1, chronic hepatitis B women should consider antiviral treatment before arranging childbirth If the woman is a chronic hepatitis B patient and does not intend to arrange childbirth in the near future, it is recommended to carry out standardized anti-hepatitis B virus treatment in accordance with the requirements of China’s “Guidelines for the Prevention and Treatment of Chronic Hepatitis B”. Because, as a chronic hepatitis B patient, she faces many risks after pregnancy, first, she already has liver damage, with the gradual development and growth of the fetus, the burden on the pregnant woman’s liver gradually increases, and her existing hepatitis B condition may further aggravate, which may affect the development of the fetus; moreover, during the period of pregnancy, for the sake of the safety of the fetus, the use of many medications will be restricted again; but if not But if not actively treated, if pregnant women with hepatitis B disease is heavy, there will be a mother and child safety difficult to solve the thorny situation. Secondly, as the replication of hepatitis B virus is active in the body of a female patient, her pregnancy, delivery and child rearing may cause the child to be infected by hepatitis B virus. Based on these two reasons, according to the eugenics point of view, we suggest that chronic female hepatitis B patients with indications should, in principle, undergo standardized antiviral treatment in a timely manner in accordance with the provisions of the Guidelines. 2, simple chronic hepatitis B virus carriers should get pregnant as early as possible According to the recommendations of the Guidelines, for chronic asymptomatic carriers of hepatitis B virus, the effect of anti-hepatitis B virus treatment is not good, even though the virus replication in their bodies is very active, anti-viral treatment is still not considered for the time being; and because of normal liver function, clinical manifestations and examinations do not suggest obvious evidence of liver damage, so there is no need for other medications for the time being. Treatment. In view of the fact that the optimal age for women to have children is limited, she was advised to arrange for pregnancy as soon as possible. If she is made to wait until the time for anti-hepatitis B virus treatment arrives and then undergoes standardized anti-hepatitis B virus treatment, it may take three to five years or even longer. This misses the best time for them to have children. Especially for older women, it is best to start pregnancy and childbirth immediately when the current liver function and reproductive function are still good, in order to successfully complete the whole process of pregnancy and delivery. If you delay for another one or two years, you will be older, and your liver function will be abnormal, and then you think of getting pregnant, you will fall into the embarrassing situation of not being able to get pregnant and not being able to get pregnant. In conclusion, the clinical decision-making of when to get pregnant in chronic hepatitis B virus infected patients is very complicated, and it needs to be analyzed according to the specific conditions of each patient and be handled in the most optimal way. 3, men infected with hepatitis B virus need to make the following preparations before arranging for childbearing If the man is a chronic hepatitis B virus infected person and the hepatitis B virus replication is relatively active, there is a possibility that the hepatitis B virus carried by his sperm or semen may be transmitted to the next generation, and such a risk theoretically exists; however, the results of our research show that even if the man is an infected person with a relatively active replication of hepatitis B virus, only a small portion of his However, our research results show that even if the male partner is an infected person with relatively active replication of the hepatitis B virus, only a small portion of his total number of spermatozoa is infected with the virus, and most of the remaining spermatozoa are healthy; moreover, the results of clinical observations and epidemiological investigations over the years suggest that the probability of father-to-child transmission of the hepatitis B virus is comparatively much lower than the risk of mother-to-child transmission of hepatitis B virus resulting from the presence of the infected woman. Therefore, for such a male infected patient, the first thing to consider is whether he is in relatively good health now. If his liver function is normal, he has no obvious symptoms, he is a chronic asymptomatic carrier of Hepatitis B virus, and the female partner has already reached a suitable age for childbearing, it is recommended to arrange for childbearing as soon as possible without further delay. If the man is a chronic hepatitis B patient with significant abnormal liver function and active replication of hepatitis B virus, it means that he is in a not so good health condition, and from the eugenics point of view, antiviral treatment should be carried out first according to the recommendations of the Guidelines. The duration of treatment should preferably be according to the Guidelines until the criteria for stopping the medication are met. The course of oral anti-hepatitis B virus medication may usually take about 2-3 years or longer. If the woman has to have a child as early as possible due to her age, or her gynecological condition that requires her to get pregnant as soon as possible, as well as some of the above social factors related to fertility; in this case, as long as the copy number of hepatitis B virus DNA is suppressed to less than 103 copies, and the liver function is stabilized and returns to normal, the woman can arrange for child birth after one month of stopping the medication. Ideally, the female partner will successfully conceive within two or three menstrual cycles; then the male partner will immediately resume antiviral treatment until completing the course of treatment stipulated in the Guidelines. 4. Wives of hepatitis B virus-infected persons should also make some medical preparations before arranging for pregnancy If the female partner is healthy, she should receive hepatitis B vaccination as early as possible before she is ready to get married, with the aim of enabling the female partner to build up immunity against hepatitis B virus infection. This is very important, not only to avoid the risk of the hepatitis B virus infecting oneself through sexual transmission; moreover, as long as the woman’s blood produces sufficiently high titers of hepatitis B surface antibodies, there will also be such antibodies present in the vaginal secretions. In this way, if the sperm in the man’s semen carries the hepatitis B virus, it can be neutralized by the antibodies in the woman’s vaginal secretions after ejaculation. Figuratively speaking, during sexual intercourse, the hepatitis B antibody in the vaginal secretion of the woman plays the role of a security guard in the security check area. It intercepts the hepatitis B virus within the semen and releases the healthy sperm so that the woman’s egg cells can be safely fertilized. As long as the wife has immunity to the Hepatitis B virus, the success rate of a male chronically infected with Hepatitis B virus having a healthy child is very high. In addition, it must be especially emphasized that no matter which one of the couple is chronically infected with the hepatitis B virus, and no matter what treatment plan is currently being used, both spouses should go to the OB/GYN hospital for a pre-pregnancy checkup, the earlier the better. The purpose is: to check whether the fertility indicators of both men and women are normal. From time to time, we meet such embarrassing situations in the clinic: the patient and his/her couple spend a lot of energy to control the chronic hepatitis B, and then stop taking medication to arrange for childbearing; as a result, after a year of efforts, they still cannot conceive successfully, and finally go to the Obstetrics and Gynecology Department for examination, and only then find out that one of the parties has a defect in fertility, and needs to spend several months of time and energy for treatment. However, the hepatitis B patient has stopped taking medication for a long period of time in order to have children, resulting in a recurrence of hepatitis B and the need to re-prepare for the treatment of hepatitis B. Due to this delay, the optimal age for childbearing is missed. Given that the incidence of infertility is now as high as 10% or more, hepatitis B couples must avoid similar embarrassing situations happening to them. Therefore, for people with chronic hepatitis B virus infection who have arrangements for childbearing, on the one hand, they should seek advice from hepatitis doctors on how to give appropriate treatment for hepatitis B virus infection, and on the other hand, couples should take the time to go to the obstetrics and gynecology department for a pre-pregnancy checkup. Both sides should be prepared accordingly, one should not be missing; and “both hands should be grasped, both hands should be hard”. 5, women of childbearing age chronic hepatitis B patients antiviral treatment should pay attention to the choice of drugs For chronic hepatitis B female patients, if in line with the requirements of antiviral treatment specifications, in the initiation of anti-hepatitis B virus treatment, the rational choice of treatment drugs is very important. After completion of antiviral therapy for chronic hepatitis B, some patients may relapse. The two major classes of anti-hepatitis B virus drugs available require relatively long courses of treatment in order to minimize the rate of relapse after discontinuation. According to the current hepatitis B guideline, for patients with triple triple positive, treatment is required to achieve HBV DNA negativity, normalization of liver function and conversion to triple triple triple positive, followed by consolidation of treatment for more than one year. For patients with minor triple positive, they should be treated until HBV DNA is negative, liver function returns to normal, and then consolidate the treatment for at least one and a half years; in other words, as mentioned above, the course of treatment will often be around two or three years, or even longer. For the population of hepatitis B couples with fertility plans, there are two factors to consider when choosing anti-HBV drugs: First, the age factor of the woman. Some of the female patients who come to the clinic are relatively young, and after several years of anti-hepatitis B virus treatment, it is not enough to delay the best time for her to have children; however, we encountered more cases in the clinic, due to a variety of factors, the women started to arrange for the birth of children, only to find out that it is chronic hepatitis B, and the age of the woman has been older, it is difficult for them to follow the general patients, as in the case of the anti-hepatitis B virus treatment for several years of the course of anti-viral therapy. For them, the duration of the course of treatment is crucial. If the course of treatment is delayed for too long, the older women will face many complications in obstetrics when they give birth. Secondly, all existing anti-hepatitis B virus treatments carry the risk of relapse after discontinuation. Even if we stop her medication according to the norms, we consider that the course of treatment has been achieved and then arrange for pregnancy. In case there is a relapse of hepatitis B during pregnancy, how do we deal with her? This is something that has to be carefully considered when choosing medications even before antiviral therapy. There are two major classes of drugs used in anti-hepatitis B virus treatment, one being polyethylene glycol interferon (i.e., long-acting interferon). Regular interferon is less effective in treating hepatitis B and is now used less frequently. Long-acting interferon treatment of chronic hepatitis B is generally better than oral drugs, but not 100% effective; although the course of treatment is shorter, about a year or so; but after the completion of the course of treatment must be discontinued half a year to get pregnant, otherwise it may have a potentially adverse effect on the development of the embryo. From this point of view, for older women with hepatitis B who are ready to get pregnant, the advantage of a shorter course of long-acting interferon is actually weakened, and may not necessarily be the best choice, unless she is quite young and has enough time to wait for the efficacy of the treatment to be realized and the optimal time to get pregnant. The other class of drugs is the oral nucleoside analogs. Overall, although the course of treatment for this type of medication can be around two or three years, or even a bit longer, after completing the treatment, fertility can be arranged as soon as the medication is discontinued for a month. Moreover, some of these drugs are safer for pregnancy. Tibivudine, for example, is classified by the U.S. Food and Drug Administration as a pregnancy safety class B. Class B means that it has not been found to adversely affect fetal development in animal studies. However, because no experimental studies of embryonic safety have been done in humans, it is not classified as Class A, the highest level of safety for use in pregnancy. As a matter of fact, among the various drugs that are often used in the clinical treatment of various diseases in pregnant women, very few of them can be classified as pregnancy-safe grade A at present. Among the anti-hepatitis B virus drugs, the fact that Tebivudine can be classified as Grade B is already an important and outstanding advantage. Therefore, for female hepatitis B patients who have the desire of arranging childbirth as early as possible, tibivudine is one of the first choice of anti-hepatitis B virus drugs. 6.Does a pregnant woman with hepatitis B need to inject hepatitis B immunoglobulin in the late stage of pregnancy? Giving hepatitis B immunoglobulin to pregnant women with hepatitis B to reduce the incidence of intrauterine infection with hepatitis B virus is a method being used in several hospitals in China. According to their published clinical trial research papers, the results show that it is effective. However, this is also hotly debated in the academic community, with several scholars arguing that the use of hepatitis B immunoglobulin in pregnant women chronically infected with hepatitis B to block intrauterine infections is ineffective. At present, these two schools of thought are at odds, and no one can convince anyone. This also reflects the situation of blossoming of flowers and a hundred schools of thought in the academic world, which is a reflection of the normal law of academic development. In the revision process of China’s 2010 version of chronic hepatitis B prevention and treatment guidelines. There was also a controversy over whether to write up the opposing views or the favorable views on the measure of injecting hepatitis B immunoglobulin into pregnant women with hepatitis B to interrupt vertical transmission. After thorough discussion, it was finally decided that the controversy should be put aside and the study should continue. Therefore, this issue is not mentioned in the Guidelines, leaving time to accumulate more evidence-based medical evidence on this academic issue and then strive to reach a consensus. After all, practice is the only standard for testing the truth. 7, hepatitis B pregnant women need to pay attention to what during pregnancy? First, to the local hospital obstetrics to establish pregnancy health card, according to the obstetrician’s arrangement of regular visits to receive obstetrics supervision, in order to timely detection and treatment of pregnant women or fetus may be a variety of problems, and peacefully through the gestation period. Secondly, if the pregnant woman has chronic hepatitis B virus infection, or even has chronic hepatitis B before pregnancy, she needs to be monitored for hepatitis B at the same time, which will be taken care of by the doctor of Hepatitis Department. This includes monitoring the liver function and HBVDNA level for any significant changes. Then the appropriate treatment will be made. Obstetricians and hepatitis doctors should maintain close consultation with each other, so that in the whole process of childbirth, such pregnant women can get the most favorable individualized treatment plan. 8.Can I breastfeed if I have hepatitis B? Pregnant women use tibivudine during pregnancy. After the baby is born, we recommend that she continues to complete standardized anti-hepatitis B virus treatment, in order to reduce the risk of recurrence of hepatitis B disease after stopping the medication. Of course, you will not be able to breastfeed while continuing to use tibivudine. Should I breastfeed if I am not taking anti-hepatitis B virus medication? The Guidelines suggest that newborns can be breastfed as long as they have received the required hepatitis B immunoglobulin and hepatitis B vaccine after birth. Newborns injected with Hepatitis B immunoglobulin and Hepatitis B vaccine are equivalent to having a means of protection against the Hepatitis B virus, and breastfeeding is generally permissible; however, this needs to be weighed against the pros and cons depending on how infectious the mother’s Hepatitis B is. If the hepatitis B virus DNA in the blood is ≥105 copies when tested during pregnancy, the hepatitis B virus can be detected in the breast milk of such mothers. Although breastmilk is the best food for babies, do you have to take the risk if you already know that her milk is contaminated with the hepatitis B virus? After all, there are many high-quality milk formulas suitable for infants on the market; accordingly, it is recommended that mothers with ≥105 copies of Hepatitis B virus DNA in their blood should preferably not breastfeed.