Serum Alanine Aminotransferase and Hepatitis B DNA Flares in Pregnant and Postpartum Women with Chronic Hepatitis B

Abstract

Flares in HBV DNA and ALT can occur during late pregnancy and early postpartum in CHB women, and can be severe. Women with CHB should therefore be closely monitored during pregnancy and early postpartum.

Management of hepatitis B in special populations

“…HBV flares during pregnancy are infrequent. In a longitudinal study of US women who were not on antiviral therapy pre-pregnancy, only 6% experienced a ≥2-log increase in HBV DNA during pregnancy accompanied by ALT flares [6]. For women on antiviral therapy pre-pregnancy who stop treatment when pregnancy is diagnosed, viral rebound with ALT flare appears to occur more frequently (67% in one study) followed by spontaneous recovery in the vast majority [7].…”

“…The majority of flares were subclinical – although there are rare reports of hepatic decompensation, likely in women who had advanced fibrosis during pregnancy. Whether HBV DNA levels predict risk of flares is unclear [6,10]. The frequency of flares in women who stopped antivirals at or soon after delivery appears similar or slightly higher than women not treated with antivirals during pregnancy [11].…”

“…The frequency of flares in women who stopped antivirals at or soon after delivery appears similar or slightly higher than women not treated with antivirals during pregnancy [11]. Continuation of antiviral therapy post-partum does not prevent flares [6,11] and most flares resolve without intervention.…”

Hepatitis B During Pregnancy in Endemic Areas: Screening, Treatment, and Prevention of Mother-to-Child Transmission

“…However, restoration of the CMI function occurs during the postpartum period, and studies have reported higher than expected HBeAg seroconversion rates [24] and higher than normal rates of alanine aminotransferase (ALT) during the initial postpartum period in HBVinfected women [23,[25][26][27][28][29]. While most hepatic flares have been mild and resolved spontaneously [25], a small number of case reports indicate severe hepatitis flares leading to hepatic decompensation during the peripartum period [29]. Some experts have suggested that HBV DNA and ALT should be monitored every 4-6 weeks during the first and second trimesters, every 4 weeks during the third trimester, and at postpartum months 3 and 6 in women with CHB [29].…”

“…While most hepatic flares have been mild and resolved spontaneously [25], a small number of case reports indicate severe hepatitis flares leading to hepatic decompensation during the peripartum period [29]. Some experts have suggested that HBV DNA and ALT should be monitored every 4-6 weeks during the first and second trimesters, every 4 weeks during the third trimester, and at postpartum months 3 and 6 in women with CHB [29]. The APASL recommends checking maternal HBeAg, HBV DNA status, and ALT levels during pregnancy to determine liver disease activity and the risk of MTCT [14].…”