Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China.
Department of Obstetrics and Gynecology, Fujian Medical University Union Hospital, Fuzhou, China.
Int J Gynaecol Obstet. 2024 Jul;166(1):115-125. doi: 10.1002/ijgo.15716. Epub 2024 Jun 4.
To explore the relationships between gestational hepatitis B virus (HBV) infection, antiviral therapy, and pregnancy outcomes.
We retrospectively selected hepatitis B surface antigen (HBsAg)-positive pregnant women hospitalized for delivery at Fujian Medical University Affiliated Hospital from October 1, 2016 to October 1, 2020. The control group included randomly selected healthy pregnant women hospitalized for delivery during the same time.
Overall, 1115 participants were enrolled and grouped into control (n = 380) and HBsAg-positive groups (n = 735), which were further divided into groups I (n = 407; low viral load), II (n = 207; high viral load without antiviral therapy), and III (n = 121; high viral load with antiviral therapy). Pregnant women with HBV were positively correlated with the incidence of intrahepatic cholestasis of pregnancy (ICP) (adjusted odds ratio [aOR] 5.1, 95% confidence interval [CI] 2.62-9.92, P < 0.001), neonatal jaundice (aOR 10.56, 95% CI 4.49-24.83, P < 0.001), and neonatal asphyxia (aOR 5.03, 95% CI 1.46-17.27, P = 0.01). Aspartate aminotransferase (AST) greater than the upper limit of normal (ULN) was an independent risk factor for increased ICP incidence (aOR 3.49, 95% CI 1.26-9.67, P = 0.019). Antiviral therapy considerably reduced HBV DNA and improved liver function. High viral load and antiviral therapy did not correlate significantly with adverse pregnancy outcomes (P < 0.05).
Pregnant women with HBV have significantly elevated incidence of ICP, neonatal jaundice, and neonatal asphyxia not significantly correlated with viral load. AST greater than ULN independently increases the risk of ICP. Antiviral therapy effectively reduces viral replication and improves liver function without increasing the risk of adverse outcomes.
探讨妊娠期乙型肝炎病毒（HBV）感染、抗病毒治疗与妊娠结局的关系。
我们回顾性选择 2016 年 10 月 1 日至 2020 年 10 月 1 日在福建医科大学附属医院住院分娩的 HBsAg 阳性孕妇，并纳入研究。对照组为同期住院分娩的健康孕妇。
共纳入 1115 例参与者，分为对照组（n=380）和 HBsAg 阳性组（n=735），其中进一步分为 I 组（n=407；低病毒载量）、II 组（n=207；高病毒载量但未行抗病毒治疗）和 III 组（n=121；高病毒载量且行抗病毒治疗）。HBV 孕妇与妊娠期肝内胆汁淤积症（ICP）（调整优势比[aOR]5.1，95%置信区间[CI]2.62-9.92，P<0.001）、新生儿黄疸（aOR 10.56，95% CI 4.49-24.83，P<0.001）和新生儿窒息（aOR 5.03，95% CI 1.46-17.27，P=0.01）的发生率升高显著相关。天冬氨酸氨基转移酶（AST）大于正常值上限（ULN）是 ICP 发生率升高的独立危险因素（aOR 3.49，95% CI 1.26-9.67，P=0.019）。抗病毒治疗可显著降低 HBV DNA 载量并改善肝功能。高病毒载量和抗病毒治疗与不良妊娠结局无显著相关性（P<0.05）。
HBV 孕妇的 ICP、新生儿黄疸和新生儿窒息发生率显著升高，但与病毒载量无显著相关性。AST 大于 ULN 可独立增加 ICP 风险。抗病毒治疗可有效降低病毒复制，改善肝功能，且不增加不良结局风险。
