Despite extensive research, there remains no universal consensus on the optimal timing for initiating antiviral therapy during pregnancy to prevent hepatitis B virus (HBV) mother-to-child transmission (MTCT). Divergent recommendations have emerged from infectious disease specialists, obstetricians, and international guidelines, varying by region and clinical practice. To address these discrepancies, robust clinical evidence is needed to evaluate the efficacy and safety of initiating tenofovir disoproxil fumarate (TDF) treatment at different gestational weeks.
At the 75th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) held on November 15–19, 2024, Dr. Xiaohong Gao and her team from Yan’an University Affiliated Hospital presented a study examining the efficacy of initiating TDF treatment at 24–28 weeks versus 28–32 weeks of gestation in HBV-high viremia pregnant women. The study evaluated the effectiveness of TDF in preventing MTCT and assessed maternal and neonatal outcomes.
This retrospective study analyzed data from 76 HBV-infected pregnant women treated with Tenofovir Disoproxil Fumarate (TDF) at Yan’an University Affiliated Hospital between February 2017 and May 2020. Women with baseline HBV DNA ≥ 2 × 10⁵ IU/mL were included and divided into two groups based on TDF initiation: Group A (24–27+6 weeks) and Group B (28–32 weeks). Maternal, neonatal outcomes, and adverse events were assessed.
Key findings revealed that pregnant women initiating TDF earlier (Group A) had lower HBV DNA levels at delivery compared to Group B. However, success rates for preventing mother-to-child transmission (MTCT) of HBV were similar between groups, with all 69 infants tested being HBsAg-negative and having undetectable serum HBV DNA. There were no significant differences in obstetric outcomes, such as delivery timing or cesarean section rates, between the groups. Neonatal health indicators, including birth weight and Apgar scores, also showed no significant differences.
Maternal and neonatal adverse events were comparable across groups, except for one case of polydactyly in a newborn whose mother started TDF at 24 weeks. The study concludes that initiating TDF treatment at either 24–27+6 weeks or 28–32 weeks is effective and safe for preventing HBV MTCT, with both regimens demonstrating good tolerability. These findings support the flexibility of timing for antiviral initiation in HBV-high viremia pregnancies, providing clinicians with more options to optimize maternal and fetal outcomes.
