One, every pregnant mother with hepatitis B has a strong desire not to infect her child! Can doctors help me to do this? A. Except for a few maternal failures with a high hepatitis B virus load, we can basically do it! Before there was a hepatitis B vaccine and highly effective hepatitis B immunoglobulin, almost 100% of pregnant women with a high hepatitis B virus load would pass it on to their children, which is why China has become a hepatitis B powerhouse. Without any intervention: 1. 88% of infants will be infected with hepatitis B if the pregnant woman is positive for both HBsAg and HBeAg; 2. 38% of infants will be infected with hepatitis B if the pregnant woman is positive for HBsAg alone; 3. 9% of infants will be infected with hepatitis B if the man is positive for HBsAg alone (but this is parallel transmission, which is caused by close living contact between the child and the father after birth); 4. 85% to 90% of infected infants will develop chronic hepatitis B. infected infants will develop into chronic hepatitis B carriers. Fortunately, at present, for hepatitis B mothers, the overall success rate reported by various medical institutions is 90-97.5% as long as the child is routinely given a full dose of highly effective hepatitis B immunoglobulin + hepatitis B vaccine within 12 hours of birth and then, at 1 month and 6 months of life, respectively, another dose of hepatitis B vaccine each. This is the combined immunization of the child after birth. The mode of delivery, the need for a special bed delivery, and the prevention of birth canal injuries, neonatal birth injuries and amniotic fluid aspiration. If the pregnant woman is in a period of high viral replication, it is better to deliver by cesarean section. Domestic and international studies have shown that cesarean delivery has a lower rate of infection in infants during delivery than natural delivery. Regardless of the delivery method, it is a crucial step to rinse the baby with water as soon as possible after delivery to thoroughly clean the amniotic fluid and the mother’s blood and try not to let the hepatitis B virus invade the child’s body. To further improve the success rate, the pediatric department will give a booster shot of high potency hepatitis B immunoglobulin at half to three months of age depending on the results of the child’s test; depending on the titer of the child’s hepatitis B surface antibody, some will need a booster shot of hepatitis B vaccine. One article reported a maternal-to-child blockade success rate of 97.5% in a total of more than 3,000 maternal cases of hepatitis B. All of the blockade failures were in high viral load mothers. The success rate of maternal-infant interruption in low viral load (i.e., DNA less than 105) pregnant women was 100%, while the success rate of maternal-infant interruption in high viral load pregnant women was 95%. Don’t underestimate this small difference, because the ultimate outcome of chronic hepatitis B is cirrhosis and liver cancer! 80% of hepatitis B transmitted vertically from mother to child will develop into chronic hepatitis B, compared to only 5% of adults. Overall, approximately 40% of men and 15% of women infected with HBV during the perinatal period will die of cirrhosis or hepatocellular carcinoma. I don’t think any mother wants to put her child at that risk. The use of HepB immunoglobulin in late pregnancy, which has become very popular in the past few years, has no preventive effect on mother-to-child transmission, so it is recognized worldwide that HepB immunoglobulin should not be used in late pregnancy in pregnant women with HepB infection. It is clear that routine co-immunization is not sufficient for pregnant women with high viral load (blood DNA >2*106copy/ml) in terms of the effectiveness of mother-to-child blockade. So is there a better way to further reduce the failure rate of blockade? Second, the problem of antiviral therapy during pregnancy It is now very clear that high levels of HBV in pregnant women are a major risk factor for mother-to-child transmission, and that reducing the viral load can reduce mother-to-child transmission. Basically, it can be assumed that a large hepatitis B triplet represents a high viral load and a small hepatitis B triplet represents a low viral load. The protection rate for newborns born to mothers with low hepatitis B viral load has reached 98% to 100% after regular prophylaxis. Therefore, such pregnant women do not need to use antiviral therapy to prevent mother-to-child transmission. However, whether anti-HBV therapy is needed to reduce mother-to-child transmission in pregnant women with high hepatitis B viral load remains to be studied in more rigorously designed, rigorously controlled, large sample, multicenter studies. In recent years, a large number of clinical studies have been conducted by experts and scholars at home and abroad, among which, Prof. Rong Han of the Second People’s Hospital in Nanjing, China, has been most widely recognized by experts at home and abroad, and she concluded that regardless of the level of transaminases and whether in the immune tolerance or immune activation phase, as long as the hepatitis B DNA load is greater than 2*106copy/ml, it is recommended to start oral tenofovir or tenofovir after 24 weeks to 28 weeks of pregnancy. The majority of the patients were observed to have a high oral dose of tenofovir or tenofovir by the time of delivery. It has been observed that by the time of delivery, the DNA load of most patients drops to less than 105 or even undetectable, and when combined with the co-immunization of the child after birth, the success rate of mother-to-child blockade can be more than 99%. A growing number of studies have found that selective use of antiviral drugs in pregnant women with high viral load can reduce the chance of mother-to-child transmission of hepatitis B to close to 0%, with little rebound after discontinuation of the drug and no significant drug resistance or severe myopathy. Therefore, many obstetricians recommend oral antiviral medication in late pregnancy for pregnant women with high viral load. When should I stop taking antiviral drugs? What should I pay attention to after stopping the medication? Will it rebound? Will it cause drug resistance? How safe is it? It is the experience of Prof. R. Korea that after postpartum evaluation, if the patient is in the immune tolerance period, the drug can be discontinued from 1 month to 42 days after delivery, and it is important to test the liver function, hepatitis B hemoglobin and viral load at 1 month, 3 months and 6 months after discontinuation. It has been found that most patients’ DNA load will return to pre-drug status within 1 month of discontinuation. A few patients will experience a “rebound” in liver function after discontinuation, i.e., elevated transaminases, or even liver failure in rare cases, requiring further consultation and treatment by a hepatitis specialist. Tenofovudine does have the possibility of resistance, but the incidence is very low, once the resistance is found, you can switch to tenofovir, currently there is no tenofovir resistance phenomenon. As for patients in the immune activation phase, that is, the active phase of hepatitis, the drug cannot be easily discontinued after delivery, and must be stopped after a consultation with a hepatitis specialist and a rigorous evaluation. Tebivudine and tenofovir are FDA approved class B drugs in pregnancy, what does this mean? You know that if a pregnant woman needs an antibiotic, her doctor will first consider penicillin, right? This is because penicillin is an FDA-approved class B drug for pregnancy, which means that no harm to the fetus has been found in animal studies, and so far there have been no reports of fetal malformations or abnormal development of the child after birth as a result of penicillin use by pregnant women. These drugs can be considered basically harmless to the fetus, and on the balance of pros and cons, they can be used if the condition requires it. After these methods, there are still a very small number of maternal mother-to-child blockade failures in high viral load pregnancies. The biggest reason for this is that about 3% of fetuses of pregnant women with hepatitis B major are already infected with the hepatitis B virus in utero and are born with hepatitis. All current measures, which cannot completely solve this problem, are being explored by scholars. Third, if the husband is surface antigen or e antigen positive, regardless of whether the woman has hepatitis B, the child needs to be injected with high potency hepatitis B immunoglobulin + hepatitis B vaccine immediately after birth.