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 Collaboration's tool for assessing risk of bias. TABULATION, INTEGRATION, AND RESULTS: We abstracted data regarding HBV intrauterine infection, mother-tochild 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. (Obstet Gynecol 2010;116:147-59)