"Aimei Yi" prevention and treatment knowledge series - Hepatitis B

Hepatitis B, as an infectious disease caused by hepatitis B virus infection, mainly causes damage to the liver. Clinically, patients often experience symptoms such as fatigue, loss of appetite, aversion to oil, abnormal liver function, and jaundice. If the condition is serious, it may also progress to cirrhosis or even liver cancer, seriously threatening people's health. Especially for pregnant women, it is very important to understand the relevant knowledge of hepatitis B during the perinatal period, which is related to the health of both mother and baby.

Preparing for pregnancy: scientific assessment and careful planning

Before planning a pregnancy, women with chronic HBV infection should go to the infectious disease department or hepatology department for a comprehensive assessment of their liver function and general condition by a professional physician to determine whether they have liver fibrosis or cirrhosis. Specifically:

1. If women do not have fatigue, loss of appetite or other clinical manifestations related to hepatitis, their liver function is normal, and there is no problem of liver fibrosis or cirrhosis, they can have a normal pregnancy.

2. Women who are in the active stage of hepatitis, that is, women with relevant clinical manifestations and/or abnormal liver function, need to temporarily use contraception. First, treat by resting and other means, and do not use antiviral drugs for the time being. After the clinical manifestations disappear and the liver function is normal and stable for 3 months, pregnancy can be considered. If the above treatment is still ineffective after 3 months, antiviral treatment is required until the liver function returns to normal before pregnancy.

3. For women with chronic hepatitis B who have fertility needs and meet the indications for antiviral treatment, the first choice of drug is tenofovir disoproxil, which is not easy to develop drug resistance. If interferon treatment is chosen, because the course of treatment is limited, pregnancy can be achieved after stopping the drug, but pregnancy is strictly prohibited during the use of interferon, and effective contraceptive measures must be taken.

Screening timing: early detection, early intervention

In order to detect and diagnose hepatitis B in a timely manner, hepatitis B screening tests should be performed before or during early pregnancy. It is particularly important for pregnant women with high risk factors for mother-to-child transmission of HBV to receive preventive antiviral treatment. Studies have shown that after antiviral treatment, the probability of mother-to-child transmission of HBV can be reduced to < 1%.

Infected pregnant women: follow-up during pregnancy and after delivery

1 Follow-up during pregnancy

It is essential for women with chronic HBV infection to have their liver function checked regularly after pregnancy, especially in the early and late stages of pregnancy. Most HBsAg-positive pregnant women have mild liver function abnormalities, and their liver function can often improve or even recover completely through conservative treatments such as rest. However, if liver function abnormalities continue to worsen after conservative treatment, or obvious clinical manifestations appear, antiviral treatment should be considered. For pregnant women with high viral loads (≥2×10^5 IU/mL), it is recommended to start antiviral treatment at 24-28 weeks of pregnancy, such as the use of tenofovir, to reduce the risk of mother-to-child transmission.

2 Postpartum follow-up

If you continue to take antiviral drugs after delivery, you need to check your liver function and HBVDNA every 3 months within 1 year after delivery; and check your hepatitis B two-pair-and-a-half, alpha-fetoprotein, upper abdominal ultrasound and liver stiffness every 6 months.

Postpartum women who stop taking medication or do not take antiviral drugs should have their liver function and HBVDNA checked 6-8 weeks after delivery. If liver function is normal, liver function and HBVDNA can be checked every 3 months; if liver function is abnormal, they need to go to the liver disease specialist clinic in time and start antiviral treatment if necessary.

Labor management: not an indication for cesarean section

It should be noted that hepatitis B itself is not an indication for cesarean section. Mothers should choose the appropriate delivery method according to their specific circumstances and under the professional guidance of doctors.

Exposed children: Careful follow-up to ensure health

Only the offspring of HBsAg-positive pregnant women need to be followed up, and hepatitis B serological indicators should be tested when the children are 7-12 months old. If the test results show that both HBSAg and anti-HBs are negative, three doses of hepatitis B vaccine should be administered again as soon as possible according to the "0, 1, 6 months" plan. If pregnant women take oral antiviral drugs during pregnancy or after delivery, they need to be closely observed for adverse effects on the baby.

Breastfeeding: Correct understanding and scientific breastfeeding

1. Regardless of whether the pregnant woman's HBeAg is negative or positive, or whether the newborn has oral lesions, breastfeeding can be carried out as long as the newborn has been vaccinated and injected with immunoglobulin.

2. If a pregnant woman is taking antiviral drugs after delivery, breastfeeding is also recommended, while paying attention to whether there are adverse effects on the newborn.

Contraceptive methods: safe choice, reducing the burden on the liver

Short-acting contraceptives are prohibited for patients who are experiencing an attack of hepatitis, or who are undergoing treatment but whose inflammation has not been completely controlled and whose liver enzymes are still above the upper limit of normal, as well as patients with benign or malignant liver tumors.

For patients who are taking antiviral drugs, whose liver inflammation has been effectively controlled and whose liver enzymes are completely normal, although taking short-acting contraceptives is not an absolute contraindication, this method of contraception is still not recommended from a cautious perspective.

In general, condoms are the most ideal contraceptive measure for women with chronic hepatitis B. Not only does it not increase the burden on the liver, but it can also effectively reduce the chance of sexual transmission of hepatitis B virus through physical barriers.

Reproductive management: pre-pregnancy assessment and advance preparation

Women who plan to have another child should have their hepatitis B virus load and liver function assessed before pregnancy. If the viral load is high, antiviral treatment is required before pregnancy to fully prepare for another pregnancy.

Key to prevention and treatment: Keep the key points in mind and eliminate misunderstandings

The key to the prevention and treatment of hepatitis B lies in the effective antiviral treatment during pregnancy and neonatal immunization. After the newborn is vaccinated, the mother with hepatitis B can breastfeed.

Common misunderstandings clarified: There is a wrong view that "mothers with hepatitis B cannot breastfeed". In fact, as long as the newborn is vaccinated and injected with immunoglobulin, breastfeeding is completely possible.

By understanding these perinatal knowledge related to hepatitis B, both pregnant women and the general public can understand and deal with hepatitis B more scientifically, and safeguard the health of mothers and babies.