Hepatitis B women, pregnant! Mother-to-child interruption! Hepatitis B antiviral! These are very real and necessary issues to face, and how to regulate the use of medication is so important, seemingly simple, but related to the health of both mother and child. According to the spirit of our two guidelines, “Clinical Guidelines for Prevention of Mother-to-child Transmission of Hepatitis B Virus (1st Edition) 2012” and “Guidelines for Prevention and Treatment of Chronic Hepatitis B in China 2015”, in fact, some of the contents of these two guidelines are inconsistent, which shows that these issues are actually very controversial. 1. Can I get pregnant? Of course you can, but you need to choose the timing. Before a woman with chronic HBV infection plans to become pregnant, it is best to have her liver function evaluated by a specialist in infection or hepatology. Infected women with normal liver function can have a normal pregnancy; those with abnormal liver function can have a pregnancy if they return to normal after treatment and are rechecked normal for more than 6 months after stopping medication. What about cirrhosis? Pregnancy in cirrhosis B is not covered by either guideline because there is not a lot of medical evidence to recommend it. Pregnancy is the right of every woman who has given birth, but pregnancy may aggravate cirrhosis, and it is prudent to recommend pregnancy in compensated cirrhosis B under close monitoring and follow-up by a specialist. Pregnancy is not recommended in decompensated hepatitis B cirrhosis. 2.How to follow up pregnant women? After pregnancy in chronic HBV infection, liver function must be reviewed regularly, especially in the early and late stages of pregnancy. If the liver function is normal in the first test, if there are no clinical symptoms of hepatitis, it should be rechecked once every l~2 months; if the alanine transferase (ALT) is elevated but not more than 2 times the normal value (<80u>80U/L), or if the bilirubin level is elevated, a consultation with a relevant professional physician is required, and if necessary, hospitalization is required, and in serious cases, pregnancy should be terminated. Any change in the condition of hepatitis B cirrhosis needs to be treated under the guidance of a specialist, and the pregnancy needs to be terminated if serious complications occur. 3.How can hepatitis B immunoglobulin block mother-to-child transmission? Application of HBIG in late pregnancy has no role in preventing mother-to-child transmission: Some scholars have proposed that HBIG applied to HBV-infected pregnant women in late pregnancy can prevent intrauterine infection of the fetus, and now the study concluded that it is impossible to reduce the amount of HBV virus by injecting 200-400 U of HBIG every 4 weeks in late pregnancy; some reports in China also pointed out that the program does not reduce mother-to-child transmission. Therefore, it is not necessary to apply HBIG to HBV-infected pregnant women in late pregnancy. Use of HBIG in newborns: When a pregnant woman is HBsAg positive, regardless of whether HBeAg is positive or negative, the newborn must receive HBIG and full vaccination against hepatitis B (3-dose regimen at 0, 1 and 6 months) in a timely manner. HBIG needs to be administered within 12h after birth (theoretically the earlier the better), and its active ingredient If the results of HBsAg in pregnant women are unknown, it is better to give HBIG to newborns if possible. After taking the above formal preventive measures, it is better to give HBIG to newborns who are HBsAg positive but The protection rate of newborns of HBeAg negative pregnant women is 98%~100%, the protection rate of newborns of HBsAg and HBeAg positive pregnant women is 85%~95%, if HBIG is not used, only the application of vaccine prevention, the overall protection rate is only 55%~85%. 4.How to prevent immunization of preterm babies? Premature infants with immature immune system usually need 4 doses of hepatitis B. Premature infants of HBsAg-negative pregnant women with stable vital signs and birth mass ≥ 2000g can be vaccinated according to the 3-dose program at O, 1, and 6 months, and it is better to strengthen 1 dose at 1~2 years old; if the vital signs of preterm infants are unstable, they should first deal with related diseases and then be vaccinated according to the above program after they are stable. If the premature infant is <2000g, the 1st vaccination should be given after the body mass reaches 2000g (if the body mass does not reach 2000g before discharge, the 1st vaccination should be given before discharge); after l-2 months, the vaccination should be re-administered according to the 3-dose protocol for O, 1 and 6 months. HBIG must be given intramuscularly within 12h after birth to premature infants of HBsAg-positive pregnant women, regardless of their physical condition, and another injection is required after an interval of 3-4 weeks. If the vital signs are stable, there is no need to consider the body mass and the 1st vaccination is given as soon as possible; if the vital signs are unstable, the 1st vaccination will be given as soon as possible after stabilization; after 1 to 2 months or after the body weight reaches 2000g, the vaccination will be given again according to the 3-dose protocol for 0, 1 and 6 months. 5. What is the problem of antiviral treatment during pregnancy? High levels of HBV in pregnant women are the main risk factor for mother-to-child transmission, and reducing the amount of virus can reduce mother-to-child transmission. When a pregnant woman is HBsAg-positive but HBeAg-negative, her newborn has a protection rate of 98%~100% after regular prophylaxis. Therefore, there is no need to use antiviral therapy to prevent mother-to-child transmission in HBeAg-negative infected pregnant women. This part of the two guidelines apparently recommend inconsistency, and the following is the view of the Guidelines for Mother-to-child Interruption: chronic HBV infection still occurs in 5%-15% of newborns of HBeAg-positive pregnant women after formal prophylaxis. Although, treatment with lamivudine or telbivudine in the middle and late stages of pregnancy has been reported to reduce mother-to-child transmission, some of these studies have a small number of cases, and some control neonates may not have formal prophylaxis, or mother-to-child transmission may still occur after treatment. Therefore, HBeAg-positive pregnant women cannot be routinely treated with antiviral therapy as an indication for reducing mother-to-child transmission at this time. The following factors are also reasons for caution in anti-HBV therapy for pregnant women: (1) nucleoside (acid) analogs do not clear the virus, and the virus will return to its original level or even higher after discontinuation, even inducing serious liver function damage; (2) long-term medication will increase the financial burden and cause the virus to mutate and develop drug resistance and other side effects; (3) 85% to 95% of HBeAg-positive pregnant women are not treated with anti-HBV therapy even if their newborns are not treated. HBV treatment, their newborns can be protected with formal prophylaxis; (4) anti-HBV treatment usually starts in mid- and late pregnancy and is not effective for intrauterine infection in early and mid-pregnancy. The 2015 edition of the Hepatitis B Guidelines recommends that "HBV DNA levels are the most critical factor influencing mother-to-child transmission of HBV. newborns of mothers with high HBV DNA levels (>106 IU/ml) are more likely to have mother-to-child transmission. Recent studies have shown that the application of antiviral drugs to these mothers in the middle and late stages of pregnancy can reduce the level of HBV DNA in the prenatal serum of pregnant women and improve the success rate of mother-to-child blockade of newborns.” 6, breastfeeding of newborns of HBV-infected pregnant women? Although, HBsAg and HBV DNA can be detected in the milk of HBV-infected pregnant women, and some scholars believe that cracked nipples, excessive sucking or even biting of the nipple by infants and children may transmit the virus to infants, but these are theoretical analysis, the lack of evidence-based medical evidence. Even without immunoprophylaxis, the infection rate of breastfed and artificially fed newborns is almost the same. More evidence proves that breastfeeding does not increase the risk of infection even if the pregnant woman is HBeAg positive. Therefore, after formal prophylaxis, regardless of whether a pregnant woman is HBeAg positive or negative, her newborn can be breastfed without testing for the presence of HBVDNA in the breast milk.