HBV-Webinar-Hepatitis B in Pregnancy.pptx

Hepatitis b in pregancy

1. Hepatitis B pada Kehamilan Nareswari I. Cininta M. Divisi Kedokteran Fetomaternal – Dept.-KSM Obstetri Ginekologi RSUD Dr. Soetomo – FK Universitas Airlangga, Surabaya 1

2. Outline 2

3. Latar Belakang 3

4. Add a footer 4 Epidemiology 254 million people living with chronic HBV infection worldwide PREGNANCY PREVALENCE Perinatal infection  ~90% risk of chronic infection

5. Add a footer 5 Epidemiology

6. Patofisiologi 6

7. Add a footer 7 Problems with Pregnancy

8. Add a footer 8 HBV Structure 3 glycoproteins,: S (attachment to albumin, hepatocytes) ; L (virion making, attachment to structure) , and M

9. Add a footer 9 Acute phase: During the pre-icteric stage        Anorexia Malaise Fatigue During the icteric phase Nausea, Vomiting Jaundice with liver tenderness Dark-colored urine Chronic phase: Cirrhosis, carcinoma Why pregnancy matters? Perinatal infections are primary source of new chronic HBV in endemic settings. Preventable with timely interventions: birth dose vaccine ± HBIG and targeted maternal antivirals.

10. Skrining & diagnosis 10

11. Signs & symptoms Add a footer 11 Acute phase: During the pre-icteric stage        Anorexia Malaise Fatigue During the icteric phase Nausea, Vomiting Jaundice with liver tenderness Dark-colored urine Chronic phase: Cirrhosis, carcinoma

12. Add a footer 12 Key markers: HBsAg: current infection (acute or chronic) HBeAg : indicates high viral replication/infectivity Anti‑HBs: immunity from vaccination or recovery IgM anti-HBc: acute infection IgG anti-HBc: IgG anti-HBc may remain present for life Total anti‑HBc (IgM vs total): prior exposure; IgM = recent infection HBV DNA: quantitative viral load (best predictor for MTCT)

13. Interpretation Add a footer 13 HBsAg negative: observe HBsAg positive: Check HBV DNA (quantitative) and ALT counsel and refer to hepatology expert If HBV DNA unavailable, HBeAg can be used HBV DNA ≥200,000 IU/m  Treat High risk of MTCT: Major drivers: maternal HBV DNA level, HBeAg positivity, lack of infant prophylaxis.

14. Tatalaksana klinis 14

15. Add a footer 15 High risk MTCT: method of delivery, prior abortion history, antepartum hemorrhage, Placental infection ( The HBV infection rates during the first trimester, second trimester, and full-term were found to be 4.2%, 16.6%, and 44.6%) Invasive procedures ( Amniocentesis has been shown to significantly increase the rate of MTCT (OR = 21.3, 95%CI: 2.90-153.775))

16. Add a footer 16 A 2020 study compared the MTCT rate in neonatal HBV-vaccinated infants born to antiviral-treated and non-treated CHB pregnant women. Antiviral treatment (either with LdT , TDF, or 3TC) resulted in zero MTCT rate (n = 60) compared to 0.1% (3/30) in infants born to non-treated mothers and 39.2% (11/28) in the control group Wibowo DP, Agustiningsih A, Jayanti S, Sukowati CHC, El Khobar KE. Exploring the impact of hepatitis B immunoglobulin and antiviral interventions to reduce vertical transmission of hepatitis B virus.  World J Exp Med  2024; 14(4): 95960 [PMID: 39713069 DOI: 10.5493/wjem.v14.i4.95960 ]

17. Maternal & Neonate treatment Add a footer 17 Recommendation from Asia Pacific Association for the Study of the Liver (APASL), EASL, and the American Association for the Study of the Liver (AASLD) Maternal: Threshold commonly used: HBV DNA ≥200,000 IU/mL Preferred agent: Tenofovir disoproxil fumarate (TDF); start usually in late second–third trimester and continue to delivery (or into postpartum with monitoring). Starts at week 24-28 of the gestation period-12 weeks postpartum Neonate: the WHO guideline advises that all newborns should receive HepB -BD within 24 hours after birth, followed by additional doses at one and six months of age. HBIG is also recommended for infants of HBsAg-positive mothers

18. Neonate prophylaxis Add a footer 18 A 2021 Chinese study reported nine cases of immunoprophylaxis failure (n = 982) in newborns receiving both HBIG and HepB -BD within an hour after delivery, who were born to women with a high HBV DNA VL (> 6.4 Log10 IU/mL)[82]. In infants born to HBeAg -positive mothers , the frequency of immunoprophylaxis failure was higher at 5.2% (16/306) compared to those born to HBeAg -negative mothers. This immunoprophylaxis failure was associated with very high HBV DNA levels (≥ 8 Log10 IU/mL, OR = 4.53, 95%CI: 1.19-17.34), inadequate initial injections (OR = 7.69, 95%CI: 1.71-34.59), and delayed vaccination time (OR = 4.14, 95%CI: 1.00-17.18)[96]. Wibowo DP, Agustiningsih A, Jayanti S, Sukowati CHC, El Khobar KE. Exploring the impact of hepatitis B immunoglobulin and antiviral interventions to reduce vertical transmission of hepatitis B virus.  World J Exp Med  2024; 14(4): 95960 [PMID: 39713069 DOI: 10.5493/wjem.v14.i4.95960 ]

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21. Add a footer 21 HBV Prevention Bundle in Pregnancy

22. THANK YOU 22 Large image