A Cross-sectional Survey About Awareness of Hepatitis B Virus Infection and Mother to Child Transmission among First Prenatal Visiting Pregnant Women / 中山大学学报(医学科学版)

[Objective]To investigate awareness of hepatitis B virus(HBV)infection and its mother to child transmis-sion(MTCT)among pregnant women attending their first prenatal visit.[Methods]Pregnant women who attended their first prenatal visit to obstetrics outpatient department of the third affiliated hospital of SUN Yat-sen University from May to Aug. 2014,were invited to participate this survey.The self-administered questionnaire about mother to child transmission of HBV was completed anonymously.Data were collected and using ANOVA and logistic analysis to assess the awareness of hepatitis B and its MTCT,and attitudes towards prevention of MTCT of HBV,and to analyze the effective factors of knowledge and at-titudes.[Results]①Of the 500 questionnaires,the effective response rate was 91.8%(459/500).② The total knowledge score of 11 knowledge questions was 11,and the mean score of participants was 6.09 ± 3.29(M±SD). Only about 50% of participants were aware of the complications of hepatitis B and increasing these complications if caused by MTCT. 65.3% of participants knew hepatitis B vaccine.The awareness about modes of HBV transmission including through blood,unprotected sexual intercourse,MTCT and unsafe needles or sharps were 72.0%,48.9%,75.9% and 66.3%,respectively.③The total attitudes score of 6 attitudes questions was 6,and the mean score of participants was 3.84±1.50(M±SD).More than 80% of pregnant women were willing to be screened for hepatitis B,and let neonate receive HBV vaccine.If diagnosed with hepatitis B,83.1% of pregnant women were willing to let neonate receive hepatitis B immunoglobulin,however,only 16.2% would take drugs to prevent MTCT of HBV.④Education with college or higher level was the independent effective factors associat-ed with better knowledge scores(OR=5.96,95%CI:2.95~12.06).Higher education level was the independent effective fac-tor associated with better attitude scores;when compared with junior high or below,the OR values of senior high and college or higher were 1.90(95%CI:1.01~3.55)and 2.50(95%CI:1.43~4.33),respectively.[Conclusion]Although education level is an independent effective factor associated with knowledge of hepatitis B and attitude towards prevention of MTCT of HBV,lack of knowledge about hepatitis B is common among first prenatal-visiting pregnant women,and more education about hepatitis B is necessary.

Identification of risk factors related to the failure of immunization to interrupt hepatitis B virus perinatal transmission / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To explore the factors influencing failure of an immunization to interrupt perinatal (mother-to-child) transmission of hepatitis B virus (HBV).</p><p><b>METHODS</b>Between June 2006 and March 2010, a total of 1355 pregnant women testing positive for the hepatitis B surface antigen (HBsAg), at gestational weeks 20 to 42, and without use of antiviral or immunomodulatory drugs during the pregnancy were prospectively recruited to the study. The mothers were given a choice of receiving hepatitis B immunoglobulin (HBIG; three 200 IU intramuscular injections give at four-week intervals starting from gestation week 28) or not. All neonates (1360, including five sets of twins) received hepatitis B vaccine (10 mug) plus HBIG (200 IU) combined immunization within 24 h of birth, as early as possible. Peripheral venous blood samples were collected from the neonates within 24 h of birth and at 7 and 12 months of age for detection of HBV markers, including hepatitis B e antigen (HBeAg) and HBV DNA. The infants were classified according to HBV perinatal transmission status (infection group and non-infection group) and various factors (maternal-related: age, gravidity, parity; pregnancy/birth-related: threatened premature labor, complications; neonate-related: sex, birth weight, apgar score) were compared between the two groups by using non-conditional logistic regression analysis to determine their potential influence on failure of immunization to inhibit transmission.</p><p><b>RESULTS</b>After 12 months of follow-up, 1.54% (21/1360) of the neonates had presented with HBV infection. Analysis of the HBV-infected neonates revealed differences in infection rates between neonates born to mothers with HBIG injection (2.22% vs. without HBIG injection: 1.11%, P less than 0.05) and caesarean section (1.35% vs. vaginal delivery: 1.73%) but neither reached statistical significance (P less than 0.05); only the practice of breastfeeding showed a significant difference for infection rate, with neonates fed artificial formula having higher infection rate (3.13%) than the breastfed neonates (0.27%, P less than 0.05). The neonate HBV infection rate was also significantly higher for neonates born to HBeAg-positive mothers (4.44% vs. HBeAg-negative mothers: 0%, P less than 0.05) and HBV DNA-positive mothers (3.13% vs. HBV DNA-negative mothers: 0%, P less than 0.05). When the mothers were stratified by serum level of HBV DNA, there was a significant difference in HBV-infected neonates born to mothers with more than or equal to 1*10(7) IU/ml(6.01% vs. 10(3)-10(6) IU/ml: 0.56% and less than 1*10(3) IU/ml: 0%, both P less than 0.05). Logistic regression analysis indicated that the independent risk factors for HBV perinatal transmission despite immunization were maternal serum HBeAg-positive status (relative risk (RR)=31.74, 95% confidence interval (CI): 3.88-259.38) and maternal HBV DNA of ≥ 10⁷ copies/mL (RR=22.58, 95% CI: 4.75-107.40).</p><p><b>CONCLUSION</b>Failure of vaccine plus HBIG to interrupt mother-to-child transmission of HBV is influenced by maternal serum HBeAg-positive status and maternal HBV DNA of ≥10⁷ copies/mL.</p>

The impact of lupus flares on maternal and fetal outcomes in pregnant patients with systemic lupus erythematosus / 中华风湿病学杂志

ObjectiveTo determine the impact of lupus flares on maternal and fetal outcomes in pregnant patients with systemic lupus erythematosus(SLE).MethodsData was obtained from 46 pregnancies of 44 pregnant women with SLE.The relationship between lupus flares and pregnant outcomes,and the risk factors for adverse maternal and fetal prognosis were analyzed.T-test,X2 test or Fisher's exact test and Logistic regression were used for statistical analysis.Results① Lupus flares occurred in19(41％)pregnancies(group A) and stable lupus disease was observed in 27(59％) pregnancies(group B) during pregnancy.Compared to pregnancies in patients with stable lupus disease at the conception(n=32),pregnancies in patients with unstable lupus disease at the conception(n=8) had higher lupus flare during pregnancy( 100％ vs 16％,P＜0.05).(②) The common manifestations of lupus flares during pregnancy were lupus nephritis (LN) (11 cases),skin rashes (10 cases),arthritis (7 cases),and the common complication was infection ( 11 cases).(③) The incidence of premature labor,fetal growth retardation (FGR) and fetal loss in group A was 42％,47％ and 26％ respectively,which was significantly higher than that of the group B (7％,15％ and 0 respectively)(P＜0.05).There was no difference in the incidence of preeclampsia,fetal distress and neonatal asphyxia between the two groups ( 16％ vs 7％,16％ vs 19％,5％ vs O,respectively,P＞0.05).The incidence of premature labor and FGR in patients with active LN was higher than that of patients without active LN (55％ vs 11％,64％ vs 17％,respectively,P＜0.05).(④)The binary Logistic regression analysis showed that renal impairment,hypocomplementemia,aPL and serum urea nitrogen level were independent risk factors for premature delivery,FGR,fetal loss and fetal distress.Conclusion(①) Lupus flares during pregnancy increase the incidence of premature labor,FGR and fetal loss.Active LN during pregnancy can increase the incidence of premature labor and FGR.② Renal impairment,hypocomplementemia,aPL and serum urea nitrogen level are associated with adverse fetal outcomes in pregnant patients with SLE.

Intrauterine HBV infection: risk factors and impact of HBV DNA / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the risk factors of intrauterine hepatitis B virus (HBV) infection and the impact of HBV DNA on the infection.</p><p><b>METHODS</b>The serum levels of HBsAg, HbsAb, HBeAg, HBeAb, HBcAb and HBV DNA were determined in blood samples from 230 HBsAg-positive pregnant women and their newborns by enzyme-linked immunosorbent assay (ELISA) and fluorescence quantitative PCR (FQ-PCR), respectively. The newborns acquiring HBV infection via intrauterine transmission were selected as the case group and others as the control group. The risk factors for intrauterine HBV infection were analyzed by non-conditional logistic regression model.</p><p><b>RESULTS</b>Six infants were found to be HBsAg-positive, and 18 HBV DNA-positive, and 3 of them were positive for both HBsAg and HBV DNA. The rate of intrauterine HBV infection was 9.6% (22/230). The grade of HBV DNA level was identified as the only risk factor of intrauterine HBV infection by non-conditional logistic regression model, with odds ratio (OR) of 1.57 (95% confidence interval 1.12-2.21). Of the 119 pregnant women positive for HBV DNA, 18 were diagnosed as having intrauterine HBV infection, and the likeliness of the infection significantly increased for a maternal serum HBV DNA level > or =10(7) copies/ml (chi(2)=7.92, P<0.05).</p><p><b>CONCLUSION</b>The grade of serum HBV DNA level is the predominant risk factor for intrauterine HBV infection in pregnant women, and for those with serum HBV DNA lever > or =10(7) copies/ml, the chance for intrauterine HBV infection can be significantly increased.</p>