Maternal Hepatitis B Infection Burden, Comorbidity and Pregnancy Outcome in a Low-Income Population on the Myanmar-Thailand Border: A Retrospective Cohort Study

Abstract

Objectives. Hepatitis B virus (HBV) was believed to have minimal impact on pregnancy outcomes apart from the risk of perinatal transmission. In more recent years, there have been reports of adverse associations, most consistently preterm birth (PTB), but this is in the context of high rates of caesarean section. The aim of this study was to explore the association of HBV on pregnancy outcomes in marginalized, low-income populations on the Myanmar-Thailand border. Methods. HBsAg positive (+) point of care rapid detection tests results were confirmed by immunoassays. Women with a confirmed HBsAg status, HIV- and syphilis-negative at first antenatal care screening, singleton fetus and known pregnancy outcome (Aug-2012 to Dec-2016) were included. Logistic regression analysis was used to evaluate associations between HBV group (controls HBsAg negative, HBsAg+/HBeAg-, or HBsAg+/HBeAg+) and pregnancy outcome and comorbidity. Results. Most women were tested, 15,046/15,114 (99.6%) for HBV. The inclusion criteria were not met for 4,089/15,046 (27.2%) women due mainly to unavailability of pregnancy outcome and nonconfirmation of HBsAg+. In evaluable women 687/11,025 (6.2%) were HBsAg+, with 476/11,025 (4.3%) HBsAg+/HBeAg- and 211/11,025 (1.9%) were HBsAg+/HBeAg+. The caesarean section rate was low at 522/8,963 (5.8%). No significant associations were observed between pregnancy comorbidities or adverse pregnancy outcomes and HBV status. Conclusions. The results highlight the disease burden of HBV in women on the Myanmar-Thailand border and support original reports of a lack of significant associations with HBsAg+ irrespective of HBeAg status, for comorbidity, and pregnancy outcomes in deliveries supervised by skilled birth attendants.

Point-of-Care Tests for Hepatitis B: An Overview

“…A common application of these HBsAg POCs is to measure seroprevalence in general or specific subpopulations in low-resource settings [ 52 , 53 , 54 , 55 , 56 ]. They have also been used in mass screening programs for hepatitis B in both community outreach [ 24 , 57 ] and health-facility-based screening [ 52 , 53 , 58 , 59 , 60 , 61 , 62 ] in low-resource settings and shown great public health benefits. For example, in a community-based outreach screening program conducted in 75 camps in Southern India [ 63 ], the “screen and vaccinate/linkage to care” strategy led to over 7700 vaccinations in the camps and 162 people with high viral load getting treatment.…”

“…The program was found to be highly cost-effective, with an ICER of US$540 per DALY averted compared to status quo where no publicly provided HBV screening or treatment was available. Integrating low-cost HBV POCs into existed healthcare services such as antenatal screening [ 52 , 58 , 107 ], blood donor screening [ 62 ] and HIV clinics [ 59 , 60 , 61 ] can be another solution to achieve scale-up of HBV testing [ 108 , 109 ]. Zhang et al [ 109 ] showed the integration of HBV screening within the existing antenatal care in Cambodia was highly cost-effective.…”

Prevalence and associated factors of hepatitis B virus infection among pregnant women attending antenatal care at Agena health center, South Ethiopia, 2019: a cross sectional study

“…This prevalence was lower than the studies reported from Osogbo, Nigeria, Gambia, Yirgalem Hospital, Ethiopia, Deder Hospital, Eastern Ethiopia, Hawassa University referral hospital, Southwestern Nigeria, Yaounde-Cameroon, Eastern Region of Ghana, Buea Health District, Cameroon, Juba Teaching Hospital, Republic of South Sudan, Myanmar-Thailand Border and Shaanxi, China in which the prevalence of HBV infection among pregnant women were 16.5%, 9.20%, 7.2%, 6.9%, 7.8%, 8.3%, 7.7%, 10%, 9.7, 11%,6.2% and 7.07% respectively [12,13,15,17,[23][24][25][26][27][28][29][30].…”

Prevention of mother-to-child transmission of hepatitis B virus: protocol for a one-arm, open-label intervention study to estimate the optimal timing of tenofovir in pregnancy

“…The maternal and child health services are in rural areas, can be provided in Karen and Burmese language and is without costs. 5 34 35 …”