Chang Christine Y, Aziz Natali, Poongkunran Mugilan, Javaid Asad, Trinh Huy N, Lau Daryl T, Nguyen Mindie H
Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto.
Los Angeles School of Medicine, University of California, Los Angeles.
J Clin Gastroenterol. 2018 Mar;52(3):255-261. doi: 10.1097/MCG.0000000000000822.
Antiviral therapy is recommended for pregnant women with chronic hepatitis B (CHB) and hepatitis B virus (HBV) DNA>200,000 IU/mL, but there is less consensus on management of women who discontinue therapy in anticipation of pregnancy or who become pregnant while on therapy. The goal of this study was to describe flares in alanine aminotransferase (ALT) during pregnancy and postpartum in CHB women with current and/or prior treatment.
This was a multicenter, retrospective study of 67 pregnancies in 56 CHB women treated before and/or during pregnancy. Main outcomes were frequency, severity, and resolution of ALT flare (≥5× upper limit of normal or ≥3× baseline, whichever was higher).
During pregnancy, ALT flares (95 to 1064 U/L) were observed in 16% (7/43) of women who stopped treatment before pregnancy and 31% (4/13) of women who discontinued treatment during first trimester, many of whom had high HBV DNA levels (4.9 to 8.0 log IU/mL). No flares (0/11) were observed in women who continued treatment. Postpartum ALT flares (104 to 1584 U/L) were observed in 0% (0/15) of women who were completely untreated during pregnancy, 29% (2/7) of women who discontinued treatment in first trimester, 33% (3/9) of women who stopped treatment at delivery, and 22% (4/18) of women who continued treatment postpartum.
In previously treated women with CHB, ALT flares were common during pregnancy and postpartum, especially if antiviral therapy was discontinued shortly before pregnancy, during first trimester, or at delivery. Thus, these pregnant women should be monitored closely throughout pregnancy and the early postpartum period; larger studies are needed to further characterize the natural history of HBV infection during pregnancy and postpartum.
对于慢性乙型肝炎（CHB）且乙肝病毒（HBV）DNA>200,000 IU/mL的孕妇，推荐进行抗病毒治疗，但对于预期妊娠而停药或治疗期间妊娠的女性的管理，共识较少。本研究的目的是描述当前和/或既往接受治疗的CHB女性在妊娠和产后丙氨酸氨基转移酶（ALT）的波动情况。
这是一项多中心回顾性研究，纳入了56例在妊娠前和/或妊娠期间接受治疗的CHB女性的67次妊娠。主要结局为ALT波动（≥5倍正常上限或≥3倍基线值，以较高者为准）的频率、严重程度及缓解情况。
妊娠期间，妊娠前停药的女性中有16%（7/43）出现ALT波动（95至1064 U/L），孕早期停药的女性中有31%（4/13）出现波动，其中许多女性的HBV DNA水平较高（4.9至8.0 log IU/mL）。继续治疗的女性未出现波动（0/11）。产后ALT波动（104至1584 U/L）在妊娠期间未接受任何治疗的女性中发生率为0%（0/15），孕早期停药的女性中为29%（2/7），分娩时停药的女性中为33%（3/9），产后继续治疗的女性中为22%（4/18）。
在既往接受治疗的CHB女性中，ALT波动在妊娠和产后很常见，尤其是在妊娠前、孕早期或分娩前不久停用抗病毒治疗的情况下。因此，这些孕妇在整个孕期和产后早期都应密切监测；需要开展更大规模的研究以进一步明确妊娠和产后HBV感染的自然史。
