Antiviral therapy in chronic hepatitis B viral infection during pregnancy: A systematic review and meta-analysis

Robert S. Brown, Brian J. Mcmahon, Anna S.F. Lok, John B. Wong, Ahmed T. Ahmed, Mohamed A. Mouchli, Zhen Wang, Larry J. Prokop, Mohammad Hassan Murad, Khaled Mohammed

Research output: Contribution to journalArticle

151 Scopus citations

Abstract

Perinatal or mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains the major risk factor for chronic HBV infection worldwide. In addition to hepatitis B immune globulin and vaccination, oral antiviral therapies in highly viremic mothers can further decrease MTCT of HBV. We conducted a systematic review and meta-analysis to synthesize the evidence on the efficacy and maternal and fetal safety of antiviral therapy during pregnancy. A protocol was developed by the American Association for the Study of Liver Diseases guideline writing committee. We searched multiple databases for controlled studies that enrolled pregnant women with chronic HBV infection treated with antiviral therapy. Outcomes of interest were reduction of MTCT and adverse outcomes to mothers and newborns. Study selection and data extraction were done by pairs of independent reviewers. We included 26 studies that enrolled 3622 pregnant women. Antiviral therapy reduced MTCT, as defined by infant hepatitis B surface antigen seropositivity (risk ratio = 0.3, 95% confidence interval 0.2-0.4) or infant HBV DNA seropositivity (risk ratio = 0.3, 95% confidence interval 0.2-0.5) at 6-12 months. No significant differences were found in the congenital malformation rate, prematurity rate, and Apgar scores. Compared to control, lamivudine or telbivudine improved maternal HBV DNA suppression at delivery and during 4-8 weeks' postpartum follow-up. Tenofovir showed improvement in HBV DNA suppression at delivery. No significant differences were found in postpartum hemorrhage, cesarean section, and elevated creatinine kinase rates. Conclusions: Antiviral therapy improves HBV suppression and reduces MTCT in women with chronic HBV infection with high viral load compared to the use of hepatitis B immunoglobulin and vaccination alone; the use of telbivudine, lamivudine, and tenofovir appears to be safe in pregnancy with no increased adverse maternal or fetal outcome.

Original languageEnglish (US)
Pages (from-to)319-333
Number of pages15
JournalHepatology
Volume63
Issue number1
DOIs
StatePublished - Jan 1 2016

ASJC Scopus subject areas

  • Hepatology

Fingerprint Dive into the research topics of 'Antiviral therapy in chronic hepatitis B viral infection during pregnancy: A systematic review and meta-analysis'. Together they form a unique fingerprint.

  • Cite this

    Brown, R. S., Mcmahon, B. J., Lok, A. S. F., Wong, J. B., Ahmed, A. T., Mouchli, M. A., Wang, Z., Prokop, L. J., Murad, M. H., & Mohammed, K. (2016). Antiviral therapy in chronic hepatitis B viral infection during pregnancy: A systematic review and meta-analysis. Hepatology, 63(1), 319-333. https://doi.org/10.1002/hep.28302