Xiaomao Li

Lamivudine in late pregnancy to interrupt in utero transmission of hepatitis B virus: a systematic review and meta-analysis.

OBJECTIVES: To evaluate efficacy of lamivudine in reducing in utero transmission of hepatitis B virus (HBV). DATA SOURCES: A database was constructed from Medline, EMBASE, Cochrane Library, National Science Digital Library, China Biological Medicine Database, and through contact with experts in the field from January 1990 to October 2009. METHODS OF STUDY SELECTION: We used the Jadad score and Cochrane Collaborations tool for assessing risk of bias. TABULATION, INTEGRATION, AND RESULTS: We abstracted data regarding HBV intrauterine infection, mother-to-child transmission, maternal HBV DNA level, treatment methods, and adverse effects. All newborns followed joint immune prophylaxis schedule of hepatitis B vaccine and hepatitis B immunoglobulin after delivery. The Mantel-Haenszel random-effects model was employed for all analyses using odds ratio (OR) and 95% confidence interval. Newborns in the lamivudine group had a 13.0–23.7% lower incidence of intrauterine infection, indicated by newborn hepatitis B surface antigen (0.38, 0.15–0.94, six randomized controlled trials [RCTs], P=.04) and HBV DNA (0.22, 0.12–0.40, four RCTs, P<.001) seropositivity, and a 1.4–2.0% lower mother-to-child transmission rate at 9–12 months, indicated by infant hepatitis B surface antigen (0.31, 0.15–0.63, four RCTs, P<.01) and HBV DNA (0.20, 0.10–0.39, two RCTs, P<.001) seropositivity. No significant higher adverse effects or complications in pregnancy were observed. CONCLUSION: Lamivudine in HBV carrier–mothers with high degree of infectiousness in late pregnancy effectively prevented HBV intrauterine infection and mother-to-child transmission.

Hepatitis B immunoglobulin injection in pregnancy to interrupt hepatitis B virus mother-to-child transmission-a meta-analysis.

OBJECTIVES To evaluate the efficacy and safety of using hepatitis B immunoglobulin (HBIG) during pregnancy to prevent hepatitis B virus (HBV) mother-to-child transmission (MTCT). METHODS We systematically reviewed the effect of HBIG in decreasing HBV MTCT from randomized controlled trials (RCTs) carried out between January 1990 and December 2008, in English and Chinese languages. Multiple databases were searched, and experts in this field were contacted. The methodological quality of each RCT was assessed by the Jadad score. We abstracted data on HBV intrauterine infection, MTCT, treatment methods, newborn immune prophylaxis methods, and adverse effects. A Mantel-Haenszel random-effects model was employed for all analyses using odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS Five thousand nine hundred newborns of asymptomatic hepatitis B surface antigen (HBsAg)-seropositive mothers from 37 qualified RCTs were included. Compared with the control group, newborns in the HBIG group had a lower intrauterine infection rate (indicated by HBsAg as OR 0.22, 95% CI [0.17, 0.29], from 32 RCTs; indicated by HBV DNA as OR 0.15, 95% CI [0.07, 0.30], from 13 RCTs; p<0.01 for both) and a higher protection rate (indicated by hepatitis B surface antibody (HBsAb) as OR 11.79, 95% CI [4.69, 29.61], from 15 RCTs; p<0.01). The same trend was found in MTCT by the time of 9-12 months after birth, indicated by HBsAg (OR 0.33, 95% CI [0.21, 0.51], from nine RCTs; p<0.01) and HBsAb (OR 2.49, 95% CI [1.55, 4.01], from 11 RCTs; p<0.01). HBIG appears to be safe, but a few RCTs have reported adverse events. CONCLUSION Multiple injections of HBIG in HBV carrier mothers with a high degree of infectiousness in late pregnancy, effectively and safely prevent HBV intrauterine transmission.

Breastfeeding of newborns by mothers carrying hepatitis B virus: a meta-analysis and systematic review.

OBJECTIVE To perform a systematic review of prospective studies to confirm the role of breastfeeding in mother-to-child transmission (MTCT) of hepatitis B virus (HBV). DATA SOURCES A database was constructed from MEDLINE, EMBASE, Cochrane Library, National Science Digital Library, and China Biological Medicine Database and through contact with experts in this field from January 1, 1990, to August 31, 2010. STUDY SELECTION All studies were peer reviewed and met the preset inclusion standards. MAIN EXPOSURE Breastfeeding. MAIN OUTCOME MEASURES Data regarding HBV intrauterine infection, MTCT, maternal blood and breast milk infectiousness, infant immunoprophylaxis methods and response, and adverse events. The Mantel-Haenszel fixed-effects model was used for all analyses using odds ratios and 95% confidence intervals. RESULTS Ten qualified studies were included. All were clinical controlled trials, involving 751 infants in the breastfeeding group and 873 infants in the nonbreastfeeding group. As indicated by infant peripheral blood hepatitis B surface antigen or HBV DNA positivity at age 6 to 12 months, the odds ratio of MTCT of HBV in the breastfeeding group compared with that in the nonbreastfeeding group was 0.86 (95% confidence interval, 0.51-1.45) (from 8 clinical controlled trials, P = .56; I(2) = 0%, P = .99). As indicated by infant peripheral blood hepatitis B surface antibody positivity at age 6 to 12 months, the odds ratio of development of hepatitis B surface antibodies in the breastfeeding group compared with that in the nonbreastfeeding group was 0.98 (95% confidence interval, 0.69-1.40) (from 8 clinical controlled trials, P = .93; I(2) = 0%, P = .99). No adverse events or complications during breastfeeding were observed. CONCLUSION Breastfeeding after proper immunoprophylaxis did not contribute to MTCT transmission of HBV.

Mother‐to‐child transmission of HBV: review of current clinical management and prevention strategies

Mother‐to‐child transmission (MTCT) of HBV is responsible for approximately half of the HBV transmission routes and continues to be a challenging problem worldwide. Even after the development of effective vaccines and clear World Health Organization guidelines toward HBV several decades ago, 1–9% newborns of HBV‐carrying mothers still acquire HBV in early life as a result of in utero infection. The prevention of MTCT is of high importance, because chronically infected individuals function as a reserve for sustained HBV transmission, and 25% of them can develop asymptomatic liver cirrhosis and hepatocellular carcinoma. In this article, we review the canonical and novel HBV infection routes/mechanisms, influencing factors, diagnostic criteria, and interruption strategies for HBV MTCT. The preventative strategy of HBV MTCT has evolved from routine postpartum HB immune globulin (HBIG) plus HB vaccine schedules to administration of HBIG or nucleoside analogs during pregnancy and minimizing the exposure of maternal body fluids to the newborn during delivery. Copyright

Obstetrical Management of Fulminant Viral Hepatitis in Late Pregnancy

Objective: To set up a routine perinatal treatment guideline for fulminant viral hepatitis in late pregnancy (FVHLP). Method: A summary of literature of successful treatment at various clinical stages. Due to the limited number of prospective studies, retrospective, observational studies and case reports were analyzed and pathophysiological mechanisms were summarized as well. Results: A comprehensive obstetrical treatment guideline was proposed as follows: (a) Awareness of FVHLP should be reinforced among medical staff; (b) Patients diagnosed with FVHLP should be transported to regional expert centers before labor onset; (c) Supportive medication should be administered to prepare the patients for incoming delivery. A central venous line should be maintained to provide rapid intravenous access and monitor central venous pressure before operation start; (d) Caesarean section is recommended for the mode of delivery, followed by peripartum hysterectomy to control postpartum hemorrhage; (e) Peritoneal/abdominal lavage and drainage tube placement are recommended following operation to decrease abdominal pressure and detect post-operational bleeding; (f) Hypertonic glucose along with insulin topical injection is recommended to promote the healing of wound; (g) Supportive medication, replenishment of coagulation factors, preventive antibiotics should be given as needed. Adjust the amount and order of intravenous fluid according to the character and amount of drainage and urine. Conclusion: Vital obstetrical measures taken include supportive treatments, delivery at appropriate time by cesarean section, and prevent and control of various complications. Guidelines developed with more robust research are still needed

Maternal and perinatal outcome in cases of fulminant viral hepatitis in late pregnancy.

To investigate maternal and perinatal outcomes in cases of fulminant viral hepatitis in late pregnancy (FVHILP).

Insulin and hypertonic glucose in the management of aseptic fat liquefaction of post-surgical incision: a meta-analysis and systematic review.

A meta‐analysis and systematic review assessing randomised controlled trials (RCTs) was sought to determine whether subcutaneous injection of insulin with hypertonic glucose promotes healing in postoperative incisions with aseptic fat liquefaction. We searched the Cochrane library, Pubmed, EMBASE, National Science Digital Library (NSDL) and China Biological Medicine Database (CBMdisc) for literature published from 1 January 1990 to 30 September 2011. RCTs that evaluated subcutaneous injection of insulin with hypertonic glucose as a treatment for postoperative wound with fat liquefaction were sought. Wound healing was the primary endpoint. Jadad score and Cochrane Collaborations tool were used for assessing quality of studies and risk of bias. We abstracted data regarding time to wound healing, cost and adverse effects. The random‐effects inverse variance model was used for all analyses using weighted mean difference and 95% confidence interval. Eight trials (414 participants) were identified that met the inclusion criteria. Subcutaneous injection of insulin with hypertonic glucose significantly reduces time to healing by 6·33 days compared with conventional drainage, with less cost. There was no report concerning adverse effects. Subcutaneous injection of insulin with hypertonic glucose may improve the healing process in postoperative wounds with aseptic fat liquefaction.

Acupuncture: how objective is the evidence from randomised clinical trials?

number of women treated. Surveillance data from Australia and New Zealand do not suggest an increase in disease severity between 2009 and 2010. Nevertheless, as Mr Dickson and Dr Anders observe, what is clear is that the disease can have severe consequences for both mothers and babies. Immunisation has the potential to prevent these adverse outcomes, and immunisation against seasonal influenza is available free to pregnant women in Australia, New Zealand and the UK. Although the safety profile of the vaccine is now well established, data suggest that vaccine uptake rates among pregnant women have been surprisingly low. A survey in Western Australia of pregnant women entering the 2010 influenza season reported uptake rates of <7%; the most commonly cited reason for nonvaccination, in 64% of women, was that it had not been suggested during visits to their medical practitioner. However, 62% of women reported that they would have declined vaccination on the basis of safety concerns. There remains a public health imperative to strongly advocate immunisation, particularly in the context of health systems in which it is freely available. The health profession plays an important role in counselling women about the benefits and safety of immunisation, not only for themselves, but also for their unborn child. Our comparison suggested that women in the UK in the second phase of the pandemic, benefited from public health interventions introduced following the first wave of infection. Ongoing public health campaigns, including immunisation of pregnant women and early use of antiviral agents, are key to improving outcomes for women and their babies in the future.j