A meta-analysis of the association between gestational diabetes mellitus and chronic hepatitis B infection during pregnancy

Kong, Dechuan; Liu, Haiyan; Shan, Wei; Wang, Yan; Hu, Anqun; Wu, Hongxu; Zhao, Ning; Lu, Yihan; Ying, Zheng

doi:10.1186/1756-0500-7-139

Cited by 20 publications

(19 citation statements)

References 34 publications

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“…The results of previous studies on the association between the HBsAg carrier status and subsequent risk of HDP, GDM and preterm birth were conflicting. Although several previous studies suggested that HBsAg carrier status is associated with the risk of HDP, GDM and preterm birth, other studies did not . This inconsistency may also be explained by differences in race, HBV endemic areas, diagnostic criteria and the confounding variables included in their analyses.…”

Section: Discussionmentioning

confidence: 86%

Maternal HBsAg carriers and adverse pregnancy outcomes: A hospital‐based prospective cohort analysis

Cai

Liu

et al. 2019

Journal of Viral Hepatitis

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Abbreviations: ALT, alanine transaminase; aOR, adjusting odds ratio; APOs, adverse pregnancy outcomes; BMI, body mass index; CI, confidence interval; DAGs, directed acyclic graphs;ELISA, enzyme-linked immunosorbent assay; FDR, false discovery rate; GDM, gestational diabetes mellitus; HBeAg, hepatitis B e antigen; HBsAg, Serum hepatitis B surface antigen; HBV, hepatitis B virus; HDP, hypertensive disorders of pregnancy; ICP, intrahepatic cholestasis pregnancy; LGA, large for gestational age; PROM, premature rupture of the membranes; PW, pregnant women; SGA, small for gestational age; TNF-a, tumour necrosis factor alpha. AbstractIt is not clear whether chronic hepatitis B virus (HBV) infection during pregnancy can increase the risk of adverse pregnancy outcomes for both mothers and neonates. We conducted a hospital-based prospective cohort study on pregnant women (PW) andused an analysis strategy that was guided by directed acyclic graphs (DAGs). Maternal characteristics and major adverse pregnancy outcomes were collected both from questionnaires and hospital-based electronic medical records. Serum hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) status were determined. In total, 3329 of the 3416 pregnant women who received routine antenatal care in a hospital setting at baseline, including 346 HBsAg carriers, were available for analysis.Maternal HBsAg carrier status was associated with an increased risk of intrahepatic cholestasis pregnancy [aOR (adjusting odds ratio) = 1.70; 95% CI (confidence interval) = 1.16-2.49], premature rupture of the membranes (aOR = 1.38; 95% CI = 1.00-1.89) and large for gestational age birth aOR = 1.67; 95% CI = 1.17-2.39).The risk of intrahepatic cholestasis remained in pregnant women with either HBeAgpositive (aOR = 2.96; 95% CI = 1.33-6.62) or HBeAg-negative (aOR = 1.52; 95% CI =1.00-2.32)] status; notably, only maternal HBeAg-negative status was associated with a higher risk of large for gestational age birth (aOR = 1.91; 95% CI = 1.33-2.76).Our results implied that chronic HBV infection during pregnancy may increase the risk of intrahepatic cholestasis of pregnancy, premature rupture of membranes and large for gestational age pregnancies. K E Y W O R D Shepatitis B virus infection, intrahepatic cholestasis during pregnancy, large for gestational age, pregnancy outcomes, premature rupture of the membranes

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Section: Discussionmentioning

confidence: 86%

Maternal HBsAg carriers and adverse pregnancy outcomes: A hospital‐based prospective cohort analysis

Cai

Liu

et al. 2019

Journal of Viral Hepatitis

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“…Our study finding was in contrast to the previous meta-analysis addressing the same question, which, however, showed no significant association. 16 This study searched the literature up to The study sample represents the population of interest on key characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with HBV infection thus might have an impact on glucose homoeostasis and insulin resistance. Several studies investigated the association between HBsAg positivity during pregnancy and GDM . Nevertheless, the findings are conflicting.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies investigated the association between HBsAg positivity during pregnancy and GDM. [16][17][18][19][20][21] Nevertheless, the findings are conflicting. The first such study by Tse et al 20 reported that maternal HBV infection could increase the risk of GDM in a Hong Kong population, in which they adjusted impor tant confounders such as parit y, maternal weight, maternal age and preterm bir th.…”

Section: Introductionmentioning

confidence: 99%

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Hepatitis B surface antigen positivity during pregnancy and risk of gestational diabetes mellitus: A systematic review and meta‐analysis

Tan

Mao

Zhang

et al. 2018

Journal of Viral Hepatitis

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Chronic hepatitis B virus (HBV) infection is a prevalent public health issue worldwide. Its impact on important pregnancy outcomes, such as gestational diabetes mellitus (GDM), has not been clearly established. The findings from published studies are inconsistent. In this systematic review and meta-analysis, we aimed to clarify whether HBV infection manifested during pregnancy is associated with an increased risk of GDM. We searched MEDLINE and EMBASE for cohort studies and case-control studies that investigated the association between maternal hepatitis B surface antigen (HBsAg) positivity and GDM. We pooled adjusted odds ratio (aOR) and unadjusted OR, respectively, using the random-effect generic inverse variance method. We assessed risk of bias using the Quality in Prognosis Studies tool and conducted five pre-specified subgroup analyses. In total, 23 cohort studies involving 3 529 223 participants were included. The risk of GDM was 6.48% (1868/28 829) among HBsAg-positive pregnant women and 3.41% (119 283/3 500 394) among HBsAg-negative pregnant women. Meta-analyses of both unadjusted and adjusted effect estimates showed that HBsAg positivity during pregnancy was associated with higher risk of developing GDM (unadjusted OR 1.35, 95% CI: 1.17 to 1.56, I = 82.6%; adjusted OR 1.47, 1.22 to 1.76, I = 62%). Among pre-specified subgroup analysis, significant differences were found among studies with high vs low or moderate risk of bias. The results were robust to sensitivity analyses. In conclusion, HBsAg positivity during pregnancy has a moderate effect on an increased risk of GDM. Given the size of the population with HBV infection worldwide, however, this effect could have substantial impact on pregnancy. Further studies are warranted to investigate whether active infection with HBeAg positivity would further elevate the risk of adverse events during pregnancy.

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“…However, the association between chronic hepatitis B infection and the risk of DM and/or GDM remains less convincing. Moreover, according to a recent meta-analysis, it was concluded that gestational diabetes mellitus is not attributable to CHB infection during pregnancy [43]. According to literature HBV can be a risk factor for diabetes mellitus and our finding could imply that the pregnant women positive for HBsAg are at a higher risk of developing gestational diabetes mellitus [17,18].…”

Section: Discussionmentioning

confidence: 59%

Factors Associated with Hepatitis B Surface Antigen Seropositivity among Pregnant Women in Kigali, Rwanda: A Cross Sectional Study

Nyamusi¹,

M’Imunya²,

Muvunyi³

et al. 2017

J Comm Pub Health Nurs

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A meta-analysis of the association between gestational diabetes mellitus and chronic hepatitis B infection during pregnancy

Cited by 20 publications

References 34 publications

Maternal HBsAg carriers and adverse pregnancy outcomes: A hospital‐based prospective cohort analysis

Maternal HBsAg carriers and adverse pregnancy outcomes: A hospital‐based prospective cohort analysis

Hepatitis B surface antigen positivity during pregnancy and risk of gestational diabetes mellitus: A systematic review and meta‐analysis

Factors Associated with Hepatitis B Surface Antigen Seropositivity among Pregnant Women in Kigali, Rwanda: A Cross Sectional Study

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