Prevalence and outcomes of hepatic flare in hepatitis B carriers during pregnancy

Authors

  • Kit-Ying YUEN
  • Kwok-Yin LEUNG

DOI:

https://doi.org/10.12809/hkjgom.21.1.09

Keywords:

Hepatitis B, Pregnancy

Abstract

Introduction: The aim of this study was to examine the prevalence and severity of hepatic flare among pregnant women with chronic hepatitis B (CHB) and to assess pregnancy and neonatal outcomes.
Methods: Records of all hepatitis B surface antigen-positive pregnant women who had their first antenatal visit between January 2017 and December 2018 and had a live birth in the Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong were retrospectively reviewed. Hepatic flare was defined as an alanine aminotransferase (ALT) ≥2 times the upper limit of normal, which is 19 U/L for females. Pregnancy and neonatal outcomes between those with and without hepatic flare were compared.
Results: 6.3% of pregnant women with CHB had hepatic flare, with ALT level ranging from 39 to 179 IU/L. None of the women had hyperbilirubinemia or liver failure. In those with hepatic flare, the median hepatitis B virus DNA level was 5.77 log10 IU/mL. The rate of postpartum haemorrhage was higher in those with hepatic flare (19.4% vs 10.8%, p=0.024).
Conclusion: 6.3% of pregnant women with CHB had hepatic flare. The rate of postpartum haemorrhage was higher in those with hepatic flare. Monitoring of liver function is recommended in pregnant women with CHB and hepatic flare.

References

World Health Organization. Hepatitis B Fact Sheet. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b/. Accessed 13 October 2020.

Liu KSH, Seto WK, Lau EHY, et al. A territory-wide prevalence study on blood-borne and enteric viral hepatitis in Hong Kong. J Infect Dis 2019;219:1924-33.

Special Preventive Programme, Centre for Health Protection, Department of Health, Hong Kong. Surveillance of Viral Hepatitis in Hong Kong - 2018 Report. https://www.chp.gov.hk/files/pdf/viral_hep_sur_report_2018.pdf. Accessed 2 November 2020.

Kushner T, Shaw PA, Kalra A, et al. Incidence, determinants and outcomes of pregnancy-associated hepatitis B flares: a regional hospital-based cohort study. Liver Int 2018;38:813-20.

Liu J, Wang J, Qi C, et al. Baseline hepatitis B virus titer predicts initial postpartum hepatic flare: a multicenter prospective study. J Clin Gastroenterol 2018;52:902-7.

Wiseman E, Fraser MA, Holden S, et al. Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust 2009;190:489-92.

Nguyen G, Garcia RT, Nguyen N, Trinh H, Keeffe EB, Nguyen MH. Clinical course of hepatitis B virus infection during pregnancy. Aliment Pharmacol Ther 2009;29:755-64.

Chang CY, Aziz N, Poongkunran M, et al. Serum alanine aminotransferase and hepatitis B DNA flares in pregnant and postpartum women with chronic hepatitis B. Am J Gastroenterol 2016;111:1410-5.

Bzowej NH, Tran TT, Li R, et al. Total alanine aminotransferase (ALT) flares in pregnant North American women with chronic hepatitis B infection: results from a prospective observational study. Am J Gastroenterol 2019;114:1283-91.

Wong S, Chan LY, Yu V, Ho L. Hepatitis B carrier and perinatal outcome in singleton pregnancy. Am J Perinatol 1999;16:485-8.

Bajema KL, Stankiewicz Karita HC, Tenforde MW, Hawes SE, Heffron R. Maternal hepatitis B infection and pregnancy outcomes in the United States: a population-based cohort study. Open Forum Infect Dis 2018;5:ofy134.

Sirilert S, Traisrisilp K, Sirivatanapa P, Tongsong T. Pregnancy outcomes among chronic carriers of hepatitis B virus. Int J Gynaecol Obstet 2014;126:106-10.

Tse KY, Ho LF, Lao T. The impact of maternal HBsAg carrier status on pregnancy outcomes: a case-control study. J Hepatol 2005;43:771-5.

Han GR, Xu CL, Zhao W, Yang YF. Management of chronic hepatitis B in pregnancy. World J Gastroenterol 2012;18:4517-21.

Xiao B, Liu A, Zhang M, Xue H, Zhu Y. Observation of the effect of the pregnancy complicated with the hepatitis B infection on the lying-in women and neonates. Saudi J Biol Sci 2019;26:1978-81.

Aithal GP, Watkins PB, Andrade RJ, et al. Case definition and phenotype standardization in drug-induced liver injury. Clin Pharmacol Ther 2011;89:806-15.

Prati D, Taioli E, Zanella A, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med 2002;137:1-10.

Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52. BJOG 2017;124:e106-e149.

Giles M, Visvanathan K, Lewin S, et al. Clinical and virological predictors of hepatic flares in pregnant women with chronic hepatitis B. Gut 2015;64:1810-5.

Lok AS. Hepatitis B virus: clinical manifestations and natural history. https://www.uptodate.com/contents/hepatitis-bvirus-clinical-manifestations-and-natural-history. Accessed 4 July 2020.

Cheung KW, Seto MTY, Lao TT. Prevention of perinatal hepatitis B virus transmission. Arch Gynecol Obstet 2019;300:251-9.

Tan HH, Lui HF, Chow WC. Chronic hepatitis B virus (HBV) infection in pregnancy. Hepatol Int 2008;2:370-5.

Trowsdale J, Betz AG. Mother’s little helpers: mechanisms of maternal-fetal tolerance. Nat Immunol 2006;7:241-6.

Oh IS, Park SH. Immune-mediated liver injury in hepatitis B virus infection. Immune Netw 2015;15:191-8.

Dekker G, Robillard PY. Pre-eclampsia: is the immune maladaptation hypothesis still standing? An epidemiological update. J Reprod Immunol 2007;76:8-16.

Elefsiniotisa IS, Brokalakia H, Argyropoulosa E, et al. Evaluation of liver enzymes in asymptomatic chronic hepatitis B virus infected pregnant women. Ann Gastroenterol 2013;26:59-65.

Wong HY, Tan JY, Lim CC. Abnormal liver function tests in the symptomatic pregnant patient: the local experience in Singapore. Ann Acad Med Singap 2004;33:204-8.

Joshi SS, Coffin CS. Hepatitis B and pregnancy: virologic and immunologic characteristics. Hepatol Commun 2020;4:157-71.

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Published

2023-04-06

How to Cite

1.
YUEN K-Y, LEUNG K-Y. Prevalence and outcomes of hepatic flare in hepatitis B carriers during pregnancy. Hong Kong J Gynaecol Obstet Midwifery [Internet]. 2023 Apr. 6 [cited 2024 Oct. 4];21(1). Available from: https://hkjgom.org/home/article/view/295

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