Effect of Invasive Tests During Pregnancy on Perinatal Transmission of Hepatitis B Infection: a Scoping Review

Overview

Journal EClinicalMedicine

Date 2025 Jan 31

PMID 39885958

Authors

Ka Wang Cheung

Tiffany Sin-Tung Au

Ying Rong Li

Zhenyan Han

Zhu Zhang

Mimi Tin Yan Seto

Affiliations

Soon will be listed here.

Abstract

Prenatal and intrapartum invasive tests are possible mechanisms of mother to child transmission (MTCT) of hepatitis B virus (HBV). The viral activity can affect the MTCT risk after invasive tests, but the evidence is scarce. This scoping review discussed the effects of prenatal or intrapartum invasive tests on the risk of HBV MTCT. The risk of MTCT after amniocentesis was low among hepatitis B infected pregnant individuals with negative hepatitis B e antigen (HBeAg) statuses or HBV DNA < 7 log IU/mL, and comparable to those that did not undergo prenatal invasive tests. Amniocentesis could increase the risk of MTCT among women with seropositive HBeAg statuses or HBV DNA ≥ 7 log IU/mL, but there were no MTCT among these women who received antiviral treatment. Data on CVS, cordocentesis and intrapartum invasive tests were insufficient to conclude their effects on MTCT. We also reviewed 50 international clinical practice guidelines. Most of them did not have recommendations on the management of hepatitis B infected pregnant individuals requiring prenatal or intrapartum invasive tests and significant discrepancies existed among the remaining guidelines. A workflow and two pragmatic approaches were discussed to assist clinical management. Furthermore, we would like to encourage future research to provide comprehensive data on the factors influencing the MTCT rate (such as maternal HBV DNA viral load and HBeAg status, availability and timing of neonatal birth dose immunizations, transplacental or transamniotic invasive tests, complications of the invasive tests and the use of antiviral prophylaxis).

References

Mokaya J, Burn E, Tamandjou C, Goedhals D, Barnes E, Andersson M . Modelling cost-effectiveness of tenofovir for prevention of mother to child transmission of hepatitis B virus (HBV) infection in South Africa. BMC Public Health. 2019; 19(1):829. PMC: 6595556. DOI: 10.1186/s12889-019-7095-4. View

Kumar M, Abbas Z, Azami M, Belopolskaya M, Dokmeci A, Ghazinyan H . Asian Pacific association for the study of liver (APASL) guidelines: hepatitis B virus in pregnancy. Hepatol Int. 2022; 16(2):211-253. DOI: 10.1007/s12072-021-10285-5. View

. Japan Society of Hepatology Guidelines for the Management of Hepatitis B Virus Infection: 2019 update. Hepatol Res. 2020; 50(8):892-923. DOI: 10.1111/hepr.13504. View

You H, Wang F, Li T, Xu X, Sun Y, Nan Y . Guidelines for the Prevention and Treatment of Chronic Hepatitis B (version 2022). J Clin Transl Hepatol. 2023; 11(6):1425-1442. PMC: 10500285. DOI: 10.14218/JCTH.2023.00320. View

Higuera-de-la-Tijera F, Castro-Narro G, Velarde-Ruiz Velasco J, Cerda-Reyes E, Moreno-Alcantar R, Aiza-Haddad I . Asociación Mexicana de Hepatología A.C. Clinical guideline on hepatitis B. Rev Gastroenterol Mex (Engl Ed). 2021; 86(4):403-432. DOI: 10.1016/j.rgmxen.2021.04.002. View

Navaratnam K, Alfirevic Z . Amniocentesis and chorionic villus sampling: Green-top Guideline No. 8 July 2021: Green-top Guideline No. 8. BJOG. 2021; 129(1):e1-e15. DOI: 10.1111/1471-0528.16821. View

. KASL clinical practice guidelines for management of chronic hepatitis B. Clin Mol Hepatol. 2022; 28(2):276-331. PMC: 9013624. DOI: 10.3350/cmh.2022.0084. View

Clark S, Gimovsky M, Miller F . The scalp stimulation test: a clinical alternative to fetal scalp blood sampling. Am J Obstet Gynecol. 1984; 148(3):274-7. DOI: 10.1016/s0002-9378(84)80067-8. View

Mocanu E, Drakeley A, Kupka M, Lara-Molina E, Le Clef N, Ombelet W . ESHRE guideline: medically assisted reproduction in patients with a viral infection/disease. Hum Reprod Open. 2023; 2021(4):hoab037. PMC: 9887941. DOI: 10.1093/hropen/hoab037. View

10.

Nayagam S, de Villiers M, Shimakawa Y, Lemoine M, Thursz M, Walsh N . Impact and cost-effectiveness of hepatitis B virus prophylaxis in pregnancy: a dynamic simulation modelling study. Lancet Gastroenterol Hepatol. 2023; 8(7):635-645. DOI: 10.1016/S2468-1253(23)00074-2. View

11.

Kutcher S, Brophy J, Banack H, Kaufman J, Samuel M . Emulating a Randomised Controlled Trial With Observational Data: An Introduction to the Target Trial Framework. Can J Cardiol. 2021; 37(9):1365-1377. DOI: 10.1016/j.cjca.2021.05.012. View

12.

Westin J, Aleman S, Castedal M, Duberg A, Eilard A, Fischler B . Management of hepatitis B virus infection, updated Swedish guidelines. Infect Dis (Lond). 2019; 52(1):1-22. DOI: 10.1080/23744235.2019.1675903. View

13.

Badell M, Prabhu M, Dionne J, Tita A, Silverman N . Society for Maternal-Fetal Medicine Consult Series #69: Hepatitis B in pregnancy: updated guidelines. Am J Obstet Gynecol. 2023; 230(4):B2-B11. DOI: 10.1016/j.ajog.2023.12.023. View

14.

Wu Y, Liu J, Feng Y, Fu S, Ji F, Ge L . Efficacy and safety of antiviral therapy for HBV in different trimesters of pregnancy: systematic review and network meta-analysis. Hepatol Int. 2020; 14(2):180-189. PMC: 7136311. DOI: 10.1007/s12072-020-10026-0. View

15.

Schillie S, Vellozzi C, Reingold A, Harris A, Haber P, Ward J . Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018; 67(1):1-31. PMC: 5837403. DOI: 10.15585/mmwr.rr6701a1. View

16.

Han Z, Zhang Y, Zhou J, Wang Q, Huang Y, Hou H . Risk of mother-to-child transmission of hepatitis B virus after fetal blood sampling: a report of six cases. BMC Infect Dis. 2021; 21(1):716. PMC: 8325253. DOI: 10.1186/s12879-021-06423-x. View

17.

Chien R, Kao J, Peng C, Chen C, Liu C, Huang Y . Taiwan consensus statement on the management of chronic hepatitis B. J Formos Med Assoc. 2018; 118(1 Pt 1):7-38. DOI: 10.1016/j.jfma.2018.11.008. View

18.

Han Z, Zhang Y, Bai X, Yin Y, Xu C, Hou H . Mother-to-child transmission of hepatitis B virus after amniocentesis: A retrospective matched cohort study. Prenat Diagn. 2019; 39(6):431-440. DOI: 10.1002/pd.5452. View

19.

Du X, Zhang L, Liu Z, Qian Y, Zhang X, Hu T . Risk of mother-to-child transmission after amniocentesis in pregnant women with hepatitis B virus: a retrospective cohort study. Am J Obstet Gynecol. 2023; 230(2):249.e1-249.e8. DOI: 10.1016/j.ajog.2023.07.032. View

20.

Katiyar R, Kriplani A, Agarwal N, Bhatla N, Kabra M . Detection of fetomaternal hemorrhage following chorionic villus sampling by Kleihauer Betke test and rise in maternal serum alpha feto protein. Prenat Diagn. 2006; 27(2):139-42. DOI: 10.1002/pd.1632. View