Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus (version 2024)
image: The Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus, developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019, serves as a valuable reference for standardizing the prevention of mother-to-child transmission in China. As new evidence continues to emerge, it is essential to update these guidelines regularly to optimize clinical practice and research. To this end, the Infectious Disease Physician Branch of the Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of the Chinese Medical Association, in collaboration with multidisciplinary experts, have updated the guidelines based on the latest domestic and international research advancements and clinical practices, providing up-to-date guidance for clinicians and maternal and child healthcare workers.
Credit: Yingren Zhao, Lanjuan Li, Wenhong Zhang, Hong Ren, Jinfeng Liu, Qinglei Zeng, Fanpu Ji
Mother-to-child transmission (MTCT) is the primary route of hepatitis B virus (HBV) transmission in China, with a chronic infection rate of approximately 90% when infection occurs during the perinatal or infant period. This transmission contributes significantly to familial clustering of HBV, increasing the risk of cirrhosis and hepatocellular carcinoma, particularly in families with a history of HBV infection. To address this, China aims to eliminate HBV MTCT by 2025 through antiviral prophylaxis for pregnant women with high HBV viremia, combined with hepatitis B vaccine and immunoglobulin (HBIG) for infants, reducing MTCT rates to as low as 0.23%.
In 2019, the Chinese Clinical Practice Guidelines for Preventing HBV MTCT were established, and recent advancements have necessitated their update. The newly updated Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus (version 2024), based on systematic evidence review and the GRADE system, provide updated recommendations for managing HBV-infected pregnant women and their infants, emphasizing individualized care and interdisciplinary collaboration., which aim to standardize prevention efforts while allowing flexibility for clinicians to adapt recommendations based on patient-specific conditions and available resources.
There are still some research gaps in the field.
- Long-term Safety of Infants Exposed to tenofovir alafenamide: Further data are needed to assess the long-term safety of infants born to mothers treated with tenofovir alafenamide for chronic HBV infection, as current evidence remains limited.
- Postpartum Antiviral Therapy and Immune Activity: Postpartum changes in immune and hormonal levels may trigger hepatitis activity, representing a unique "immune active stage." Future research should focus on optimizing and evaluating the efficacy of postpartum antiviral regimens.
- Cost-Effectiveness of MTCT Prevention Without HBIG: While the current standard for preventing HBV MTCT in China involves the hepatitis B vaccine and HBIG, the high cost and cold chain requirements of HBIG pose challenges in underdeveloped regions. Studies are exploring the effectiveness of antiviral prophylaxis during pregnancy combined with infant vaccination, excluding HBIG.
- Long-term Safety of Antiviral Exposure During Pregnancy: With expanding indications for antiviral therapy, more infants are exposed to these drugs throughout pregnancy. Long-term follow-up cohorts are needed to evaluate the safety of antiviral agents for both mothers and children, as current data are limited and follow-up periods are short.
- Risk of HBV Transmission via Germ Cells: Although HBV markers have been detected in oocytes, spermatocytes, and zygotes, the risk of germ cell transmission remains unclear. While current strategies have reduced MTCT rates to approximately 0.3%, further research is needed to clarify this potential transmission route.
Additionally, further investigation is required to assess the risks of HBV transmission through germ cells and the long-term safety of antiviral exposure during pregnancy.
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https://www.xiahepublishing.com/2310-8819/JCTH-2024-00258
The study was recently published in the Journal of Clinical and Translational Hepatology.
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