Kinetic Changes of Viremia and Viral Antigens of Hepatitis B Virus During and After Pregnancy

Abstract

Whether pregnancy may influence the replication of hepatitis B virus (HBV) remains unknown. The authors aimed to clarify this issue by observing the kinetics of HBV deoxyribonucleic acid (DNA) and viral antigens in women during and after pregnancy.Total, 371 pregnant women with positive hepatitis B surface antigen (HBsAg) were enrolled. Serial sera collected during and after pregnancy were quantitatively measured for HBV DNA, HBsAg, and hepatitis B e antigen (HBeAg).Total, 34 HBeAg-positive women underwent alanine aminotransferase (ALT) elevation during or after pregnancy; levels of HBV DNA and HBsAg in them showed no obvious change between second trimester or delivery and 7 to 12 months postpartum (P > 0.05). The 337 others had normal alanine aminotransferase levels during pregnancy and postpartum. In 147 HBeAg-positive women with follow-up 7 to 12 months postpartum, the average levels of HBV DNA (>7.0 log10 IU/mL), HBsAg (>4.0 log10 IU/mL), and HBeAg (>3.0 log10 S/CO) were longitudinally constant during pregnancy and postpartum, respectively. In 173 women with follow-up 4.8 years postpartum, neither HBV DNA levels nor antigen titers showed significant difference between second trimester and 4.8 years postpartum, regardless of the HBeAg status. In addition, levels of HBV DNA and viral antigens in second trimester, around delivery, 6 to 8 weeks and 7 to 12 months postpartum showed no marked fluctuations, respectively.Serum levels of HBV DNA and viral antigens in HBsAg-positive women are highly constant during pregnancy and postpartum, regardless of the HBeAg status and alanine aminotransferase levels. This demonstrates that pregnancy has little influence on the HBV replication and antigen expression.

Optimal timing of hepatitis B virus DNA quantification and clinical predictors for higher viral load during pregnancy

“…17,18 A mean 0.4 log 10 increase in late pregnancy or in the early postpartum period was observed. 16 However, significant change in the antenatal viral load was not demonstrated in other studies; 19,20 our finding was consistent with the latter in that the viral load did not change significantly during pregnancy. Therefore, we propose that HBV DNA should be performed earlier in pregnancy (before 22 weeks) to determine the risk of immunoprophylaxis failure to optimize antiviral therapy and prevent vertical transmission.…”

“…Previous studies evaluating the risk of immunoprophylaxis failure from maternal viral load did not specify the timing of viral load quantification or the use of postpartum samples . Since pregnancy is an immunomodulated state, to avoid rejection of the fetal allograft, the dynamic immune and hormonal changes throughout pregnancy may affect the activity of HBV replication . In this study, we aimed to evaluate the correlation of HBV DNA level at earlier gestations (before 22 weeks) with the levels found at 28‐30 weeks.…”

“…[5][6][7][8] Since pregnancy is an immunomodulated state, to avoid rejection of the fetal allograft, the dynamic immune and hormonal changes throughout pregnancy may affect the activity of HBV replication. [16][17][18][19][20] In this study, we aimed to evaluate the correlation of HBV DNA level at earlier gestations (before 22 weeks) with the levels found at 28-30 weeks. We also investigated the clinical predictive factors for high viral load (>6 log 10 IU/mL) at 28-30 weeks.…”

Safety and efficacy of telbivudine in late pregnancy to prevent mother‐to‐child transmission of hepatitis B virus: A multicenter prospective cohort study

“…Maternal HBV DNA level ≥10 8 copies/mL (2 × 10 7 IU/mL), or ≥10 6 copies/mL (2 × 10 5 IU/mL), is usually considered a threshold for MTCT of HBV under combined passive (hepatitis B immunoglobulin, HBIG) and active (hepatitis B vaccine) immunoprophylaxis in infants. Anyhow, positivity for hepatitis B e antigen (HBeAg) is a risk marker, as average HBV DNA level in HBeAg‐positive pregnant women is >7 log 10 copies/mL . With the combined immunoprophylaxis, the chronic infection rate in children of HBeAg‐positive mothers is 5%‐12%, while that in children of HBeAg‐negative mothers only 0 to <0.3% .…”

“…Anyhow, positivity for hepatitis B e antigen (HBeAg) is a risk marker, 6 as average HBV DNA level in HBeAg-positive pregnant women is >7 log 10 copies/mL. [7][8][9] With the combined immunoprophylaxis, the chronic infection rate in children of HBeAg-positive mothers is 5%-12%, while that in children of HBeAgnegative mothers only 0 to <0.3%. [2][3][4][5][6][7][8][10][11][12] Therefore, it is critical to develop strategies to further reduce MTCT in infants of HBeAg-positive mothers, although the universal vaccination of infants has significantly reduced the chronic HBV infection rate in the children.…”