Maternal <scp>HB</scp>sAg carriers and adverse pregnancy outcomes: A hospital‐based prospective cohort analysis

Cai, Qianying; Liu, Haiyan; Wu, Hongxu; Liu, Huan; Xu, Yunyun; He, Yining; Li, Qing; Zhang, Miao; Hu, Anqun; Ying, Zheng

doi:10.1111/jvh.13105

Cited by 31 publications

(45 citation statements)

References 39 publications

(56 reference statements)

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“…Our results have demonstrated that in our obstetric population with an intermediate endemic city of 3.3% for HBV infection, HBV status did not exert any signi cant adverse effect on obstetric outcome. This was largely in line with studies conducted in western societies [8][9][10][11][12] and another in China [35], while the most recently reported prospective cohort study in China found only increased intrahepatic cholestasis, premature rupture of the membranes (but not PTB), and LGA infants [36]. Thus it appears that maternal chronic HBV infection would at most exert minimal or no adverse effects on pregnancy outcome, and at the same time even enhancing fetal growth which could manifest as reduced SGA [9,12] or increased…”

Section: Discussionsupporting

confidence: 85%

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Chronic Maternal Hepatitis B Virus Infection and Pregnancy Outcome - A Single Center Study in Kunming, China

Sun

Lao

et al. 2020

Preprint

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Background: Chinese population has a high prevalence of chronic hepatitis B virus (HBV) infection, the impact of which on pregnancy outcome remains controversial. A single-center retrospective cohort study was performed in Kunming, a multi-ethnic city in south-western China to examine this issue. Methods: The singleton pregnancies delivering at ≥28 weeks gestation under our care in 2005-2017 constituted the study cohort. Maternal characteristics and pregnancy outcome were compared between mothers with and without seropositivity for hepatitis B surface antigen (HBsAg) determined at routine antenatal screening. Results: Among the 49,479 gravidae in the cohort, the 1624 (3.3%) HBsAg seropositive gravidae had a lower incidence of nulliparity (RR 0.963, 95% CI 0.935-0.992) and having received tertiary education (RR 0.829, 95% CI 0.784-0.827). There was no significant difference in the medical history, pregnancy complications, or labor or perinatal outcome, except that HBV carriers had significantly lower incidence of labor induction (RR 0.827, 95% CI 0.714-0.958) and of small-for-gestational age (SGA) infants (RR 0.854, 95% CI 0.734-0.994). On regression analysis, maternal HBV carriage was independently associated with spontaneous labor (aRR 1.231, 95% CI 1.044-1.451) and reduced SGA infants (aRR 0.842, 95% CI 0.712-0.997). Conclusions: Our 3.3% prevalence of maternal HBV infection was around the lower range determined in the Chinese population. The association with spontaneous labor and reduced SGA infants could have helped to promote the perpetuation of the infection through enhanced survival of the offspring infected at birth, thus explaining the high prevalence in the Chinese population.

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Section: Discussionsupporting

confidence: 85%

“…LGA and macrosomic infants [13][14][15]36]. Furthermore, there was a signi cant independent increase in spontaneous labor, which would in turn reduce the need for intervention such as labor induction.…”

Section: Discussionmentioning

confidence: 99%

Chronic Maternal Hepatitis B Virus Infection and Pregnancy Outcome - A Single Center Study in Kunming, China

Sun

Lao

et al. 2020

Preprint

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“…Intrahepatic cholestasis of pregnancy is a common liver disease in pregnancy, with highly variable prevalence worldwide (0.3%–8.5%) 21,22 . ICP is diagnosed in women with gestational pruritus and increased serum levels of bile acids.…”

Section: Discussionmentioning

confidence: 99%

Impact of maternal infection with hepatitis B virus on pregnancy complications and neonatal outcomes for women undergoing assisted reproductive technology treatment: A population‐based study

Xiong

Liu

Huang

et al. 2021

Journal of Viral Hepatitis

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The aim of this study was to investigate the impact of maternal hepatitis B virus (HBV) status on pregnancy complications and neonatal outcomes for women undergoing assisted reproductive technology (ART). A total of 7,011 pregnancies achieved by ART were included from a population‐based database involving 523,111 pregnancies. Exposures of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) among pregnant women were routinely tested at the first antenatal visit for all pregnancies. We collected pregnancy complications (e.g., gestational diabetes mellitus [GDM], intrahepatic cholestasis of pregnancy [ICP]), neonatal outcomes and confounding variables from the same database. Univariate and multivariate analyses by adjusting confounders were conducted to evaluate the impact of maternal HBV infection. Prevalence of HBsAg seropositivity (HBsAg+) was 11.34% (95% CI 10.6–12.1) and that of HBsAg and HBeAg co‐seropositivity (HBsAg+HBeAg+) was 2.55% (2.1–3.0) among included population. Compared with HBsAg−group, ICP risk in the HBsAg+group was higher (4.03% vs. 1.79%; adjusted odds ratio [aOR] 2.49, 1.65−3.77). Similarly, ICP prevalence in the HBsAg+HBeAg+ group was higher than that in the HBsAg−HBeAg− group (6.47% vs. 1.61%; aOR 4.78, 2.28–9.98). No associations were found between maternal HBV infection (i.e., HBsAg+, HBsAg+HBeAg+, or HBsAg+HBeAg−) and other adverse outcomes for women undergoing ART (i.e., GDM, pre‐eclampsia, placental previa, premature separation of placenta, premature rupture of membranes, preterm birth and low birthweight) in this study. In conclusion, maternal HBV infection (HBsAg+or HBsAg+HBeAg+) probably increase ICP risk, but may not associate with other pregnancy complications or neonatal outcomes for pregnant women who underwent ART.

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“…Although several studies have demonstrated that HBV infection is not a cause of excessive maternal morbidity and mortality and has no effect on fetal growth restriction or preeclampsia rates, [ 18 – 20 ] other studies have found that HBV infection is associated with a higher incidence of adverse pregnancy outcomes, such as gestational diabetes mellitus, [ 21 ] hypertensive disorders of pregnancy, [ 22 ] preterm birth, [ 20 , 21 , 23 ] macrosomia, [ 22 ] and recently ICP. [ 24 – 26 ] However, unlike the former study, a prospective study by Cui et al found no significant difference in the incidence of ICP between pregnant women with and without HBV infection. [ 27 ]…”

Section: Introductionmentioning

confidence: 79%

“…[ 33 – 35 ] Recent studies have shown that HBV infection is associated with a higher incidence of ICP. [ 24 – 26 ] Tan et al discovered that pregnant women positive for HBsAg had a higher risk of intrahepatic cholestasis (age-adjusted OR 1.74; 95% CI 1.40–2.16) and surmised that hepatitis B increased the risk of ICP. [ 25 ] In a hospital-based prospective cohort study, Cai et al found that maternal HBsAg carrier status was associated with an increased risk of intrahepatic cholestasis pregnancy (age-adjusted OR 1.70; 95% CI 1.16–2.49); thus HBV infection during pregnancy may increase the risk of ICP.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis B infection and intrahepatic cholestasis of pregnancy

Jiang

Wang²,

Yao³

et al. 2020

Medicine

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Background: Viral hepatitis type B is caused by hepatitis B virus (HBV) infection. Several studies have linked HBV infection to a higher risk of developing intrahepatic cholestasis of pregnancy (ICP), although some give contradictory results. To investigate the association and estimated risk of ICP in patients with HBV infection, we conducted this meta-analysis to summarize all available evidence. Methods: This study consists of 2 meta-analyses. A literature search was performed using MEDLINE and EMBASE from inception to July 2019. The first study included studies that reported associations between HBV infection and the risk of ICP. The second analysis included studies comparing the risk of HBV infection in ICP patients with those without ICP. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using a random-effect, inverse variance method. Results: Four studies were included in both analyses. The OR of ICP in HBV-infected pregnant women compared with non-HBV pregnant women was 1.68 (95% CI 1.43–1.97; I 2 = 0%). The OR of HBV infection among ICP patients compared with non-ICP patients was 1.70 (95% CI 1.44–2.01; I 2 = 0%). Conclusions: Our meta-analysis demonstrates not only a higher risk of ICP among HBV-infected pregnant women but also an increased risk of HBV infection among ICP patients. These findings suggest that HBV is a high-risk factor for ICP and screening for hepatitis B in women with ICP symptoms may be beneficial.

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Maternal HBsAg carriers and adverse pregnancy outcomes: A hospital‐based prospective cohort analysis

Cited by 31 publications

References 39 publications

Chronic Maternal Hepatitis B Virus Infection and Pregnancy Outcome - A Single Center Study in Kunming, China

Chronic Maternal Hepatitis B Virus Infection and Pregnancy Outcome - A Single Center Study in Kunming, China

Impact of maternal infection with hepatitis B virus on pregnancy complications and neonatal outcomes for women undergoing assisted reproductive technology treatment: A population‐based study

Hepatitis B infection and intrahepatic cholestasis of pregnancy

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