Hepatitis B immunoglobulin during pregnancy for prevention of mother-to-child transmission of hepatitis B virus

• Published in: Cochrane database of systematic reviews 2017-02, Vol.2 (2), p.CD008545-CD008545
• Main Authors: Eke, Ahizechukwu C, Eleje, George U, Eke, Uzoamaka A, Xia, Yun, Liu, Jiao
• Format: Article
• Language: English
• Subjects: Adult; DNA, Viral - blood; Female; Gastroenterology & hepatology; Hepatitis B - blood; Hepatitis B - transmission; Hepatitis B e Antigens - blood; Hepatitis B Surface Antigens - blood; Hepatitis B virus - genetics; Hepatitis B virus - immunology; Humans; Immunization, Passive - methods; Immunoglobulins - administration & dosage; Infant, Newborn; Infectious disease; Infectious Disease Transmission, Vertical - prevention & control; Pregnancy; Randomized Controlled Trials as Topic
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD008545.pub2

Hepatitis is a viral infection of the liver. It is mainly transmitted between people through contact with infected blood, frequently from mother to baby in-utero. Hepatitis B poses significant risk to the fetus and up to 85% of infants infected by their mothers at birth develop chronic hepatitis B virus (HBV) infection. Hepatitis B immunoglobulin (HBIG) is a purified solution of human immunoglobulin that could be administered to the mother, newborn, or both. HBIG offers protection against HBV infection when administered to pregnant women who test positive for hepatitis B envelope antigen (HBeAg) or hepatitis B surface antigen (HBsAg), or both. When HBIG is administered to pregnant women, the antibodies passively diffuse across the placenta to the child. This materno-fetal diffusion is maximal during the third trimester of pregnancy. Up to 1% to 9% infants born to HBV-carrying mothers still have HBV infection despite the newborn receiving HBIG plus active HBV vaccine in the immediate neonatal period. This suggests that additional intervention such as HBIG administration to the mother during the antenatal period could be beneficial to reduce the transmission rate in utero. To determine the benefits and harms of hepatitis B immunoglobulin (HBIG) administration to pregnant women during their third trimester of pregnancy for the prevention of mother-to-child transmission of hepatitis B virus infection. We searched the The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE Ovid, Embase Ovid, Science Citation Index Expanded (Web of Science), SCOPUS, African Journals OnLine, and INDEX MEDICUS up to June 2016. We searched ClinicalTrials.gov and portal of the WHO International Clinical Trials Registry Platform (ICTRP) in December 2016. We included randomised clinical trials comparing HBIG versus placebo or no intervention in pregnant women with HBV. Two authors extracted data independently. We analysed dichotomous outcome data using risk ratio (RR) and continuous outcome data using mean difference (MD) with 95% confidence intervals (CI). For meta-analyses, we used a fixed-effect model and a random-effects model, along with an assessment of heterogeneity. If there were statistically significant discrepancies in the results, we reported the more conservative point estimate. If the two estimates were equal, we used the estimate with the widest CI as our main result. We assessed bias control using the Cochrane Hepato-Biliary Group suggested bias