Maternal hepatitis B virus carrier status and pregnancy outcomes: a prospective cohort study

Abstract

BackgroundInfection with hepatitis B virus (HBV) in pregnant women may be a threat for both mothers and fetuses. This study was performed to explore the impact of maternal HBV carrier status on pregnancy outcomes.MethodsWe conducted a prospective cohort study at the Obstetrics & Gynecology Hospital of Nantong University between January 1, 2012 and September 30, 2015. A consecutive sample of 21,004 pregnant women, 513 asymptomatic HBV carriers and 20,491 non-HBV controls, was included in this study. The main outcomes of interest were selected pregnancy outcomes including miscarriage, stillbirth, preterm birth (PTB), gestational diabetes (GDM), intrahepatic cholestasis of pregnancy (ICP), preterm premature rupture of the membrane (PPROM), low birth weight (LBW), small for gestational age (SGA) and Apgar scores. The incidence of adverse pregnancy outcomes between asymptomatic HBV carriers and non-HBV controls were compared using the chi-square test and logistic regression. P values were two sided, and P <0.05 was considered to indicate statistical significance.ResultsThe incidences of stillbirth, PTB, GDM, ICP, PPROM, LBW, and SGA were similar between the HBV carrier and non-HBV groups. The proportion of miscarriage was significantly higher among the HBV carriers than the controls (9.36 % vs 5.70 %; P <0.001). After using multivariate modelling to adjust for possible socio-demographical variables and obstetric complications, women with HBV carrier status were still more likely to have miscarriage (adjusted OR 1.71, 95 % CI 1.23–2.38). In addition, the incidences of other maternal and neonatal outcomes were similar between the two groups.ConclusionMaternal HBV carrier status may be an independent risk factor for miscarriage and careful surveillance is warranted.

Hepatitis B surface antigen positivity during pregnancy and risk of gestational diabetes mellitus: A systematic review and meta‐analysis

“…The lowest reported prevalence of HBsAg positivity was 0.09%, and the highest was 11.6% . Eleven studies reported prevalence's higher than 3.61%, as opposed to nine with lower than 3.61% . The other three studies did not include this information …”

“…After screening the title and abstract, 88 reports were potentially eligible. Finally, 23 studies, including 21 full reports and two conference abstracts published after 1999, were eligible after full‐text screening . The flow chart of included studies is presented in Figure .…”

“…In total, 28 829 individuals HBsAg positive were identified among 3 529 223 pregnant women. The median sample size was 11 916, and 16 studies had sample size larger than 1000 . One study reported as a conference abstract did not report the number of patients included .…”

“…One study reported as a conference abstract did not report the number of patients included . The majority of studies were conducted in Asia and Oceania (eight in Hong Kong, three in Mainland China, three in Thailand, two in Iran, one in Israel and one in Australia), and the other five were conducted in America and Europe …”

“…Among 23 studies, five reported diagnostic criteria for GDM, in which two adopted the WHO criteria (1980), and three used the criteria of the American Diabetes Association (ADA) 2003, American College of Obstetricians and Gynecologists Committee (ACOG) 2001 and Australian Diabetes in Pregnancy Society . The others either used the ICD coding or failed to report specific criteria . The diagnosed event rate of GDM varied from 0.44% to 16.57% among the studies.…”