In the course of clinic visits, the most common problem raised by men and women of childbearing age is the issue of having the next generation. They (they) are worried about wanting to have children, but they are afraid that their children will be infected with hepatitis B. If they do not want to have children, they feel that it is a shortcoming, so they are indecisive and often consult their doctors. Without children, a family may lack a lot of joy and happiness, and may lack a part of the motivation of life, and will not be able to experience the joy of the next generation to the family! So, what is the solution for these confused families, for young couples to be able to have the next generation, and for the next generation to be healthy, without mother-to-child transmission (or paternal transmission), and without having a deformed child? This is a question that is difficult to answer with certainty, because research in this area is still very poor and there is no more theoretical basis to consider than the available information. The answer must vary from person to person, and can be divided into the following cases: a. The male partner is a chronic hepatitis B or chronic HBV carrier In general, the possibility of paternal transmission (including vertical and horizontal transmission) certainly exists, but the chances are much smaller than the chances of mother-to-child transmission! Therefore, the following principles can be followed: (a) the minor triplet, normal liver function, HBV-DNA negative: safe pregnancy, unlikely to transmit to the next generation. After birth, newborns should be vaccinated with hepatitis B vaccine, just like ordinary children; however, if the family has a history of paternal transmission, it is best to vaccinate the newborn with hepatitis B vaccine, in addition to hepatitis B high-valent immunoglobulin after birth! (2) The newborn is born with major triple-positive, normal liver function and positive HBV-DNA: paternal transmission cannot be completely excluded, and the higher the viral load, the greater the possibility of transmission! In addition to hepatitis B vaccination, newborns must be vaccinated with hepatitis B high-valent immunoglobulin after birth! (C) Department of minor triplets, normal liver function, HBV-DNA positive: In general, the patient has a long course of disease, may be older, the first thing to do is to locate the patient’s disease, must exclude hepatitis cirrhosis; but also to evaluate the patient’s liver reserve capacity to ensure fertility, overexertion will not bring the patient liver function loss of compensation, triggering life-threatening, in daily life, there are such lessons! If the patient’s condition is mild, childbirth is not harmful to him/her. Whatever the case, it is better to vaccinate newborns with hepatitis B highly effective immunoglobulin after birth, in addition to hepatitis B vaccine! Especially if the viral load is greater than or equal to 107 or more. The same principles as above apply when chronic hepatitis B patients are not on antiviral therapy! (d) chronic hepatitis B is on antiviral therapy: the male partner in the process of antiviral therapy, HBV-DNA has maintained negative, or even E antigen has disappeared, but has not reached the E antigen seroconversion, at this time, if you want to have children, there are two cases: 1, the current application of alpha interferon (ordinary or long-acting) antiviral therapy: be sure to wait for 3 months after the discontinuation of alpha interferon, and then consider pregnancy The problem. This is because for one thing, interferon has a definite course of treatment and it is easier to stop; secondly, if alpha interferon treatment alone achieves the above goals especially the seroconversion of E antigen or the disappearance of E antigen, the interval of relapse after stopping the drug is generally much longer than that of nucleoside (acid) analogs, so the possibility of paternal transmission after stopping the drug is very small. Thirdly, so the proposed discontinuation of the drug for 3 months – six months, unlike women of childbearing age (need to stop the drug for six months – drug instructions require), one is to consider the short half-life of interferon (according to pharmacokinetic principles, in general, after the drug enters the body, after about 4-5 plasma half-life to reach the drug steady-state blood concentration. After discontinuation of the drug, the drug can be basically cleared in the body after 6-7 half-lives (cumulative excretion is 98.5% and 99.3% respectively). After 3 months of discontinuation, there is no more interferon in the body (ordinary interferon half-life is 4-6 hours, long-acting interferon Pyroxin half-life is 50 hours longer than pelargon), so on the one hand, the teratogenic problem of interferon will not occur, on the other hand, if the patient has only achieved a negative HBV-DNA, the short discontinuation time is not easy to relapse. Secondly, the infant is conceived in the mother and the possibility of neonatal malformations caused by the use of interferon by the male partner is extremely low. If the E antigen has disappeared (or even the E antigen seroconverted), then the likelihood of recurrence will be minimal if the pregnancy occurs 3 months after stopping the drug. In this case, the chances of having a healthy baby will be high. 2, the antiviral treatment is simply applied nucleoside (acid) analogues or was once combined with alpha interferon treatment (has been discontinued 3 months – six months): my personal opinion is that the male partner can continue to maintain antiviral treatment. The reasons are as follows: at this point, the possibility of paternal transmission and the possibility of the male partner having a malformed newborn due to the application of nucleoside analogues causing sperm malformation must be considered, and the second possibility is much lower than the first one. However, if parents are still unsure, those who have achieved the disappearance of E antigen can also stop taking the medication and have a pregnancy within 6 months of stopping the medication, which is less likely to result in a recurrence of hepatitis B. If only a negative HBV-DNA is achieved, pregnancy within 3 months of stopping the medication is also possible. Each person’s situation is different, and you will need to discuss it carefully with your supervising physician at that time. The woman is a chronic hepatitis B or chronic HBV carrier The situation is more complicated and the following principles can be followed: (a) chronic HBV or HBsAg carrier 1, is a minor triplet, normal liver function, HBV-DNA negative: safe pregnancy, unlikely to transmit to the next generation. After the birth of a newborn baby, in addition to hepatitis B vaccination, hepatitis B high-valent immunoglobulin should also be vaccinated! 2, is a major triple-positive, normal liver function, HBV-DNA positive: can not be completely excluded from mother-to-child transmission, viral load ≥ 107, 108 (currently used in China and imported kits measured), the newborn baby after birth, even if vaccinated with hepatitis B vaccine and hepatitis B high-valent immunoglobulin, there will be about 5-15% of the possibility of mother-to-child transmission! Please see below for further interruptions. If the patient’s HBV-DNA is less than 106, mother-to-child transmission can generally be prevented by regular hepatitis B vaccination and hepatitis B HVP immunoglobulin blocking measures for newborns! 3, is a small triple-positive, normal liver function, HBV-DNA positive: the same as the previous, in general, the patient’s disease is longer, the age may be older, the first thing to do is to locate the patient’s disease, more must exclude hepatitis cirrhosis; but also to evaluate the patient’s liver reserve capacity to ensure fertility, overexertion does not bring liver function loss to the patient, causing life-threatening! First determine if pregnancy is possible. If such patients are in the process of antiviral therapy, if the clinical diagnosis of hepatitis cirrhosis or even for patients with decompensated cirrhosis, then, must not stop the nucleoside (acid) analogues of! In this way, one avoids the risk of discontinuing the drug to the mother, and the other ensures that mother-to-child transmission does not occur, as far as the risk of teratogenicity is concerned has to be taken! If the patient’s condition is mild and belongs to the general improvement phase of chronic HBV carriers with HBV-DNA load ≤ 107, it is estimated that the patient’s liver reserve capacity is strong and can withstand pregnancy, it is possible to have a normal child and mother-to-child transmission is unlikely to occur. Such patients generally have lower viral loads than those with E positivity. But whatever the case, newborns should also be vaccinated with hepatitis B vaccine and hepatitis B high-valent immunoglobulin after birth! (ii) Patients with chronic hepatitis B liver disease 1. When not antiviral: Pregnancy is possible as long as hepatitis cirrhosis is not developed in the decompensated stage. If it is already early stage of hepatitis cirrhosis, pregnancy will assume certain risks. Both men and women should communicate closely with their doctors before deciding to become pregnant, and make a decision after fully understanding the threat of pregnancy to the female partner! As for the risk of mother-to-child transmission is still related to the high or low load of hepatitis B virus DNA, not to be repeated. (1) Those who are applying alpha interferon must stop taking it for 6 months after pregnancy to ensure the safety of the newborn. (2) The following options are available for nucleoside (acid) analogue antiviral therapy: ① Pregnancy as early as possible after 3 months of stopping nucleoside (acid) analogue, because the sooner you stop the drug, the less likely you will relapse; in addition, the early or late relapse is also related to the good or bad effect achieved after treatment. ②Pregnancy after stopping nucleoside (acid) analogs, if the viral load rebounded to ≥107 after stopping the drug, then lamivudine and telbivudine can be taken in the last 3 months of pregnancy. ③If the patient is a person with early or decompensated hepatitis cirrhosis, it is important to weigh the risk of liver failure to the pregnant woman by discontinuing the drug against the risk of malformation in the newborn, as it is probably the former risk that is greater and therefore, it is better not to discontinue the drug! ④ If the patient is a general chronic hepatitis B with a high pretreatment viral load and treatment has not yet achieved seroconversion of E antigen or even disappearance of E antigen, but only achieved negative HBV-DNA; especially if the pregnant woman is herself infected with HBV due to mother-to-child transmission, then it is better not to discontinue the drug and to have a pregnancy while maintaining treatment. Because nucleoside (acid) analogs are very safe, especially lamivudine, which has been used for 10 years, and there is also extensive experience in Africa with the use of lamivudine in pregnant women to prevent HIV transmission to newborns; there are also scientific studies that have shown that lamivudine taken during the second trimester of pregnancy can further increase the chance of preventing mother-to-child transmission in high-carrier virus carriers (hepatitis B vaccine plus hepatitis B high-valent immunoglobulin The prevention of mother-to-child transmission has been reported to be ineffective. However, since there is no such indication in any of the currently available nucleoside (acid) analogs’ instructions, informed consent must be signed with the physician! In summary, the issue of pregnancy in patients with hepatitis B virus carriers or chronic hepatitis B disease is a complex one, involving various aspects such as disease conditions, rational drug application, and ethical relationships, and each patient’s perception and requirements are different. The above views are personal and presented for the general reader’s reference! There may be incorrect points, welcome criticism and correction! I hope that the world’s many families associated with hepatitis B virus infection will have a healthy baby! Happy family! Early recovery of health!