Clinical and virological predictors of hepatic flares in pregnant women with chronic hepatitis B

Giles, Michelle; Visvanathan, Kumar; Lewin, Sharon R.; Bowden, Scott; Locarnini, Stephen; Spelman, Tim; Sasadeusz, Joe

doi:10.1136/gutjnl-2014-308211

Cited by 101 publications

(117 citation statements)

References 19 publications

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“…However, restoration of the CMI function occurs during the postpartum period, and studies have reported higher than expected HBeAg seroconversion rates [24] and higher than normal rates of alanine aminotransferase (ALT) during the initial postpartum period in HBVinfected women [23,[25][26][27][28][29]. While most hepatic flares have been mild and resolved spontaneously [25], a small number of case reports indicate severe hepatitis flares leading to hepatic decompensation during the peripartum period [29].…”

Section: Effects Of Pregnancy On Hbv-associated Liver Diseasementioning

confidence: 95%

Hepatitis B During Pregnancy in Endemic Areas: Screening, Treatment, and Prevention of Mother-to-Child Transmission

Chamroonkul

Piratvisuth

2017

Pediatr Drugs

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The proper management of pregnant women infected with hepatitis B virus (HBV) is necessary to prevent maternal and fetal morbidity and mortality and to protect the baby from HBV infection. In the majority of cases, vertical transmission can be prevented with a universal screening program, HBV vaccine immunoprophylaxis, and administration of hepatitis B immunoglobulin (HBIg) for babies born to mothers with HBV. However, in mothers with a high viral load (>200,000 or >1,000,000 IU/ml, depending on the guideline), the chance of immunoprophylaxis failure remains high. The standard recommendation is to give an antiviral agent during the third trimester in these patients. US FDA pregnancy category B agents such as tenofovir and telbivudine are allowed through all trimesters of pregnancy. Breastfeeding for patients who receive antiviral agents can be allowed after a risk-benefit discussion with the patient.

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Section: Effects Of Pregnancy On Hbv-associated Liver Diseasementioning

confidence: 95%

Hepatitis B During Pregnancy in Endemic Areas: Screening, Treatment, and Prevention of Mother-to-Child Transmission

Chamroonkul

Piratvisuth

2017

Pediatr Drugs

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“…A minority of patients required antiviral therapy for treatment of flare. Similarly, another observational study of 126 women with HBV followed through pregnancy found that 25 % of women had a postpartum flare, defined as two times the upper limit of normal ALT [47]. Most of the women included in this analysis were not taking antiviral medications during pregnancy.…”

Section: Postpartum Carementioning

confidence: 96%

Management of HBV in Pregnancy

Kelly¹,

Peters²

2015

Curr Hepatology Rep

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Hepatitis B in pregnancy must include diagnosis and management of the pregnant woman as well as modalities to decrease mother to child transmission (MTCT). MTCT remains the most important mode of hepatitis B virus (HBV) transmission, although effective strategies exist to reduce this risk. Universal screening for HBV can identify women with previously unrecognized infection and allow for targeted therapy to prevent MTCT. All children of HBV-infected mothers should receive passive active immunoprophylaxis with hepatitis B immune globulin (HBIG) and HBV vaccination within 12 h of birth. With such measures, the risk of transmission can be decreased to less than 1 % in women with low viral loads. Immunoprophylaxis failures occur in as many as 15 % of children born to mothers with high viral loads at the time of delivery (>6 log copies/ml or >200,000 IU/ml), and therefore, additional treatment in the third trimester is warranted in this group. Antiviral therapy with lamivudine, tenofovir, or telbivudine in the third trimester can decrease MTCT to less than 5 % and should be used in women with high viral loads in the third trimester. Postpartum flares of liver disease are common, and therefore, careful monitoring is warranted in women who stop therapy. The decision to breastfeed while on antiviral therapy should be individualized, but current evidence suggests that it is safe.

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“…Il tema della profilassi antibiotica in questa situazione è molto [ o n l y dibattuto e la letteratura specifica è piuttosto carente, per cui le raccomandazioni fatte sono basate prevalentemente sul parere di esperti. C'è chi non la ritiene necessaria, almeno nei difetti interatriali, 59 chi la ritiene ragionevole nelle pazienti ad alto rischio (precedente endocardite infettiva, difetti residui dopo la correzione chirurgica; nei primi sei mesi dopo la correzione chirurgica) 60 e chi la consiglia anche in situazioni di rischio non eccessivamente elevato. 61 Un altro aspetto non particolarmente chiaro riguarda il momento della pratica della profilassi, se va fatta in coincidenza con il parto (vaginale o cesareo) o meno.…”

Section: Messaggi Chiaveunclassified

“…Esacerbazioni lievi della malattia possono verificarsi dopo il parto. 58,59 Nella pratica clinica, le donne portatrici HBV-DNA positive devono essere informate per quanto riguarda la gravidanza, sia se sono in trattamento che se non lo sono. In tutti i casi, l'indicazione al trattamento, secondo le raccomandazioni attuali, dovrebbe essere considerato e discusso con la paziente.…”

Section: Epatite Virale Cronicaunclassified

Problematiche internistiche in corso di gravidanza

2017

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<img src="/public/site/images/pgranata/rass.jpg" alt="" /> L’internista in ostetricia V. Donvito, A. Maina, L. Balbi, D. ManfellottoTromboembolismo venoso in gravidanza A. Fontanella, M. Gino Cardiopatie e gravidanza R. Gerloni, D. Panuccio Ipertensione arteriosa in gravidanza e preeclampsia F. Saladini, N. Lazzarin, D. ManfellottoTrombocitopenia in gravidanza R. Mestroni, A. CivardiMalattie broncopolmonari in gravidanza Gravidanza ed apparato respiratorio in fisiologia e patologia O. Para, A. SacchettaManagement del diabete mellito in gravidanza Parte 1: Gestante con diabete pregravidico I. Ambrosino, T.M. Attardo, G. AugelloManagement del diabete mellito in gravidanza Parte 2: Il diabete mellito gestazionale T.M. Attardo, I. Ambrosino, G. AugelloTireopatie in gravidanza E. BarbagelataMalattie del fegato e gravidanza P. Crispino, L. Fontanella, M. Visconti, P. GnerreHyperemesis gravidarum M.S. Montini, P. GnerreBatteriuria asintomatica e infezioni delle vie urinarie sintomatiche in gravidanza P. Gnerre, M. GiustiTerapia antibiotica in gravidanza P. Gnerre, M. GiustiConclusioni: Learning points per chi richiede (e per chi esegue) la consulenza G. Pinna, R. Re

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Clinical and virological predictors of hepatic flares in pregnant women with chronic hepatitis B

Cited by 101 publications

References 19 publications

Hepatitis B During Pregnancy in Endemic Areas: Screening, Treatment, and Prevention of Mother-to-Child Transmission

Hepatitis B During Pregnancy in Endemic Areas: Screening, Treatment, and Prevention of Mother-to-Child Transmission

Management of HBV in Pregnancy

Problematiche internistiche in corso di gravidanza

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