Association between maternal hepatitis B virus carrier and gestational diabetes mellitus: a retrospective cohort analysis

Abstract

Introduction Given that many pregnant women have chronic hepatitis B virus (HBV) infection and that gestational diabetes mellitus (GDM) is linked to poor maternal and neonatal outcomes, we looked into the relationship between the hepatitis B surface antigen (HBsAg) and GDM to see if a high HBV DNA load is linked to a higher risk of GDM in chronic maternal HBsAg carriers. Materials and methods Our study included 39,539 pregnant women who gave birth at the Third Affiliated Hospital of Guangzhou Medical University in Guangzhou, China, between January 1, 2009, and December 31, 2019. The patients were divided into two groups: HBsAg negative (36,500) and positive (3039). The viral load levels of 1250 HBsAg-positive women who had tested their HBV DNA load during pregnancy were separated into three groups. We utilized univariate and multivariable logistical regression analysis to determine the relationship between maternal chronic HBsAg carrier and GDM. Results Being HBsAg positive was discovered to be an independent risk factor for GDM.Pre-pregnancy Obesity and advanced age were linked to an increased incidence of GDM. Those with a high HBV DNA load (> 106 IU/mL) had a higher risk of GDM than HBsAg-positive women with a low viral load (< 103 IU/mL). Pre-eclampsia and intrahepatic cholestasis of pregnancy (ICP) appeared to be more common in HBsAg-positive women than in uninfected women. Conclusions Being HBsAg positive, advanced age, and pre-pregnancy obesity were all revealed to be independent risk factors for GDM in our study. In HBsAg carrier, pregnant women, a high HBV DNA burden was linked to a greater risk of GDM. Furthermore, being an HBsAg carrier during pregnancy raised the risk of ICP and pre-eclampsia.

Prevalence of hepatitis B virus infection among pregnant women in the mountainous regions of southern China: A retrospective single‐center study

“…The current study showed that the prevalence rate of HBsAg positivity in the study area was 11.74%, which was similar to that in Fujian (11.39%) 22 and Anhui (10.39%). 19 However, it was higher than that in Shaanxi (7.07%), 10 Guangdong (7.69%), 18 and Zhejiang (5.88%). 23 Similar to other reports, the prevalence of HBV infection was significantly lower in Liaoning (3.08%), 24 Tianjin (3.77%), 25 Shanxi (4.90%), 26 Xinjiang (4.43%), 26 Sichuan (4.24%), 27 and Yunnan (3.28%).…”

“…There are numerous epidemiological studies about HBV among pregnant women in China. 18 , 19 Meizhou City is a remote mountainous region located in the northeast of Guangdong Province in Southern China, with an area of 15,876 square kilometers and a population of 5.43 million. It remains one of the most undeveloped regions in China due to its mountainous terrains coupled with a sparsely distributed population.…”

“…Hence, studies about HBV infection among pregnant women may increase knowledge about the infection, thereby possibly contributing to transmission reduction. There are numerous epidemiological studies about HBV among pregnant women in China 18,19 . Meizhou City is a remote mountainous region located in the northeast of Guangdong Province in Southern China, with an area of 15,876 square kilometers and a population of 5.43 million.…”

Unravelling the mechanisms by which chronic hepatitis B infection is associated with an increased risk of gestational diabetes

“…Chronic viral hepatitis has been associated with iron-overload and high serum hepcidin, a peptide hormone involved in the homeostasis of iron ( 38 ). Excess iron can directly affect insulin synthesis/secretion and enhance oxidation of free fatty acids, in turn decreasing glucose utilisation in muscles and promoting gluconeogenesis in the liver, ultimately leading to insulin resistance ( 39 ).…”

“…Lao et al ( 2013 ) reported that HBV DNA was detected in 19.6% and 30.4% in the second and third trimesters respectively of HBsAg positive mothers without detectable HBV DNA in the first trimester ( 41 ). It has been hypothesised that positive maternal HBeAg status and high HBV viral load could incite a more vigorous immune response exacerbating inflammation thereby worsening insulin resistance, leading to GDM ( 4 , 6 , 7 , 14 , 39 ). However, with the exception of one study ( 39 ), recent literature exploring this proposition has largely shown no association ( 4 , 6 , 7 , 14 ).…”