I. About HBIG injection in late pregnancy In China, some scholars advocate that pregnant women receive HBIG injection in late pregnancy, believing that the risk of mother-to-child transmission of HBV can be reduced. However, opponents argue that (1) these relevant literature are all studies from China, and these studies are not randomized controlled studies; (2) neither the World Health Organization nor the Ministry of Health in China recommend this method to prevent mother-to-child transmission of HBV. Nie Guang, Department of Traditional Chinese and Western Medicine and Hepatology, Shenzhen Third People’s Hospital The opponents’ opinion is: Is it true that HBIG injection in pregnant women can neutralize the virus? Does this lead to the creation of an immune escape strain of HBV? If this immune escape strain is transmitted in the population, is it possible that the current hepatitis B vaccine will not be successful in preventing HBV infection? There is not yet sufficient evidence to answer the above questions, so this method is not recommended to interrupt mother-to-child transmission of HBV. Second, on antiviral treatment 1, HBV mother-to-child transmission blocking failure are high viral load Swiss scholars published in 2010 a multicenter study showed that during 2005-2006, in 141 newborns whose mothers were HBsAg positive and received combined immunization, the mother-to-child transmission blocking rate was 100%. A study published this year by scholars at the Fourth Military Medical University showed that the failure rate of HBIG combined with hepatitis B vaccination for mother-to-child transmission of HBV among 214 HBsAg-positive pregnant women was 4.7% (10/214 cases), and in the failure group, all mothers had high HBV DNA loads. In the United States, it was reported that 90% of newborns born to HBsAg-positive mothers could be infected with HBV without co-immune blockade of the newborn, and the failure rate of mother-to-child transmission with co-immunization was 3% to 7%, with the main reason for failure being high viral load (>108copies/ml) in pregnant women. A national prospective study conducted by Australian scholars included 313 HBsAg-positive pregnant women, of whom 213 (68%) were HBV DNA-positive and 92 (29%) were HBeAg-positive. The results showed that 138 infants delivered by HBV DNA-positive mothers were tested for HBV DNA 9 months after birth, and only 4 infants were positive for both HBsAg and HBV DNA. The main reason for the failure of MTCT was the occurrence of immune escape of the virus from the vaccine and HBIG. However, in the group of mothers with HBV DNA <108 copies/ml, the success rate of mother-to-child transmission interruption was 100%. 2. Antiviral treatment in pregnant women with high viral load A multicenter, randomized, placebo-controlled study conducted by our scholars included 150 pregnant women with high viral load (HBV DNA >109 copies/ml), 56 of whom started oral LAM at 26-30 weeks of gestation and 59 of whom did not receive antiviral treatment (control group). All newborns delivered by these women received HBIG and hepatitis B vaccination. The results showed that infants delivered in the antiviral treatment group had HBsAg positivity, HBsAb positivity, and HBV DNA positivity rates of 18% and 84% and 20%, respectively, at 52 weeks of life, compared with 39%, 46%, and 61%, respectively, in the control group. However, the study shed too many cases, 13% in the treatment group and 31% in the control group, and the level of evidence of the study was compromised. Dutch scholars reported a failure rate of 12.5% (1/8 cases) for mother-to-child transmission blockade in pregnant women with HBV DNA >1.2 × 109 copies/ml who received oral LAM in the last month of pregnancy, compared with 28% (7/25 cases) in the group not receiving antiviral therapy. However, the study sample size was small. A meta-analysis last year (which included 37 randomized controlled studies with a total of 5900 newborns) showed that the success rate of mother-to-child transmission blockade with co-immunization was >90% and that oral antiviral drugs were safe and effective in women with high viral load pregnancies. 3. consensus For pregnant women with high HBV DNA load, antivirals can be administered late in pregnancy, but the evidence on the benefits and risks of treatment is far from adequate. It is believed that the decision to administer antiviral therapy in late pregnancy should still be based on the viral load of the pregnant woman, and for the viral load threshold for initiating therapy, correlates with whether mother-to-child transmission of HBV has occurred in the pregnant woman’s previous delivery. The threshold for initiating antiviral therapy should be lower (HBV DNA >106 copies/ml) if the previously delivered infant tested positive for the virus; if the previously delivered infant was negative for the virus, the HBV DNA threshold for antiviral therapy can be set at >108 copies/ml [Cleveland Clin J Med 2009 (Cleveland Clinic J Med) 2009, 76 S3): S25]. Third, on breastfeeding 1, controversy Some studies have shown that for mothers who are positive for hepatitis B e antigen (HBeAg), hepatitis B virus (HBV) DNA can be detected in most breast milk. in theory, the virus in breast milk may enter the body through the infant’s broken oral or digestive tract mucosa, which may cause HBV infection in the infant. Therefore, some scholars believe that breast milk is dangerous and oppose breastfeeding. However, there are also many clinical studies that show that even though HBV DNA can be detected in breast milk, it does not actually cause HBV infection in newborns, thus advocating that breastfeeding can be done. 2. Consensus Regardless of whether the mother is HBeAg positive or negative, as long as the newborn receives hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine within 12 hours after birth, he can be breastfed. The reasons are: (1) our 2010 guidelines clearly recommended; (2) a recent meta-analysis completed by Zheng Yingjie et al, scholars from Shanghai Fudan University, showed that mothers who are HBV-infected can breastfeed their babies who have been routinely vaccinated against hepatitis B, regardless of their infectiousness (for details, see July 21, 2011, China Medical Forum Post-Discontinuation of Antiviral Drugs will guide, page A2). Fourth, on cesarean delivery to prevent perinatal mother-to-child transmission of HBV Chinese scholars conducted a study in 301 HBsAg-positive pregnant women. In this study, all infants received standardized co-immunization. The results showed no difference in the effect of vaginal delivery, use of forceps or vacuum suction, or cesarean delivery on the risk of HBV infection in infants [Chinese Medical Journal (English) 2002, 115:1510]. A meta-analysis of randomized controlled studies showed that elective cesarean delivery reduced the incidence of mother-to-child transmission of HBV compared with the transvaginal delivery group (28% versus 10.5%), but the difference was not significant [Virol J 2008, 5:100]. Consensus: Currently, most international obstetric guidelines do not recommend the use of cesarean delivery to prevent perinatal mother-to-child transmission of HBV.