I often get this question in the clinic: “Doctor, I have hepatitis B and I want to get pregnant, is it okay? Doctor, I am already 3 months pregnant and now I have been tested for hepatitis B. What should I do? Doctor, I have hepatitis B, will my baby be infected? All of these questions are of concern to women of childbearing age.
Simply put, women of childbearing age are women who are facing the need to get pregnant or are already pregnant, including
1.Women who are about to consider pregnancy.
2.Women who become pregnant accidentally while on antiviral treatment.
3.Women whose liver function abnormalities have just been detected during pregnancy.
4. Women who are not on antiviral therapy and have a high viral load.
”October pregnancy is a happy and difficult task for women, and women with hepatitis B virus infection are extra worried about whether they can successfully complete the pregnancy and give birth to a healthy and lovely baby. What should they do if they find out that their liver function is abnormal during the pregnancy? Secondly, will the baby be affected by her hepatitis B? Is there a reliable way to ensure that the baby will not be infected?
1. If you are a woman who is planning to get pregnant, the problem will be simpler. You can determine your liver damage before you get pregnant by examining.
1, if HBVDNA is found to be higher than 105 (i.e. E+05) copies/mL, and the liver is heavily damaged, there is severe liver fibrosis or even cirrhosis, or there is severe hepatitis activity / persistent high level of ALT elevation, you should first receive antiviral treatment to clear the virus before considering pregnancy, as to how to find out the liver damage, you can read the author’s article on this site “Hepatitis B Antiviral therapy needs to focus on liver fibrosis assessment”. In terms of treatment drugs, priority is given to interferon therapy, and if interferon is not effective, then consider oral drug therapy;
2. If it is determined after relevant examinations that the liver damage is mild, there is no liver fibrosis, or the liver fibrosis is mild, or you have insisted on having normal liver function indicators every 3 months for the past 3 years, you should be able to get pregnant with confidence.
If you have a strong desire to continue your pregnancy, depending on the medications you are using.
1. So far, foreign data on pregnancy in women with AIDS show that lamivudine as well as tenofovir should be safe for pregnancy, while there is no reliable information to judge the effect of other drugs on early pregnancy; although there are individual women using other antiviral drugs who insist on pregnancy, there is no evidence that drugs such as telbivudine, entecavir and adefovir have an effect on pregnancy.
However, there is limited information and thus safety cannot be confirmed; in any case, even if you risk continuing your pregnancy, if you are treated with drugs such as telbivudine, entecavir and adefovir, it is recommended that you immediately stop using the above drugs and switch to treatment with lamivudine or tenofovir, but tenofovir is not yet approved for hepatitis B treatment in China;
2. If there is evidence that your liver was mildly diseased before the medication was administered, you may also choose to discontinue the medication directly.
If you discover liver function abnormalities during pregnancy, which is more complicated.
1, if the liver function abnormalities are found in early and middle pregnancy (i.e. in the first 6 months of pregnancy), you need to recall your previous medical history: if you insist on checking your liver function every 3-6 months for several years before pregnancy are normal, you can continue your pregnancy without considering any medication and monitor your liver function closely; if you did not insist on checking before, you need to monitor your bilirubin closely, if bilirubin continues to be normal, it is usually not a big problem; but if If the bilirubin rises more than 2 times, it is necessary to consider tenofovir or lamivudine antiviral therapy and add liver protection drugs with higher safety;
2. If liver function abnormalities are found in late pregnancy (3 months after pregnancy), then tenofovir, telbivudine or lamivudine treatment can be considered, with priority given to telbivudine treatment before tenofovir is approved for use in China.
The second problem is relatively simple to deal with, regardless of whether the “mother-to-be” is “major triple-positive” or “minor triple-positive”, should be checked for HBVDNA.
Measures to prevent the baby from being infected include.
1. As long as the “mother-to-be” is positive for HBsAg, she should inject 10ug of hepatitis B vaccine and 100-200 IU of hepatitis B immunoglobulin into the lateral muscles of the anterior buttocks of both sides within 12 hours after the birth of her baby, and inject the second and third doses of hepatitis B vaccine in January and June after birth.
2. If the mother-to-be’s HBVDNA is higher than 106 (E+06) copies/mL, in order to ensure that the baby is not infected, the mother-to-be can consider receiving treatment with tenofovir in the late pregnancy (after the third month of pregnancy) (tenofovir can be used after the approval of the drug). It can be used after the drug is approved).
Regarding the discontinuation of the drug for the “mother-to-be”.
1. If it is confirmed that the mother-to-be has minimal previous liver damage and does not require antiviral therapy, and if the drug is used in late pregnancy only to protect the baby from infection, the drug should be discontinued immediately after the birth of the baby, especially if the mother-to-be plans to breastfeed the baby;
2. If liver function abnormalities are found during pregnancy, the mother-to-be should continue to take the medication in order to take into account the treatment of hepatitis B. The timing of discontinuing the medication depends on the treatment of the disease, but the mother-to-be who continues to take the medication should not breastfeed (with the exception of tenofovir: foreign studies The concentration of tenofovir in breast milk is very low, and breastfeeding is safe.