Chronic hepatitis B virus (HBV)
infection poses a serious public health problem in many parts of the world. Presently, even with proper joint immunoprophylaxis, approximately 10-15% of newborns from HBV carrier mothers suffer from HBV
infection through intrauterine transmission. One of the risk factors is the level of maternal viraemia.
Telbivudine is a synthetic
thymidine nucleoside analogue with activity against HBV. A few studies have evaluated the efficacy of
telbivudine in preventing intrauterine HBV
infection during late pregnancy. So we conducted this meta-analysis to arrive at an evidence-based conclusion. We searched Medline/PubMed, EMBASE, Cochrane Library, Web of Knowledge and China
Biological Medicine Database from January 1990 to December 2011. Relative risks (RR) of the seropositivity rates for
hepatitis B surface antigen (
HBsAg) and HBV
DNA in newborns and infants were studied. Mean differences (MD) in maternal HBV
DNA levels were reviewed. Finally two randomised controlled trials (RCTs) and four non-randomised controlled trials (NRCTs) were left for analysis which included 576 mothers in total, of whom 306 received
telbivudine treatment and 270 did not receive any
drug. All newborns received
hepatitis B vaccine (HBVac) and
hepatitis B immunoglobulin (
HBIG) after birth. The seropositivity rate for
HBsAg or HBV
DNA was significantly lower in the
telbivudine group, both at birth and at 6-12 months follow up. Meanwhile, maternal HBV
DNA levels prior to delivery were significantly lower in the
telbivudine group. In addition, the frequency of serum
creatine kinase (CK) elevation was similar in the two groups. Our meta-analysis provides preliminary evidence that
telbivudine application in late pregnancy is effective in the interruption of intrauterine HBV
infection, with no significant adverse effects or complications. More high quality, well-designed, double-blinded, randomised controlled and large size clinical trials are needed for further investigation and more convincing results in the future.