Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.
Department of Obstetrics, Joan Kirner Women's and Children's at Sunshine Hospital, Western Health, Melbourne, VIC, Australia.
Womens Health (Lond). 2024 Jan-Dec;20:17455057241265083. doi: 10.1177/17455057241265083.
Hepatitis B infection has been associated with the development of gestational diabetes but the underlying mechanism is not known.
To examine associations between viral activity, gestational diabetes mellitus (GDM), and insulin resistance in pregnant people with chronic hepatitis B infection (HBV).
Prospective cohort study across three tertiary maternity centres in Melbourne, Australia, between May 2021 and April 2023.
Participants were followed prospectively through pregnancy to evaluate subsequent GDM diagnosis. Demographics, pregnancy outcomes, and markers of viral activity were compared between those with GDM versus those without. Logistic regression analysis was performed pre- and post-adjustment for known confounders. Sub-group analysis of participants from South East Asia (SEA) was performed. Outcome measures included GDM diagnosis, insulin resistance (Homeostatic Model Assessment Insulin Resistance score (HOMA-IR) score), HBV activity as measured by liver function tests, HBV viral load, hepatitis B e antigen, and quantitative hepatitis B surface antigen (quantHBsAg).
A total of 113 women were recruited. One third (38/112, 33.9%) developed GDM, mostly diagnosed on isolated postprandial hyperglycaemia (25/38, 65.8%). Over half were born in SEA (66/113, 58.4%). Mean quantHBsAg was significantly lower in those with GDM ( = 0.044). No other associations were identified between GDM or HOMA-IR and markers of hepatic activity on multivariate logistic regression analysis and on sub-group analysis of those born in SEA.
QuantHBsAg was significantly lower in those with GDM; otherwise, no association between GDM and measures of HBV viral activity was found. QuantHBsAg may be useful as an early pregnancy marker for GDM risk and warrants further research.
乙型肝炎病毒（HBV）感染与妊娠期糖尿病（GDM）的发生有关，但具体机制尚不清楚。
探讨慢性 HBV 感染孕妇病毒活性、GDM 和胰岛素抵抗之间的关系。
2021 年 5 月至 2023 年 4 月在澳大利亚墨尔本的三家三级妇产中心进行的前瞻性队列研究。
前瞻性随访参与者妊娠情况，以评估 GDM 的后续诊断。比较 GDM 组与非 GDM 组的人口统计学、妊娠结局和病毒活性标志物。在进行已知混杂因素的调整之前和之后进行逻辑回归分析。对来自东南亚（SEA）的参与者进行亚组分析。主要结局指标包括 GDM 诊断、胰岛素抵抗（稳态模型评估胰岛素抵抗评分（HOMA-IR）评分）、肝功能试验测量的 HBV 活性、HBV 病毒载量、乙型肝炎 e 抗原和定量乙型肝炎表面抗原（定量 HBsAg）。
共纳入 113 名女性。三分之一（38/112，33.9%）发生 GDM，其中大部分（25/38，65.8%）为餐后高血糖诊断。超过一半的人出生于 SEA（66/113，58.4%）。与未发生 GDM 的参与者相比，GDM 组的平均定量 HBsAg 明显更低（=0.044）。在多变量逻辑回归分析和 SEA 出生者的亚组分析中，GDM 或 HOMA-IR 与肝活性标志物之间没有发现其他关联。
GDM 患者的定量 HBsAg 明显降低；否则，GDM 与 HBV 病毒活性的测量值之间没有关联。定量 HBsAg 可能作为预测 GDM 风险的早期妊娠标志物，值得进一步研究。
