Comparison of HBV-DNA and HBeAg as antiviral therapeutic indicators among HBV-infected pregnant women: a systematic review and meta-analysis

Background: Hepatitis B virus deoxyribonucleic acid level (HBV-DNA) >= 5.3 log10IU/mL among pregnant women was recommended as an antiviral therapeutic indicator. However, implementation of HBV-DNA testing has varying difficulties in places. In this study, we explored the implementation rate of HBV-DNA testing worldwide, and possibility of HBeAg testing replacing HBV-DNA as an antiviral treatment indicator during pregnancy. Methods: We searched five electronic databases including PubMed, Embase, Cochrane Library, Scopus, and China National Knowledge Infrastructure (CNKI) for studies published between Jan 1, 2000, and Nov 16, 2020. Studies were eligible for inclusion if HBV DNA testing implementation rate is available, or if maternal HBV DNA level could be analyzed by HBeAg status. The rates were pooled after data was made a Freeman-Tukey double arcsine transformation. This study is registered with PROSPERO, CRD42021235711. Results: A total of 9,575 studies were identified, 79 were finally included in this study. The HBV-DNA testing implementation rate was 36.6% (95% CI, 28.3-45.3%) globally. The rate of HBV-DNA >= 5.3 log10IU/mL was 81.51% (95% CI, 71.68-89.74%) among HBeAg positive pregnant women, and was 4.08% (95% CI, 2.14-6.54%) in HBeAg negative pregnant women. Even if infants were immunized with hepatitis B vaccine and hepatitis B immunoglobulin, the rate of mother-to-child transmission was still 4.87% (95% CI, 4.10-5.68%) among HBeAg positive mothers, and was 0 (95% CI, 0-0.07%) among HBeAg negative mothers, with a RR of 30.40 (95% CI, 11.31-81.72). Conclusions: The implementation rate of HBV DNA testing varies from region to region. Limited studies show that HBV DNA testing does not cover all pregnant women with hepatitis B. When HBV-DNA testing is not available, it is worth considering to use HBeAg positivity as an antiviral therapeutic indicator among HBV-infected pregnant women for preventing MTCT.