Questions about mother-to-child hepatitis B interruption
1.What is the effect of hepatitis B virus on the fetus?
Hepatitis B virus will not cause malformation in the fetus, and will not cause miscarriage, premature birth and difficult birth. In other words: these problems will not occur more in hepatitis B carriers than in pregnant women without hepatitis B.
2. Can I get pregnant with a major triplet and a minor triplet?
At present, there is no effective way to turn the major triplet into a stable minor triplet with negative DNA, as long as the major triplet and minor triplet can be pregnant when the liver function is normal. If you wait for the DNA to turn negative or completely negative, it is unattainable, and if you wait until the liver function is abnormal, you will be very passive.
Those with a DNA viral load above the 7th power may choose to start taking Tibi and Tylenol (2012 Asia Pacific Guidelines) at 20-28 weeks of pregnancy and discontinue or continue treatment 1 month after delivery, depending on liver function. To be taken and monitored with informed physician. Take care to test CK (creatine kinase) during tibi. mothers with DNA 7 times, who underwent this descending viral blockade, can only guarantee about 95% success rate. However, in view of the current medical science, it is impossible to have 100% blockade in the foreseeable years. I still recommend to have children as soon as possible, rather than waiting until the onset of the disease while taking medication and creating problems.
3.What is intrauterine infection?
It means that the infection is already present in the fetus. The cause of this infection is not the presence of virus in the fertilized egg, because the sperm and egg do not carry virus. The main cause of intrauterine infection is the high amount of viral DNA in the mother’s blood, combined with the placenta that has undergone significant or non-significant damage during the time of pregnancy, resulting in direct invasion of the mother’s blood into the fetus without going through the barrier system of the placenta and thus viral replication. The placental factor is one of the biggest known causes. The only thing we can do is to take care of the safety of life during pregnancy, reduce the chance of pre-eclampsia, try not to move, not to fall, not to have big bumps, abstain or avoid intercourse, etc. It is difficult to know if the placenta is damaged, so just try to be careful and don’t think about it in case of bumps and bruises. Intrauterine infections usually occur after the 7th month of pregnancy. the rate of intrauterine infections in the 7th DNA is about 15-20%.
4. Do I have to take globulin during pregnancy?
Officially, WHO and the country do not recommend injections. The following is a detailed explanation of this view.
5.Immunoglobulin injections during pregnancy need to be clarified in the prevention of hepatitis B.
Monthly injections of globulin for blockade in pregnant women starting at week 28 are not advisable for the following reasons.
(1) WHO does not recommend this method for prevention of mother-to-child transmission of HBV.
(2) The Ministry of Health in China also does not recommend this method to prevent mother-to-child transmission of HBV.
(3) To date, no country in the world has used this method to interrupt mother-to-child transmission of HBV.
(4) The use of globulin during pregnancy may produce a variant of the virus. If this variant of the virus is transmitted in the population, the current hepatitis B vaccine will be ineffective.
(5) The use of globulin during pregnancy may result in the formation of 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 injected hepatitis B immunoglobulin is so low that it is impossible to produce the effect of blocking mother-to-child transmission of HBV.
(7) If 200 IU of hepatitis B immunoglobulin administered to HBsAg-positive pregnant women could reduce blood levels of HBV, then this method would have been used long ago in the treatment of patients with chronic hepatitis B. It is clear that this is not the case.
(8) HBV mother-to-child transmission mainly occurs in the perinatal period, the application of hepatitis B vaccine and protein combined immunization, the blocking rate of 95% to 97%, which also shows that HBV mother-to-child transmission mainly occurs in the perinatal period.
6.Where is the key to interruption?
The most critical and non-controversial part of interruption is the injection of globulin and vaccine for babies. After birth, it is strongly recommended that the first injection of globulin be given as early as possible (within 2 hours) or no later than 12 hours; babies of mothers with major triplets are considered to receive the second injection of globulin in about 20 days, while babies whose mothers are DNA negative may not receive the second injection. The vaccine is administered according to the normal process: 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 (one 10 microgram shot is recommended instead of two 5 microgram shots.)
7.What is the mother-to-child infection rate?
After blockade is performed, the blockade success rate is about 85% for mothers with major triplets and infinitely close to 100% for mothers with minor triplet DNA negative. Therefore, the average of the two is the total blocking rate announced by the state: 95%.
8.Can I breastfeed?
Both the state and WHO recommend breastfeeding. There is a potential risk of HBV-DNA high substrate, especially when the nipple is broken or the baby has mouth ulcers, etc.
9.Which is better for interruption: normal birth or cesarean section?
Both are the same and there is no question of which is better. Either way, the baby must be exposed to a large amount of maternal blood, and the perinatal infection rate is as high as 90%. The infection rate in the perinatal period is 90%. Hepatitis B virus is not a factor in determining the mode of delivery. Should be determined by their own condition at the time of delivery by the doctor to determine the mode of delivery.
10.How to contact between mother and child 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 interruption, the chance of infection later on is also extremely low. Just go about your life as usual. If we can pay a little more attention than a healthy mother, we can be sure that there is nothing wrong. In fact, no matter how careful we are with our children, it is impossible to completely cut off contact with these bodily fluids. There are viruses everywhere in the house.
11.Is globulin safe? Are there any side effects?
It should be safe as long as it is produced by a regular manufacturer. Theoretically, the side effects of globulin include: causing virus mutation; causing vaccination failure in infants; causing functional burden on the mother’s kidneys; and the possibility of transmitting other diseases from blood products.
12.Does preterm abortion and placental damage increase intrauterine infection?
As placental problems are a clear cause of intrauterine infections, placental damage may cause direct infiltration of maternal blood into the fetus, and most intrauterine infections occur in the second trimester because the placenta degenerates and gradually decreases in function after 8 weeks. The situation of placental damage in pre-eclampsia is similar to this.
13.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, even healthy people may have abnormal liver function after pregnancy, so don’t be nervous, stay calm and relaxed, monitor the trend closely and try to avoid medication. If the liver function stays high it should be pregnancy hepatitis, consider to have antiviral treatment. There is a relationship between liver function and mood, and a good mood is often better than any medication. It is important to strengthen the monitoring of DNA when the liver function is abnormal and to observe the self clearance.
14.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, so it is worried about the substantial rise of liver function to the detriment of mother and child. If you have abnormal liver function before pregnancy, it is more likely to rise further after pregnancy, which is more detrimental to the safety of pregnancy. Therefore, you should protect your liver for a period of time to stabilize it before getting pregnant. However, there is a situation that is not in the period of medication, but the liver function has been slightly abnormal, and at this time and have to get pregnant, you can also consider pregnancy, but should pay more attention to the liver function, early detection and early solution to deal with.
15.Can I get pregnant while taking Lamy, Tibi, Enty, Ader, Tylenol, Interferon?
The U.S. Food and Drug Administration (FDA) classifies nucleoside (acid) tibi and tino as category B, which are relatively safe for embryos and can be used during pregnancy; lamis, enanthate, and ad are classified as category C and are not recommended for use during pregnancy. However, Lamy has been used in clinical practice for more than ten years and no adverse effects on fetus have been found, so Lamy is often put in category B in clinical practice. There are no Class A drugs because clinical trials cannot be conducted on humans. If pregnancy occurs during enantium or aldehyde, a switch to lamis, tippi, or tylenol may be recommended to continue treatment. However, these are at the discretion of assessing the benefits and risks of treatment. A prudent approach is not to recommend medication for the first trimester of pregnancy, which is the most important period for fetal development. Interferons have anti-proliferative effects on cells and are contraindicated during pregnancy and even during the first few months of pregnancy. There are already a lot of lamivudine and tippi babies out there.
Some data: What is the basis for the safety of lamivudine and tenofovir for human reproduction?
The birth defect rate for general pregnancy as 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 begin using them in early pregnancy, with corresponding figures of 2.6% and 1.5% for starting the two drugs in mid- to late-term, which are not significantly different from the CDC data. No data are available from either pregnancy registry for tenbivudine on the fetus.
To date there has been a lot of clinical experience both domestically and internationally, and there is no evidence that lamivudine or tenofovir is teratogenic or has adverse effects on pregnancy during pregnancy.
16.What additional tests should be done before and after pregnancy than healthy pregnant women?
Detailed liver function, ultrasound and DNA quantification should be done before pregnancy. Liver function tests should also be done in the early, middle and late stages of pregnancy. DNA quantification in the 7th month of pregnancy is good to consider whether to breastfeed and whether to perform the descending viral blocking method of Lamy or Tibi. A complete and detailed set of medical records is important for us.
17.When should a hepatitis B mother avoid pregnancy?
(1) Acute hepatitis B with obvious liver function abnormalities.
(2) Severe liver damage with confirmed cirrhosis with significant thrombocytopenia, hypersplenism, coagulation disorders, etc.
(3) More pronounced liver function abnormalities and fluctuating liver function, often accompanied by inversion of protein ratio or hypoproteinemia;
(4) Severe extrahepatic manifestations such as nephropathy, aplastic anemia, etc;
(5) A history of pregnancy that was terminated because the liver could not tolerate it;
(6) Hepatitis B virus-infected patients with obstetrical and gynecological disorders who are not suitable for pregnancy, such as those with a history of repeated cesarean deliveries.
18.Can I get hepatitis B vaccination during pregnancy?
It is not recommended to receive hepatitis B vaccine during pregnancy.