Accelerating the momentum to achieve global elimination of hepatitis B infection: a scoping review of hepatitis B guidelines to reduce mother to child transmission
Summary: Progress towards achieving global elimination of hepatitis B virus (HBV) by 2030 remains unsatisfactory. Prevention of mother to child transmission is crucial but current Clinical Practice Guidelines (CPGs) gave diverse recommendations, creating confusion and leading to significant challeng...
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Elsevier
2025-02-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537024006175 |
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| author | Ka Wang Cheung Ying Rong Li Ms Tiffany Sin-Tung Au Mimi Tin Yan Seto |
| author_facet | Ka Wang Cheung Ying Rong Li Ms Tiffany Sin-Tung Au Mimi Tin Yan Seto |
| author_sort | Ka Wang Cheung |
| collection | DOAJ |
| description | Summary: Progress towards achieving global elimination of hepatitis B virus (HBV) by 2030 remains unsatisfactory. Prevention of mother to child transmission is crucial but current Clinical Practice Guidelines (CPGs) gave diverse recommendations, creating confusion and leading to significant challenges in the practical implementation across various regions owing to global inequity. We reviewed 47 CPGs on the management of hepatitis B during pregnancy against twelve important clinical questions. Of 47 guidelines, 80.9% (38/47) supported the universal approach to HBV screening. To select women for antiviral prophylaxis, 78.7% (37/47) recommended the use of HBV DNA levels, while 31.9% (15/47) recommended the use of HBeAg. Of 37 guidelines recommending HBV DNA levels, 94.6% (35/37) recommended a viral load threshold of >200,000 IU/mL to initiate antiviral prophylaxis. Of 16 guidelines addressing the mode of delivery, 87.5% (14/16) encouraged vaginal birth. Of 30 guidelines addressing breastfeeding, 60% (18/30) recommended breastfeeding. However, controversies were found in the optimal timing of HBV disease evaluation during pregnancy and the ideal timing to stop antiviral prophylaxis after delivery. Of 36 guidelines addressing the timing to initiate antiviral prophylaxis, 25% (9/36) advised starting prophylaxis between 24 and 28 weeks, while 75% (27/36) suggested other timings or provided vague descriptions. Of 38 guidelines addressing birth-dose vaccination, 42% (16/38) emphasized the importance of “vaccination as soon as possible after birth.” These deficiencies and discrepancies among CPGs could significantly impede global HBV elimination. |
| format | Article |
| id | doaj-art-036dea68818243ada006f6842a39d401 |
| institution | Kabale University |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-036dea68818243ada006f6842a39d4012025-01-13T04:19:06ZengElsevierEClinicalMedicine2589-53702025-02-0180103038Accelerating the momentum to achieve global elimination of hepatitis B infection: a scoping review of hepatitis B guidelines to reduce mother to child transmissionKa Wang Cheung0Ying Rong Li1Ms Tiffany Sin-Tung Au2Mimi Tin Yan Seto3Corresponding author. 6/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.; Department of Obstetrics and Gynecology, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, ChinaDepartment of Obstetrics and Gynecology, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, ChinaDepartment of Obstetrics and Gynecology, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, ChinaDepartment of Obstetrics and Gynecology, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, ChinaSummary: Progress towards achieving global elimination of hepatitis B virus (HBV) by 2030 remains unsatisfactory. Prevention of mother to child transmission is crucial but current Clinical Practice Guidelines (CPGs) gave diverse recommendations, creating confusion and leading to significant challenges in the practical implementation across various regions owing to global inequity. We reviewed 47 CPGs on the management of hepatitis B during pregnancy against twelve important clinical questions. Of 47 guidelines, 80.9% (38/47) supported the universal approach to HBV screening. To select women for antiviral prophylaxis, 78.7% (37/47) recommended the use of HBV DNA levels, while 31.9% (15/47) recommended the use of HBeAg. Of 37 guidelines recommending HBV DNA levels, 94.6% (35/37) recommended a viral load threshold of >200,000 IU/mL to initiate antiviral prophylaxis. Of 16 guidelines addressing the mode of delivery, 87.5% (14/16) encouraged vaginal birth. Of 30 guidelines addressing breastfeeding, 60% (18/30) recommended breastfeeding. However, controversies were found in the optimal timing of HBV disease evaluation during pregnancy and the ideal timing to stop antiviral prophylaxis after delivery. Of 36 guidelines addressing the timing to initiate antiviral prophylaxis, 25% (9/36) advised starting prophylaxis between 24 and 28 weeks, while 75% (27/36) suggested other timings or provided vague descriptions. Of 38 guidelines addressing birth-dose vaccination, 42% (16/38) emphasized the importance of “vaccination as soon as possible after birth.” These deficiencies and discrepancies among CPGs could significantly impede global HBV elimination.http://www.sciencedirect.com/science/article/pii/S2589537024006175AntiviralHepatitis B virusPregnancyVaccineViral loadVertical transmission |
| spellingShingle | Ka Wang Cheung Ying Rong Li Ms Tiffany Sin-Tung Au Mimi Tin Yan Seto Accelerating the momentum to achieve global elimination of hepatitis B infection: a scoping review of hepatitis B guidelines to reduce mother to child transmission EClinicalMedicine Antiviral Hepatitis B virus Pregnancy Vaccine Viral load Vertical transmission |
| title | Accelerating the momentum to achieve global elimination of hepatitis B infection: a scoping review of hepatitis B guidelines to reduce mother to child transmission |
| title_full | Accelerating the momentum to achieve global elimination of hepatitis B infection: a scoping review of hepatitis B guidelines to reduce mother to child transmission |
| title_fullStr | Accelerating the momentum to achieve global elimination of hepatitis B infection: a scoping review of hepatitis B guidelines to reduce mother to child transmission |
| title_full_unstemmed | Accelerating the momentum to achieve global elimination of hepatitis B infection: a scoping review of hepatitis B guidelines to reduce mother to child transmission |
| title_short | Accelerating the momentum to achieve global elimination of hepatitis B infection: a scoping review of hepatitis B guidelines to reduce mother to child transmission |
| title_sort | accelerating the momentum to achieve global elimination of hepatitis b infection a scoping review of hepatitis b guidelines to reduce mother to child transmission |
| topic | Antiviral Hepatitis B virus Pregnancy Vaccine Viral load Vertical transmission |
| url | http://www.sciencedirect.com/science/article/pii/S2589537024006175 |
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