Nguyen H.T.Thavorncharoensap M.Phung T.L.Anothaisintawee T.Chaikledkaew U.Sobhonslidsuk A.Talungchit P.Chaiyakunapruk N.Attia J.McKay G.J.Thakkinstian A.Mahidol University2023-06-182023-06-182022-08-01American Journal of Obstetrics and Gynecology Vol.227 No.2 (2022) , 163-17200029378https://repository.li.mahidol.ac.th/handle/20.500.14594/85693Objective: This study investigated the efficacy and safety of pharmacologic interventions to prevent vertical transmission of the hepatitis B virus. Data Sources: Medline, Cochrane, and Scopus databases were searched up to October 28, 2020. Study Eligibility Criteria: All randomized controlled trials reporting vertical hepatitis B virus transmission with pharmacologic intervention were included. Methods: Risk of bias was assessed using the Cochrane Risk-of-Bias tool, version 2. Treatment efficacy was estimated using stratified network meta-analysis on the basis of maternal hepatitis B envelope antigen status. Results: Nineteen studies were included for mothers positive for hepatitis B surface and envelope antigens. Pooling indicated that a combination of hepatitis B vaccination and hepatitis B immunoglobulin in infants significantly reduced transmission risk compared with vaccination alone, with a risk ratio of 0.52 (95% confidence interval; 0.30–0.91). Only the addition of maternal tenofovir disoproxil fumarate, but not telbivudine, lamivudine, or maternal hepatitis B immunoglobulin further reduced transmission risk compared with a combination of hepatitis B vaccination and hepatitis B immunoglobulin in infants, with a pooled risk ratio of 0.10 (0.03–0.35). Twelve studies conducted in mothers with hepatitis B surface antigen positivity and mixed, unknown, or negative hepatitis B envelope antigen status provided limited evidence to suggest that maternal hepatitis B immunoglobulin combined with hepatitis B vaccination and immunoglobulin in infants was the likely best treatment, but this failed to reach statistical significance compared with a combination of hepatitis B vaccination and immunoglobulin in infants. Similarly, infant hepatitis B immunoglobulin, added to vaccination, likely provides additional benefit but failed to reach statistical significance. Conclusion: A combination of hepatitis B vaccination and immunoglobulin in infants is the cornerstone for prevention of vertical transmission for mothers positive for both hepatitis B surface and envelope antigens. The addition of maternal tenofovir to this infant combination regimen was considered the likely most effective treatment. For infants of mothers with hepatitis B surface antigen positivity and mixed, unknown, or negative hepatitis B envelop antigen status, no additional agents provided further benefit beyond hepatitis B vaccination alone.MedicineReviewSCOPUS10.1016/j.ajog.2022.02.0422-s2.0-851279159761097686835263648