Having a healthy and smart baby is the ideal of every woman of childbearing age. However, any negligence in the middle of the pregnancy in October may leave you and your child with regrets. If you are a hepatitis B patient or hepatitis B carrier, or may be infected with hepatitis B virus due to close contact with hepatitis B patients, and want to have a healthy child without hepatitis B, this lecture will help you to solve your problems and make you understand the knowledge about hepatitis B prevention. I. Why do we need to prevent hepatitis B? Why should we strengthen the knowledge of hepatitis B prevention for women of childbearing age? Hepatitis B is a viral infectious disease that seriously endangers human health and is the most harmful disease to human beings among all types of viral hepatitis. Most newborns and infants under 3 years of age who are infected with hepatitis B virus become carriers of hepatitis B surface antigen (HBsAg) or HBV. Some of these carriers can develop acute or chronic hepatitis B, cirrhosis or liver cancer. Because of the long course of cirrhosis and liver cancer (about 30 years), the likelihood of developing cirrhosis or liver cancer in infants and children infected with HBV is greater than in adults infected with HBV. Adults infected with HBV have less than a 5% chance of developing into surface antigen-positive carriers and chronic liver disease, so the World Health Organization and China have long attached great importance to the prevention of hepatitis B, and have focused on newborns and children. China has implemented free hepatitis B vaccination for newborns, the significance and impact of which is very significant and far-reaching, which provides a guarantee that our next generation will be free from the hepatitis B virus and take off the hat of a big hepatitis B country. In 1997, I undertook a research project of the provincial health department to investigate the hepatitis B virus infection of 1,500 children aged 5-10 years in Suzhou, and the total HBV infection rate of children aged 5-10 years was 3.6%. 5‰ or less. It can be seen that the immunization effect of hepatitis B vaccination is very obvious. Second, what are the ways of transmission of hepatitis B? There are four main ways of transmission of hepatitis B: perinatal mother-to-child transmission, transmission through blood transfusion or use of blood products, medical transmission through the use of inadequately sterilized medical devices, and close contact transmission. What is mother-to-child transmission of hepatitis B? Mother-to-child transmission refers to the process by which a mother who is positive for hepatitis B surface antigen, especially a mother who is double positive for surface antigen and e antigen (commonly known as the major triplet), can transmit the hepatitis B virus to her infant, causing the infant to become infected with HBV. Mothers who are positive for both HBsAg and HBeAg have about 80% of their children infected. Since the immune organs and functions of newborns are not yet mature, they often develop immune tolerance to the hepatitis B virus after infection, and not only carry the virus themselves for a long time and infect others, but also respond poorly to anti-hepatitis B virus medication, resulting in the gathering of many families with chronic hepatitis B patients. So trying to cut off the mother-to-child transmission route is an important measure to prevent hepatitis B virus infection in China. The process of mother-to-child transmission can be divided into three stages: transmission through the placenta during pregnancy, transmission during labor and delivery, and transmission through close contact during feeding after delivery. Transmission during labor and delivery accounts for the majority of transmission. Intrauterine HBV infection is defined as the presence of hepatitis B virus replication markers measured at birth from peripheral venous blood collected from a newborn baby that has been consistently positive for at least 3 months. The lack of recent immunization effect, despite the use of combined active + passive immunization, is associated with high maternal HBsAg titers, HBsAg, HBeAg positivity and DNA positivity. IV. Effects of hepatitis B virus-infected mothers on the fetus (i). susceptibility to mother-to-child transmission of hepatitis B virus. Whether mother-to-child transmission occurs in positive mothers, there are roughly these situations: 1, a single HBsAg +, risk factors for 31%, HBsAg titer 1:32 for 22%, > 1:128 for more than 80%. 2, HBsAg +, HBeAg + risk factors of 85-95% 3, high HBVDNA load 4, artificial insemination techniques (ii), the impact of hepatitis B virus infection on the fetus and newborn, which can also be manifested as susceptible to miscarriage, fetal death in utero, premature birth and neonatal asphyxia. V. Can a hepatitis B mother (or positive mother) have a healthy baby? The answer is yes, she can. I think we should take measures and pay attention to the following aspects: 1. Marriage and childbirth stage: When you get married, you should have a medical check-up before making a birth plan, and check your liver function and two-to-one half. If one or more of the two halves are found to be positive, you should go to a specialist hospital for consultation to understand the actual significance of the positivity, the impact on the birth of a fetus, and whether treatment is needed. If the liver function is not normal, or if you originally had hepatitis B, you need to further check HBV-DNA. If there is positive surface antigen, positive e antigen, positive DNA, along with abnormal liver function, it is not advisable to get pregnant at this time, and active antiviral treatment is needed. It is in the interest of both mother and child to wait until liver function has returned to normal and the amount of hepatitis B virus in the body has decreased and has been stable for a period of time before becoming pregnant. If you are pregnant, then you need to strengthen monitoring, keep abreast of changes in liver function, and strengthen preventive measures such as liver protection to ensure the safety of mother and child. 2. Pregnancy stage: If you are HBsAg, HBeAg, HBV-DNA positive, you need to check your liver function regularly, which is especially important. Chronic hepatitis during pregnancy is prone to develop into chronic heavy hepatitis, and pregnant women with cirrhosis are prone to ascites during pregnancy, which can also induce gastrointestinal bleeding; hypertension in pregnancy is also often more severe. For pregnant women with recurrent abnormal liver function during pregnancy, where general liver-protective therapy is not effective, antiviral therapy with tibivudine, or lamivudine may be considered in HBVDNA-positive pregnant women. This needs to be done with informed consent and under the guidance of a specialist in person. If the infant previously delivered is HBsAg positive, or if the current pregnancy has a high HBVDNA load, it is recommended that lamivudine or telbivudine be considered at 24 – 28 weeks of pregnancy to help prevent mother-to-child transmission and increase the effectiveness of mother-to-child interruption. 3. Postpartum period: The focus is on fetal and neonatal protection. Method 1: HBIG 100 – 200u (intramuscularly in the buttocks) within 6 hours of birth, along with the first injection of hepatitis B recombinant yeast vaccine 10 micrograms (intramuscularly in the right upper arm triangle), and the second and third injections at 1 month of age and 6 months of age. This method is suitable for babies born to mothers with minor triplets, HBVDNA negative or low viral load. Method 2: Newborns whose mothers are double positive for HBsAg and HBeAg and have high HBVDNA should receive 200iu of hepatitis B immunoglobulin within 6 hours of birth and a booster dose of 200iu two weeks later. one injection of hepatitis B recombinant yeast vaccine (10ug each time, three times) in January, February and July after birth. Method 3: HBIG 200u (intramuscularly in the buttocks) within 12 hours of birth, followed by a second injection of HBIG 200 units 1 month later, and the first injection of hepatitis B recombinant yeast vaccine 10 ug (intramuscularly in the right upper arm triangle) at the same time, and the second and third injections at 2 months and 7 months of age. This approach is suitable for babies born to mothers with major triplets and HBVDNA positivity. Taking these combined active + passive immunization measures is more than 95% effective in interrupting mother-to-child transmission of hepatitis B. Therefore, we say that hepatitis B mothers can also have healthy babies. Hepatitis B mothers should have their liver function rechecked 1 month and 3 months after delivery to detect any postpartum hepatitis activity in time. The baby should be checked once at 9 months of age for quantitative two-to-one half or HBsAg and anti-HBs. VI. Reasons for immunization failure against hepatitis B: 1. High titer hepatitis B virus carrier status of the mother. 2, Hepatitis B virus gene variation: S gene variation. 3, Infant intrauterine infection with HBV. 4, Genetic factors. 5, Combined cytomegalovirus infection. Can HBsAg-positive mothers breastfeed normally? If the newborn receives combined active + passive immunization measures after delivery, postpartum infection (including breastfeeding) is generally less likely to occur. Note: ①. If the mother’s nipples break and bleed, breastfeeding should be stopped and replaced with other milk substitutes. ②. Develop good feeding habits and do not chew the food by mouth and then feed the baby, because there may be hepatitis B virus in the saliva. VIII. Marriage and childbirth for male infected patients. 1. Spouses should be vaccinated against hepatitis B if they are diametrically negative. 2. There are two main effects on the fetus and the child: ①, close postnatal contact transmission; ②, hepatitis B virus genes are inherited to the next generation, making their children susceptible to hepatitis B virus infection. The chance of father-to-child transmission is generally <10%. Nine, the choice of contraceptive methods. 1, can use condoms, intrauterine contraceptive ring or birth control surgery. 2, avoid the use of drug contraception, so as not to increase the burden on the liver or cause drug-related hepatitis. 3, hepatitis B patients preferably do not use intrauterine contraceptive ring, so as not to increase the volume of menstruation, which is not conducive to the observation of hepatitis B condition. X. Summary: Today, we have focused on the prevention of hepatitis B, especially on the prevention of hepatitis B for women of childbearing age, which is a very important issue related to the possibility of having a healthy baby. We talked about the dangers of mother-to-child transmission of hepatitis B, introduced measures to interrupt mother-to-child transmission, and finally had a few suggestions: 1. For women who are ready to get pregnant and give birth, a medical check-up before pregnancy, including liver function and diphosphorus, etc. If both diphosphorus are negative, it is recommended to get vaccinated against hepatitis B. 2. If you have hepatitis B or positive hepatitis B surface antigen, go to a specialist hospital for consultation.