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. 2023 Apr 24;5(8):100777. doi: 10.1016/j.jhepr.2023.100777

Table 2.

Estimated impact of interventions on HBV MTCT; data summarised from peer-reviewed meta-analyses published in English over a 10-year period from 2013.

Study location(s)
(publication date)		 Number of individuals represented Prophylactic interventions for PMTCT MTCT risk
[I] Maternal antenatal prophylaxis
Worldwide; Brown et al., 2016.149 3,622 pregnant women Maternal NA prophylaxis NA therapy reduced MTCT risk in infants at 6-12 months:
  • -

    HBsAg seropositivity (RR 0.3, 95% CI 0.2–0.4)

  • -

    HBV DNA seropositivity (RR 0.3, 95% CI 0.2–0.5)
Worldwide (majority in China); Li et al., 2018.150 1,046 pregnant women Maternal TDF prophylaxis Compared to other NA or no NA prophylaxis, TDF reduced:
  • -

    Infant HBsAg positivity rate (RR 0.25, 95% CI 0.16–0.38)

  • -

    Infant HBeAg positivity rate (RR 0.26, 95% CI 0.14–0.48)

  • -

    Infant HBV DNA positivity rate (RR 0.15, 95% CI 0.07–0.31)

  • -

    Immunoprophylaxis failure rate (RR 0.31, 95% CI 0.13–0.73).
Worldwide; Khalighinejad et al., 2019.151 2,667 pregnant women Maternal 3 TC prophylaxis Significant difference between the seropositive HBsAg infants between groups receiving prophylaxis vs. controls: RR 16.97, 95% CI 8.36-34.45.
Worldwide; Sali et al., 2019.152 7,717 pregnant women; 7467 infants Maternal NA prophylaxis (3 TC, LdT and TDF) Overall, NA treatment reduced MTCT rate:
  • -

    HBsAg positive infants at birth: OR 0.50, 95% CI 0.38–0.67

  • -

    HBV DNA positive infants at birth: OR 0.19, 95% 0.10–0.36

  • -

    Reduction in HBV positivity at 6 months: OR 0.15, 95% CI 0.11–0.19.
Worldwide; Song et al., 2019.68 9,228 mother-infant pairs Maternal NA prophylaxis (3 TC, LdT and TDF) NAs reduced MTCT risk at birth:
  • -

    HBsAg positive: RR 0.51, 95% CI 0.45–0.57

  • -

    HBV DNA positive: RR 0.22, 95% CI 0.18–0.26

No differences in efficacy of PMTCT between 3 TC, LdT and TDF.
NAs more effective when administered from the second than from the third trimester based on HBV DNA (RR: 0.08 vs. 0.22)
Worldwide (majority in China); Wu et al., 2020.67 6,738 pregnant women Maternal NA prophylaxis (3 TC, LdT and TDF) Compared to placebo:
  • -

    3 TC, LdT, TDF all reduced HBV MTCT:

  • -

    In early pregnancy: RR 0.06; 95% CI 0.03–0.10

  • -

    In late pregnancy: RR 0.19; 95% CI 0.11–0.32

  • Timing of NA therapy:

  • -

    Compared with initiation during trimester 3, MTCT was reduced when antiviral therapy was given earlier (RR 0.045, 95% CI 0.0053 to 0.20)
Worldwide; Funk et al., 2021.27 TDF: 1,092 mothers/1,072 infants;
3 TC: 2,080 mothers/2,007 infants;
LdT: 6,036 mothers/5,971 infants.		 Maternal NA prophylaxis (3 TC, LdT and TDF) Pooled ORs for RCTs:
  • -

    0.10 (95% CI 0.03-0.35) for TDF

  • -

    0.16 (95% CI 0.10-0.26) for 3 TC

  • -

    0.14 (0.09-0.21) for LdT
[II] Caesarian section and/or avoidance of breastfeeding
Worldwide (focus on China); Yang et al., 2017.153 9,906 pregnant women Caesarian section (± HBIG and/or maternal NA prophylaxis) MTCT rate
  • -

    Overall: 6.76%

  • -

    Caesarian group: 4.37%

  • -

    Vaginal delivery group: 9.31%

RR 0.51, 95% CI 0.44–0.60
Worldwide; Chen et al., 2019.154 11,446 mother-child pairs Caesarian section combined with immuno-prophylaxis Average incidence of MTCT:
  • -

    Caesarian group: 3.3%

  • -

    Vaginal delivery group: 4.1%

  • -

    OR 0.79, 95% CI 0.61–1.02

In the presence of immunoprophylaxis, no significant risk associated with vaginal delivery.
Worldwide; Pan et al., 2020.86 3,429 participants (mode of delivery analysis);
2,443 participants (mode of feeding analysis)		 Caesarian section and non- breastfeeding In the absence of maternal antiviral prophylaxis, MTCT risk:
  • -

    In Caesarean section group lower than vaginal delivery group: RR 0.58, 95% CI 0.46-0.74.

  • -

    In the nonbreastfeeding group lower than in breastfeeding group: RR 0.74, 95% CI 0.56-0.98.
Worldwide, He et al., 2022.87 11,144 women Caesarian section Caesarian vs. vaginal delivery at infant age >6 months OR 0.42, 95% CI 0.23–0.76
[III] Infant immunoprophylaxis (passive HBIG, and/or active HBV vaccination)
China; Lin et al., 2014.155 7,561 pregnant women Vaccine and HBIG MTCT risk despite immunoprophylaxis:
  • -

    Overall 4.9%

  • -

    In HBeAg-positive mothers: 9.7%
Worldwide; Jin et al., 2014.156 4,274 antenatal prophylaxis;
1,061 postnatal prophylaxis assessed at birth
1,453 postnatal prophylaxis assessed at 7-12 months		 Vaccine and HBIG Antenatal prophylaxis:
  • -

    Reduced MTCT (RR 0.36, 95% CI 0.28–0.45) at birth

Postnatal prophylaxis:
  • -

    Reduced MTCT: RR 0.66, 95% CI 0.52–0.84 at birth

  • -

    Reduced MTCT: RR 0.54, 95% CI 0.42–0.69 at 7-12 months
Worldwide; Machaira et al., 2015.129 3,426 pregnant women Vaccine only, vs. vaccine + HBIG MTCT risk in neonates who received vaccine only, compared with those who received vaccine + HBIG:
  • -

    No difference in MTCT: OR 0.82, 95% CI 0.41–1.64.
China; Eke et al., 2017.157 6,044 pregnant women HBIG vs. no intervention HBIG reduced MTCT compared with no intervention:
  • -

    6% MTCT with HBIG vs. 21% with no intervention; RR 0.30, CI 0.20–0.52
Worldwide; Chen et al., 2020.158 2,440 pregnant women Vaccine + HBIG HBIG and vaccine group had a significant decrease in MTCT risk:
  • -

    At birth: RR 0.2, 95% CI 0.18-0.40

  • -

    At age one year: RR 0.09, 95% CI 0.04–0.20
[IV] Combined interventions
China; Xu et al., 2014.159 2,033 pregnant women HBIG, NA treatment, Caesarean section HBIG vs. control:
  • -

    Lower MTCT risk: RR 0.44, 95% CI 0.32–0.61

  • In NA prophylaxis group:

  • -

    Lower MTCT risk: RR 0.06, 95% CI 0.01–0.24

  • In the vaginal delivery group:

  • -

    Higher MTCT risk: RR 2.20, 95% CI 1.02–4.74
Worldwide; Chen et al., 2017.160 2,706 infants HBV vaccine from birth, HBIG + vaccine, antenatal NA prophylaxis Reduced MTCT risk:
  • -

    With HBV vaccine series RR 0.32; 95% CI 0.21–0.50).

  • -

    With HBIG + vaccine vs. vaccine alone (RR, 0.37; 95% CI 0.20-0.67).

  • -

    WIth antenatal NA prophylaxis vs. infant vaccine + HBIG alone if maternal HBV DNA >105 IU/ml (RR 0.31; 95% CI 0.10–0.99).
Worldwide; Yao et al., 2022.60 63,293 infants Vaccination and maternal antiviral prophylaxis ± HBIG Without prophylaxis, overall MTCT incidence: 31.3% (variable rates by region)
Vaccination reduced MTCT risk:
  • -

    In HBeAg-positive mothers from 82.9% to 15.9%

  • -

    In HBeAg-negative mothers from 10.3% to 2.3%

Maternal peripartum NA prophylaxis alongside infant immunoprophylaxis further decreased MTCT incidence to 0.3% (95% CI 0.1%-0.5%).
Transmission risk stratified by HBV VL, with MTCT events documented at VL >4.29 log IU/ml

MTCT, mother-to-child transmission; RR, risk ratio; OR, odds ratio; RCTs, randomised-controlled trials; TDF, tenofovir disoproxil fumarate; 3TC, lamivudine; LdT, telbivudine; HBIG, hepatitis B immunoglobulin; VL, viral load.

Studies representing >1,000 individuals are listed, ordered according to the MTCT intervention, and then presented chronologically, starting with the oldest evidence.