A post introducing the annual Asia Pacific Liver Conference was read 360,000 times in a few days, and many other netizens raised inquiries about prevention of mother-to-child transmission of hepatitis B. Many of them had lively discussions at the bottom of the post. I have especially compiled the articles previously published in, the content of my lectures, updated with new developments at home and abroad, and written the following article in the hope that it will be helpful to mothers and fathers-to-be with hepatitis B infection. Of course, I hope you will understand that this is only a popular science article and cannot replace face-to-face consultation or even telephone consultation, so it should not be copied completely. 1.What is the effect of hepatitis B virus on the fetus? Can it cause fetal malformation? I have analyzed the data of more than 2130 cases of hepatitis B mothers and found no significant difference between babies born to mothers with hepatitis B virus and those born to mothers without the infection, in terms of malformation, miscarriage, premature birth and difficult birth. In other words: these problems do not occur more in hepatitis B mothers than in pregnant women without hepatitis B. Many international and national studies are also in agreement with my conclusions. Did you catch that: it won’t! 2. Can a woman with major and minor hepatitis B get pregnant? Although there have been great advances in the treatment of hepatitis B, there is still no effective way to make stable transitions in a short period of time for patients with major and minor triplets and HBV-DNA, but the optimal age for childbirth is limited. So I suggest that if the liver function is normal, regardless of the major and minor triplets, women should hurry up and get pregnant. If you wait until you are older and have abnormal liver function, you will be more passive. I like to evaluate the severity of hepatitis B in terms of both viral infection and liver damage. I remind all women with hepatitis B to ask their doctors for a more comprehensive evaluation before they plan to get pregnant, to visit the obstetrics and gynecology clinic and get a maternal and child health card in a timely manner after pregnancy, and to follow up their liver function frequently during pregnancy in addition to normal obstetrical examinations, and to give the necessary therapeutic interventions in a timely manner when there are abnormalities in liver function. The course of pregnancy for pregnant women without liver function abnormalities is basically the same as for non-infected mothers. A special reminder for decompensated cirrhosis is recommended not to get pregnant to avoid untoward events during the long pregnancy. 3. What is intrauterine infection? What is the rate of mother-to-child infection? After regular interruption, the success rate of interruption for mothers with “major triplets” is about 85%, and the interruption rate for mothers with minor triplets and DNA below the test value is very good, even close to 100%. Therefore, the average of the two is the total blocking rate that we know: about 95%. The main reasons affecting the intrauterine infection of hepatitis B are the high amount of viral DNA in the mother’s blood and the positive E antigen. Intrauterine infection usually occurs after 28 weeks of pregnancy. the rate of intrauterine infection is significantly higher in pregnant women with HBV-DNA 7 times and above. Antiviral therapy to effectively reduce HBV-DNA to less than sub-5th power can significantly increase the rate of mother-to-child interruption. If you are not satisfied with a blockage rate of about 85%, those with a DNA viral load above the 7th power may choose to start taking telbivudine, or tenofovir, at 20-28 weeks of pregnancy and discontinue or continue treatment 42 days after delivery, depending on liver function. The dosing process should be under the guidance and monitoring of the doctor and should not be missed or stopped at will. Take care to test CK (creatine kinase) for long-term Tibibi patients. If the placenta is damaged during the time of pregnancy inflammation and other causes of damage, the fetus destroyed the integrity of the placental barrier, the hepatitis B virus may directly invade the fetus. Pregnant friends should pay attention to protect their abdomen from collisions, extrusions and shocks, pay attention to the prevention and treatment of reproductive tract infections, and try to avoid situations such as pre-eclampsia miscarriage. 4.Is it necessary to take globulin during pregnancy? The WHO, national and other officials do not recommend the injection. The following is a detailed explanation of this view. 5, the injection of immunoglobulin during pregnancy in the prevention of hepatitis B needs to be clarified: Zhuang Hui academician once explained in detail that it is not necessary to carry out the mother’s pregnancy for hepatitis B immunoglobulin, pregnant women in the 28th week onwards monthly injection of globulin for blockade, this method is not desirable for the following reasons: (1), WHO does not recommend this method to prevent mother-to-child transmission of HBV. (2), China’s Ministry of Health also does not recommend this method to prevent mother-to-child transmission of HBV. (3) No country in the world has so far used this method to interrupt mother-to-child transmission of HBV. (4).The use of globulin during pregnancy may produce a viral variant. If this variant of the virus is spread in the population, the current hepatitis B vaccine will be ineffective. (5).The use of globulin during pregnancy may form antigen-antibody immune complexes, which are potentially dangerous to the organism. (6), Theoretically, it is also difficult to explain that this method can prevent mother-to-child transmission of HBV. Everything is clinically proven that the virus replicates in large quantities in the liver, and the dose of hepatitis B immunoglobulin injection is so low that it is impossible to produce the effect of blocking mother-to-child transmission of HBV. (7), If the injection of hepatitis B immunoglobulin 200 IU to HBsAg-positive pregnant women could reduce the level of HBV in the blood, then this method would have been used long ago for the treatment of patients with chronic hepatitis B. It can be seen that this is not the case. (8) The main transmission occurs during delivery rather than during pregnancy. 6. Mother-to-child blocking program: After the baby is born, it is recommended to finish the first globulin injection as early as possible (within 6 hours) or no later than 12 hours; babies of mothers with major triplets are considered to have the second globulin injection around 20 days, and babies of DNA-negative mothers may not have the second injection. The vaccine is administered according to the normal procedure: the first shot (on a different side than globulin) within 24 hours of birth, one in January and one in June. The vaccines are given at 10 micrograms each (it is recommended to give one 10 micrograms shot instead of two 5 micrograms shots.) 7. Can a hepatitis B mother breastfeed? Both the state and WHO recommend breastfeeding. However, the major triplet, HBV-DNA high substrate still has the potential risk of transmission, so it is recommended to be cautious. Especially when the mother has broken nipples or the baby has mouth ulcers or diarrhea, the risk increases exponentially, so breastfeeding should be temporarily stopped and restarted when the situation improves. Mothers taking antiviral drugs because the milk has a lower concentration of drugs than the blood, and breastfeeding is long-term, the cumulative effect of drugs on the baby’s damage can not be ignored, it is recommended that breastfeeding carefully. 8.Which is better for blockage in normal birth and caesarean section? Both are the same, there is no which is better. No matter which way the baby must be exposed to a large amount of maternal blood, as long as the timely injection of adequate amount of globulin can be. The specific delivery method should be decided according to the obstetrical situation. 9.How to contact between mother and baby after birth? Blood and saliva should not be in direct contact, such as wounds, the mother’s blood stains, etc.. Other normal contact can be made, such as kissing the face head and feet, etc. As long as the birth of the blockade, the chances of infections later in life is also very low, so according to the general life can be carried out. 10.Is hepatitis B immunoglobulin safe? Are there any side effects? Hepatitis B immune globulin with a regular lot number should be safe. The theoretical side effects are these: (1) cause virus mutation; (2) cause infant vaccination failure; (3) cause the functional burden of the mother’s kidneys; (4) blood products have the possibility of transmitting other kinds of diseases. 11.What should I do if I find abnormal liver function after pregnancy? Because of the early pregnancy reaction and the burden of the fetus on the mother’s liver, it is possible for healthy people to have abnormal liver function after pregnancy, so there is no need to be nervous, stay calm and relaxed, monitor the trend closely and avoid random medication, but the necessary treatment is needed. If the liver function has been high and the effect of hepatoprotective treatment is not good, antiviral treatment should be considered. There is a relationship between liver function and mood, and a good mood is often better than all drugs. It is important to strengthen the monitoring of DNA when the liver function is abnormal and to observe the self clearance. 12.Can’t I get pregnant if my liver function is abnormal before I get pregnant? It is best to avoid it. The fetus will increase the burden on the liver after pregnancy, and the deterioration of liver function is not conducive to the safety of mother and child. If you have abnormal liver function before pregnancy, then it is more likely to rise further after pregnancy. So you should first protect your liver or if necessary antiviral treatment for a period of time to stabilize before getting pregnant. 13.Can I get pregnant when the mother-to-be is taking lamivudine, telbivudine, entecavir, adefovir, tenofovir and interferon? The U.S. Food and Drug Administration (FDA) classifies the nucleoside (acid) of telbivudine and tenofovir as category B, which are relatively safe for embryos and can be used during pregnancy. Lamivudine, entecavir, and adefovir are classified as Category C and are not recommended for use during pregnancy. Since lamivudine has been used clinically for more than 10 years to prevent mother-to-child transmission of HIV and no adverse effects on the fetus have been found, it is often used clinically as a class B drug. There are no Class A drugs because clinical trials cannot be conducted in pregnant humans. If pregnancy occurs during entecavir and adefovir, a switch to tipifovir and tenofovir may be recommended to continue treatment. However, these are discretionary to assess the benefits and risks of treatment. Interferon has anti-proliferative effects on cells and is contraindicated during pregnancy and even during the first 6 months of pregnancy. The birth defect rate for general pregnancy monitored by the Centers for Disease Control in the United States is 2.72%. The African Anti-Immunodeficiency Virus (HIV) Pregnancy Registry, which also registers the fetal teratogenicity of anti-HBV drugs, has a neonatal defect rate of 2.9% for lamivudine and 2.3% for tenofovir when pregnant women start using them in early pregnancy, with corresponding figures of 2.6% and 1.5% when the two drugs are started in the middle and end of pregnancy. So far there have been many clinical experiences at home and abroad to prove that lamivudine, telbivudine and tenofovir are teratogenic during pregnancy or have no significant adverse effects on pregnancy. At present, as lamivudine now has more drug-resistant effects, many doctors no longer recommend it as a preventive drug for mother-to-child blockade. 14.What tests should be done before and after pregnancy for hepatitis B mothers-to-be more than for healthy pregnant women? Before pregnancy, detailed liver function, ultrasound, DNA quantification and even liver fibrosis index tests should be done. Liver function tests should also be done in the early, middle and late stages of pregnancy. A comprehensive assessment of their liver function and viral activity status. Liver function should be rechecked every 1-2 months during pregnancy so that changes in the condition can be detected and treated in time. 15.What kind of conditions should a hepatitis B mother avoid pregnancy? (1) acute hepatitis B with obvious liver function abnormalities; (2) chronic hepatitis B with severe liver damage, confirmed cirrhosis, accompanied by obvious thrombocytopenia, hypersplenism, coagulation dysfunction, etc.; (3) recent liver function abnormalities are more obvious, and liver function fluctuates greatly, often accompanied by protein ratio inversion or hypoproteinemia; (4) with serious extrahepatic system manifestations, such as nephropathy, aplastic anemia (5) Those who had a history of pregnancy but terminated the pregnancy because the liver could not tolerate it. 16.Can I get hepatitis B vaccination during pregnancy? In principle, all vaccinations should be completed before 3 months before pregnancy. Therefore, it is not recommended to receive hepatitis B vaccination during pregnancy. 17.When should babies born to pregnant women with hepatitis B be checked for hepatitis B infection? Babies born to pregnant women with hepatitis B should be tested for HBV markers, liver function and HBV-DNA in venous blood 3 months after birth; if the antigen is negative and HBV-DNA is lower than the test value, successful blockade can be determined; if the antigen is positive and HBV-DNA (+), it is possible to turn negative within 18 months after birth. If the child is still positive for HBV-DNA and antigen after 18 months of age, the child will be diagnosed as infected and the mother-to-child blockade will fail; after 18 months of age, the child will be positive not by mother-to-child transmission but by other means.