体外受精-胚移植が慢性HBV感染女性における母子感染に及ぼす影響

Impact of in vitro Fertilization-Embryo Transfer on Mother-to-Infant Transmission in Women with Chronic HBV Infection.

抄録

体外受精-胚移植（IVF-ET）は、B型肝炎ウイルス（HBV）の母子感染（MTCT）リスクを高める可能性があります。本研究の目的は、慢性HBV感染（CHB）の女性におけるIVF-ETのMTCTへの影響と安全性を調査することである。

BACKGROUND & AIMS: In vitro fertilization-embryo transfer (IVF-ET) may increase the risk of mother-to-child transmission (MTCT) of hepatitis B virus (HBV). The purpose of this study was to investigate the impact and safety of IVF-ET on MTCT in women with chronic HBV infection (CHB).

方法:

IVF-ETで妊娠した女性298名とその子供375名のデータをレトロスペクティブに収集した。母親はCHB群（n=224）と対照群（HBsAg陰性、n=74）に分けられた。出生後，新生児には定期的にB型肝炎ワクチンを接種し，CHB群の乳児には出生後2時間以内にB型肝炎免疫グロブリンを注射した．人口統計学的情報，臨床データおよび臨床検査結果が収集された．主要評価項目はHBVのMTCT率であり，副次評価項目は母児の安全性であった。

METHODS: The data of 298 women who got pregnant by IVF-ET and their 375 children was collected retrospectively. Mothers were divided into CHB group (n=224) and control group (HBsAg negative, n=74). After birth, newborns were routinely vaccinated with hepatitis B vaccine, and infants in CHB group were injected with hepatitis B immunoglobulin within 2 hours after birth. Demographic information, clinical data and laboratory test results was collected. The primary outcome measures was the MTCT rate of HBV, and the secondary outcome measures was the safety of mother and infant.

結果:

CHB群282例，対照群93例の新生児すべてにおいてHBVのMTCT例はなかった。2群の出生時体重（3056.74±601.65 vs 2926.24±704.86, P =0.083）， 体長（49.22±1.97 vs 48.74±3.09, P =0.167）， 5分アプガー得点（9.97±0.21 vs 9.90±0.51, P =0.212), 妊娠日数 (265.70±12.73 vs 262.02±17.50, P =0.064), 新生児奇形率 (0.71% vs 0, P =1.000) は同程度であった．CHB群では新生児奇形が2例発生した。妊娠・出産時の合併症の発生率は両群で同程度であった．

RESULTS: There was no case of HBV MTCT in all 282 newborns born to CHB group and 93 neonates born to control group. Of the 2 groups, the birth weight (3056.74±601.65 vs 2926.24±704.86, P = 0.083), length (49.22±1.97 vs 48.74±3.09, P = 0.167), 5-minute Apgar score (9.97±0.21 vs 9.90±0.51, P = 0.212), days of pregnancy (265.70±12.73 vs 262.02±17.50, P = 0.064), neonatal malformation rate (0.71% vs 0, P = 1.000) were similar. Two cases of neonatal malformation occurred in CHB group. The incidences of pregnancy and childbirth complications were similar between the two groups.

結論:

IVF-ETは慢性HBV感染女性におけるMTCTのリスクを増加させず、母体および乳児に安全である。

CONCLUSION: IVF-ET does not increase the risk of MTCT in women with chronic HBV infection, and it is safe for mothers and infants.