4% (95% CI, 0.1-4.6; P = 0.04), 8.6% (95% CI, 4.5-12.7; P < 0.001), and 26.4% (95% CI, 12.6-40.2; P < 0.001).
  
  
  
  Quantitative maternal HBsAg predicts infection in infants as well as maternal viral load does. Antiviral therapy may be considered in pregnant women with an HBsAg level above 4-4.5 log10IU/mL to interrupt mother-to-infant transmission. (Hepatology 2016;64:1451-1461).
authors.affiliation: Department of Pediatrics, Cardinal Tien Hospital, New Taipei City, Taiwan.|School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Wan-Hsin
authors.initials: WH
authors.lastname: Wen
authors.affiliation: Department of Pediatrics, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.|Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Chi-Wen
authors.initials: CW
authors.lastname: Huang
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Wei-Chu
authors.initials: WC
authors.lastname: Chie
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chun-Yan
authors.initials: CY
authors.lastname: Yeung
authors.affiliation: Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
authors.forename: Lu-Lu
authors.initials: LL
authors.lastname: Zhao
authors.affiliation: Department of Pediatrics, En Chu Kong Hospital, New Taipei City, Taiwan.
authors.forename: Wen-Terng
authors.initials: WT
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Jia-Feng
authors.initials: JF
authors.lastname: Wu
authors.affiliation: Department of Pediatrics, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Yen-Hsuan
authors.initials: YH
authors.lastname: Ni
authors.affiliation: Department of Pediatrics, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.|Department of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Hong-Yuan
authors.initials: HY
authors.lastname: Hsu
authors.affiliation: Department of Pediatrics, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Mei-Hwei
authors.initials: MH
authors.lastname: Chang
authors.affiliation: School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan. lhlinlh@yahoo.com.tw.|Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan. lhlinlh@yahoo.com.tw.
authors.forename: Lung-Huang
authors.initials: LH
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan. hueyling@ntu.edu.tw.|Department of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan. hueyling@ntu.edu.tw.
authors.forename: Huey-Ling
authors.initials: HL
authors.lastname: Chen
mesh_terms: D000328:Adult; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D019562:Viral Load
chemical_list: D006514:Hepatitis B Surface Antigens