Postpartum subsidence of hepatitis B viral replication in hbeag‐positive carrier mothers

Lin, Ho‐Hsiung; Chen, Pei‐Jer; Chen, Ding‐Shinn; Sung, Juei‐Low; Yang, Kung-Ho; Young, Yiang-Chin; Liou, Y; Chen, Yuanping; Lee, Tzu-Yao

doi:10.1002/jmv.1890290102

Cited by 58 publications

(55 citation statements)

References 24 publications

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“…Three of the 19 women whose ALT levels were within the normal range during pregnancy showed transient elevations in ALT after delivery. Exacerbation of hepatitis B during pregnancy and the postpartum period, accompanied by clearance of HBeAg has been reported elsewhere (16)(17)(18). Although no changes in the HBeAg/antiHBe were observed in the present study, the changes in the ALT levels observed in some of the subjects are consistent with previous reports that disease exacerbation may occur in some patients.…”

Section: Discussionsupporting

confidence: 92%

Clinical Features and Hepatitis B Virus (HBV) Genotypes in Pregnant Women Chronically Infected with HBV

et al. 2012

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Objective The purpose of this study was to clarify the clinical features and hepatitis B virus (HBV) genotypes in pregnant women chronically infected with HBV. Methods Among 1,489 pregnant women who visited our hospital in 2010, 26 were positive for hepatitis B surface antigens (HBsAg). Of these subjects, 21 from whom informed consent was obtained were included in this study. The clinical features and HBV markers, including genotypes, were investigated. Results No adverse events were observed in the subjects or the neonates during pregnancy or the perinatal period. The HBV genotypes were C in 14 cases, D in six cases, and undetermined in one case. Hepatitis B e antigens and a high viral load (>7.0 log copies/mL) were found in four and six subjects with genotype C, respectively, and in none of subjects with genotype D. The alanine aminotransferase (ALT) levels and platelet counts were within the normal ranges during pregnancy in all subjects except two and three subjects with genotype C, respectively. Three subjects with genotype C showed transient elevations of ALT after delivery. Conclusion The majority of subjects were anti-HBe-positive with normal ALT levels; however, some subjects with genotype C showed a high viral load, elevated ALT levels and/or low platelet counts. The pregnancies and deliveries were safe; however, transient elevations of ALT after delivery were observed in some subjects with genotype C.

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Section: Discussionsupporting

confidence: 92%

Clinical Features and Hepatitis B Virus (HBV) Genotypes in Pregnant Women Chronically Infected with HBV

et al. 2012

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“…Even in HBeAg-negative mothers, serum HBV DNA levels increased in 25% of the patients by more than 1 log 10 copies/ml during pregnancy. Elevations in ALT levels occurred in both HBeAg-positive and HBeAg-negative women in late pregnancy and immediately postpartum [31,32]. The incidence of fulminant hepatitis is increased in pregnant women with CHB, especially in the last trimester, compared with nonpregnant women and men with CHB.…”

Section: Chb In Women and Its Effect On Pregnancymentioning

confidence: 99%

Chronic hepatitis B in Asian women of childbearing age

Leung

2009

Hepatol Int

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Hepatitis B virus (HBV) infection is a serious clinical problem affecting approximately 2 billion people worldwide. An estimated 350 million live with chronic hepatitis B (CHB) infection and are at an increased risk for serious liver sequelae and death from acute or chronic consequences of CHB infection. Individuals with CHB have a 20-30% risk of early death from complications, including liver cirrhosis and hepatocellular carcinoma. In the Asia-Pacific region, half of the CHB burden results from vertical or mother-to-child transmission, with early childhood horizontal transmission accounting for the remaining half. Screening and vaccination are key factors in the successful prevention and control of HBV infection. Over the last 20 years, the implementation of screening programs and universal HBV vaccination for all individuals born in endemic areas have reduced the prevalence of HBV infection and HBV-related liver diseases among individuals younger than 30 years. Women of childbearing age are key stakeholders in preventing HBV infection and, as such, play a critical role in reducing the vertical and horizontal transmission of HBV. Further efforts are needed to implement screening and educational programs for women of childbearing age, particularly those with CHB, to prevent the transmission of HBV to newborns, spouses, other household members, and sexual partners. In addition, healthcare workers need to learn how to avoid iatrogenic transmission in the healthcare setting. This article reviews these issues and highlights areas in which their engagement with public health efforts serves to improve quality of life and society as a whole.

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“…15,16 A proportion of women have hepatitis flares with or without HBeAg seroconversion (12.5-17%) within the first months after delivery. [17][18][19] Among HBeAg positive chronic HBV-infected mothers, low HBeAg titers and low HBV DNA viral loads have been associated with HBeAg loss after delivery. 19 In a recent study from Netherlands, among pregnant patients with chronic HBV infection, there was an overall increase in median HBV DNA levels during pregnancy, which declined after pregnancy.…”

Section: Effect Of Pregnancy On Chronic Hepatitis B Virus Infectionmentioning

confidence: 99%

Chronic Hepatitis B Virus Infection and Pregnancy

Kumar

Singh

Sinha

2012

Journal of Clinical and Experimental Hepatology

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Planning of pregnancy and management of chronic hepatitis B virus during pregnancy includes recognition of maternal virological status, assessment of liver disease severity and minimization of risk for mother to infant transmission of infection. Decisions regarding the use of antivirals during pregnancy need to be individualized. Monitoring for infection and immunization in newborns is also important. For mothers on antiviral therapy, breastfeeding is not recommended. ( J CLIN EXP HEPATOL 2012;2:366-381) A pproximately 400 million people are chronically infected with hepatitis B virus (HBV) worldwide, 1 and almost half have acquired their infections either through mother to infant transmission or in early childhood, especially in countries where HBV has intermediate to high prevalence.2 In Asia, 8%-10% of the population is chronically infected with HBV, and up to 50% of new cases of hepatitis B infection are due to mother to infant transmission.3 In contrast, the majority of new hepatitis B cases in developed countries are the result of horizontal transmission in adulthood. Before the adoption of standard passive-active immunoprophylaxis treatment, approximately 70%-90% of infants born to hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive mothers became chronically infected with HBV. 4 The mother to infant transmission rate was reduced to 5%-10% when infants received appropriate postnatal hepatitis B immunoglobulin (HBIg) and a series of HBV vaccines. However, despite passive-active immunoprophylaxis provided to infants, up to 8%-30% of infants born to highly viremic mothers still become infected with HBV (Figures 1-3). This review will address several issues important to chronic hepatitis B virus infection and pregnancy including effect of pregnancy on chronic HBV infection, effect of chronic HBV infection on pregnancy, mother to infant transmission, safety data on HBV antivirals during pregnancy, management of chronic HBV infection in women who desire pregnancy or become pregnant while taking antivirals. PREVALENCE OF CHRONIC HEPATITIS B VIRUS INFECTION AMONG PREGNANT WOMEN IN INDIAThe prevalence of chronic HBV infection varies widely, with rates ranging from 0.1% to 20% in different parts of the world.2 "High" prevalence (HBsAg positivity rates > 8%) regions include the Asia (except Japan), parts of the Middle East, sub-Saharan Africa, and the Amazon basin. "Intermediate" (2%-7% HBsAg positive) prevalence regions include, the Indian subcontinent, parts of central Asia and the Middle East, Eastern and Southern Europe, as well as parts of South America. "Low" prevalence (<2% HBsAg positive) regions include the United States, Northern Europe, Australia, Japan and the southern part of South America. Overall, 45% of the world population lives in "high" prevalence regions.The HBsAg positivity rate of Hepatitis B in India is different in the different regions of the country. The overall chronic HBsAg positivity rate is often quoted as being 4.7%.5 In India, the prevalence rate of HBsAg...

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Postpartum subsidence of hepatitis B viral replication in hbeag‐positive carrier mothers

Cited by 58 publications

References 24 publications

Clinical Features and Hepatitis B Virus (HBV) Genotypes in Pregnant Women Chronically Infected with HBV

Clinical Features and Hepatitis B Virus (HBV) Genotypes in Pregnant Women Chronically Infected with HBV

Chronic hepatitis B in Asian women of childbearing age

Chronic Hepatitis B Virus Infection and Pregnancy

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