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怀孕与乙型肝炎

如果我怀孕了,我应该接受乙型肝炎测试吗?
应该,所有孕妇都应该接受乙型肝炎的测试!如果您怀孕了,确保您的医生在您的宝宝出生之前为您做乙型肝炎测试。


为什么这些测试对孕妇如此重要?
如果您乙型肝炎测试呈阳性并且怀孕,病毒可以在您怀孕期间或分娩期间传给您的新生儿。如果您的医生知道您患有乙型肝炎,他或她可以安排在产房里准备适当的药物来预防您的宝宝受到感染。如果不遵循适当的程序,您的宝宝有 95% 的可能性会发展为慢性乙型肝炎!


乙型肝炎感染会影响我的妊娠吗?
在您怀孕期间,乙型肝炎感染应该不会给您或您未出生的宝宝造成任何问题。对您的医生来说,清楚您的乙型肝炎感染是十分重要的,这样他或她便可以监测您的健康状况,如此,您的宝宝在出生后就可以免受感染。


如果我怀孕了而且患有乙型肝炎,我可以如何保护我的宝宝?
如果您的乙型肝炎测试呈阳性,您的医生也应该测试您的乙型肝炎 e 抗原 (HBeAg),如果呈阳性,您应该进行乙型肝炎病毒载量验血(HBV DNA 定量)。在某些情况下,实验室测试结果可能显示病毒载量非常高。在这些情况下,您的医生可能会建议您在妊娠晚期口服抗病毒药物,服药是安全的,可以降低新生儿出生时的感染风险。

如果您的乙型肝炎测试呈阳性,那么您的新生儿必须在产房里立即接受两次注射:

  • 第 1 剂为乙型肝炎疫苗 
  • 另一剂为乙型肝炎免疫球蛋白 (HBIG)

如果这两种药物在生命的最初 12 小时内正确给药,则新生儿有 90% 以上的可能性会终生免患乙型肝炎感染。

您必须确保您的宝宝按照计划表接受其余 2-3 剂乙型肝炎疫苗。为了使您的婴儿能够彻底抵御乙型肝炎,必须完成所有剂量。同样重要的是,HBV 呈阳性的母亲所生的宝宝在 9-12 个月时需接受疫苗接种后的血清测试,以确认宝宝能够抵抗乙型肝炎病毒,而且未受感染。测试包括 HBsAg 和 anti-HBs 滴度测试。

只有一次机会保护您的新生儿!


美国之外接种疫苗
在许多国家,五价疫苗(一种五合一疫苗组合,可用于预防五种疾病:白喉、百日咳、破伤风、乙型流感嗜血杆菌 (Hib) 和乙型肝炎)可为年龄 6 周至 1 岁的婴儿注射。首剂在 6 周时给予注射,第二剂和第三剂在年龄 10 到 14 周时给予注射。五价疫苗可在全球疫苗免疫联盟 (Gavi)(一个疫苗联盟)的支持下免费提供。检查 Gavi 的国家中心,以查看可能提供的资源和免疫接种:http://www.gavi.org/country/.


对于患有乙型肝炎的母亲所生的宝宝,等待第一剂五价疫苗接种太迟了,不会保护宝宝在出生时或生命的最初六周内免受感染。乙型肝炎呈阳性的女性很可能将病毒传给她的宝宝,宝宝之后会慢性感染。

WHO 建议所有婴儿在出生 24 小时内接种乙型肝炎疫苗。提前计划并询问单价(单一)疫苗的可获得性和费用,疫苗的出生剂次,因为它不是 Gavi 提供的免疫接种。这对于乙型肝炎呈阳性的女性尤为重要。

如果您不确定您的乙型肝炎状况,请确保您的医生给您做乙型肝炎测试!
对于未接受五价疫苗的婴儿,单价 HBV 疫苗的首剂必须在出生 12 个小时内接种,随后根据计划表接种其余 2-3 剂乙型肝炎疫苗。

对于接种五价疫苗的婴儿,在出生 12 小时内接种第一剂单价乙型肝炎疫苗,而第二剂和第三剂 HBV 疫苗将包括在五价疫苗的剂量 1 和剂量 2 中。

*注释:CDC 建议 HBV 疫苗和 HBIG 的首次注射都在出生 12 小时内进行。HBIG 可能不在所有国家提供。


我怀孕期间需要治疗吗?
在您怀孕期间,乙型肝炎感染应该不会给您或您未出生的宝宝造成任何问题。对您的医生来说,清楚您的乙型肝炎感染是十分重要的,这样他或她便可以监测您的健康状况,如此,您的宝宝在出生后就可以免受感染。如果您住在美国以外,而且不确定您的乙型肝炎状况,请要求您的医生为您做乙型肝炎测试。
出生剂次的 HBV 疫苗和 HBIG 未能成功可能会发生在 HBeAg 呈阳性且病毒载量很高的女性身上,这会将乙型肝炎传播给婴儿。

所有在妊娠期间被诊断为乙型肝炎的女性,都应被转介给一位擅于控制乙型肝炎感染的医生接受后续护理。您的医生应该进行额外的实验室检测,包括乙型肝炎 e 抗原、HBV DNA 水平和肝功能测试 (ALT)。

超过 200,000 IU/mL 或 100 万 cp/ml 的病毒水平表明在该水平,出生剂次疫苗和 HBIG 的结合可能会失败。可能推荐使用采用替诺福韦的一线抗病毒疗法,以在出生之前减少病毒载量。据显示,替诺福韦在怀孕期间和对母乳喂养的母亲来说都是安全的。在替诺福韦无效的情况下,医生可能开具替比夫定或拉米夫定。抗病毒治疗开始于 28-32 周,并在产后持续 3 个月。


我怀孕后需要治疗吗?
如果您在怀孕期间医生向您开了抗病毒药物,您应该每三个月监测一次您的 ALT (SGPT),持续 6 个月。这将有助于确定是否应该继续抗病毒治疗。请不要中断您的抗病毒药物,除非医生根据您的测试结果给您建议您这样做。对于大多数后续检测没有显示出活动性疾病迹象的女性,您的医生会建议到肝脏专家处进行定期检查。

在所有情况下,十分重要的是,您的产科医生和您的新生儿的儿科医生都知道您的乙型肝炎状态,以确保您的新生儿在出生时接种适当的疫苗,以防止终生乙型肝炎感染,并且您得到适当的后续护理。


如果我患有乙型肝炎,我可以母乳喂养我的宝宝吗?
母乳喂养的好处远远大于极低的潜在感染风险。此外,由于建议所有婴儿在出生时都接种乙型肝炎疫苗,所以任何潜在的风险会进一步降低。有数据显示,可开具处方用于控制乙型肝炎的替诺福韦对于母乳喂养的妇女是安全的。

Pregnancy and Hepatitis B

Should I be tested for hepatitis B if I am pregnant?
Yes, ALL pregnant women should be tested for hepatitis B! If you are pregnant, be sure your doctor tests you for hepatitis B before your baby is born.


Why are these tests so important for pregnant women?
If you test positive for hepatitis B and are pregnant, the virus can be passed on to your newborn baby during your pregnancy or during delivery. If your doctor is aware that you have hepatitis B, he or she can make arrangements to have the proper medications in the delivery room to prevent your baby from being infected. If the proper procedures are not followed, your baby has a 95% chance of developing chronic hepatitis B!


Will a hepatitis B infection affect my pregnancy?
A hepatitis B infection should not cause any problems for you or your unborn baby during your pregnancy. It is important for your doctor to be aware of your hepatitis B infection so that he or she can monitor your health and so your baby can be protected from an infection after it is born.


If I am pregnant and have hepatitis B, how can I protect my baby?
If you test positive for hepatitis B, your doctor should also test you for the hepatitis B e-antigen (HBeAg), and if positive, you should have a hepatitis B viral load blood test (HBV DNA quantification). In some cases, the laboratory test results may show a very high viral load. In these cases, your physician may recommend that you take an oral antiviral drug in the third trimester, which is safe to take to reduce the risk of infecting your newborn at birth.

If you test positive for hepatitis B, then your newborn must be given two shots immediately in the delivery room:

  • First dose of the hepatitis B vaccine 
  • One dose of hepatitis B immune globulin (HBIG)

If these two medications are given correctly within the first 12 hours of life, a newborn has more than a 90% chance of being protected against a lifelong hepatitis B infection.

You must make sure your baby receives the remaining 2-3 doses of the hepatitis B vaccine according to schedule. All doses must be completed in order for your infant to be fully protected against hepatitis B. It is also important that a baby born to an HBV-positive mother receive post-vaccination serologic testing at 9-12 months to confirm the baby is protected against HBV and is not infected. Tests include the HBsAg and anti-HBs titer test.

There is no second chance to protect your newborn baby!


Vaccination Outside the United States
In many countries, the pentavalent vaccine, a combination 5-in-one vaccine that protects against five diseases (diphtheria, pertussis, tetanus, Hib and hepatitis B) may be given to babies more than 6 weeks of age, and can be given up to 1 year of age. The first dose is given at 6 weeks, and the second and third doses are given at 10 and 14 weeks of age. The pentavalent vaccine may be made available free of charge with the support of Gavi, the Vaccine Alliance. Check the Gavi country hub to see the resources and immunizations that may be available: http://www.gavi.org/country/.

For babies born to mothers with hepatitis B, waiting for the first dose of the pentavalent vaccine is too late and will NOT protect the baby from becoming infected during birth or within the first six weeks of life. A woman who is hepatitis B positive is likely to pass the virus on to her baby, who will then be chronically infected.

WHO recommends the hepatitis B vaccine within 24 hours of birth for ALL babies. Plan ahead and inquire about the availability and cost of the monovalent (single), birth dose of the vaccine, as it is not a Gavi provided immunization. This is particularly important to women who are positive for hepatitis B.

If you are unsure of your hepatitis B status, please be sure your doctor tests you for hepatitis B!

For babies NOT receiving the pentavalent vaccine, the first dose of the monovalent, HBV vaccine must be given within 12 hours of birth, followed by the remaining 2-3 doses of the hepatitis B vaccine according to schedule.

For babies receiving the pentavalent vaccine, the first, monovalent dose of the hepatitis B vaccine is given within 12 hours of birth, and the second and third doses of the HBV vaccine will be included in dose 1 and dose 2 of the pentavalent vaccine.

*Note: CDC recommends both the first shot of the HBV vaccine and HBIG within 12 hours of birth. HBIG may not be available in all countries.


Do I need treatment during my pregnancy?
A hepatitis B infection should not cause any problems for you or your unborn baby during your pregnancy. It is important for your doctor to be aware of your hepatitis B infection so that he or she can monitor your health and so your baby can be protected from an infection after it is born. If you live outside of the U.S. and are unsure of your hepatitis B status, please ask your doctor to test you for hepatitis B.

Failure of the birth dose of the HBV vaccine and HBIG may occur in women who are HBeAg positive and have a very high viral load, allowing for the transmission of hepatitis B to your baby.

All women who are diagnosed with hepatitis B in pregnancy should be referred for follow up care with a physician skilled at managing hepatitis B infection. Your physician should perform additional laboratory testing, including hepatitis B e-antigen, HBV DNA level, and liver function tests (ALT).

A virus level greater than 200,000 IU/mL or 1 million cp/ml indicates a level where the combination of the birth dose of the vaccine and HBIG may fail. First-line, antiviral therapy with tenofovir may be recommended to reduce the viral load prior to birth. Tenofovir has been shown to be safe both during pregnancy and for breastfeeding mothers. In cases where tenofovir is not effective, doctors may prescribe telbivudine or lamivudine. Antiviral treatment begins at 28-32 weeks and continues 3 months postpartum.


Do I need treatment after my pregnancy?
If you are prescribed antivirals during pregnancy, you should have your ALT (SGPT) monitored every 3 months for 6 months. This will help determine if you should continue antiviral treatment. Please do not discontinue your antiviral medication unless the doctor advises you to, based upon test results. For most women whose follow up testing shows no signs of active disease, your physician will recommend regular monitoring with a liver specialist.

In all cases, it is very important that your obstetrician and your newborn’s pediatrician, are aware of your hepatitis B status to ensure that your newborn receives the proper vaccines at birth to prevent a lifelong hepatitis B infection, and that you receive appropriate follow up care.


Can I breastfeed my baby if I have hepatitis B?
The benefits of breastfeeding outweigh the potential risk of infection, which is minimal. In addition, since it is recommended that all infants be vaccinated against hepatitis B at birth, any potential risk is further reduced. There is data that shows that tenofovir, which may be prescribed to manage hepatitis B, is safe for breastfeeding women.