Asian Pacific association for the study of liver (APASL) guidelines: hepatitis B virus in pregnancy

Abstract

Hepatitis B virus (HBV) infection still remains a major public health issue in the Asia-Pacific region. Most of the burden of HBV-related disease results from infections acquired in infancy through perinatal or early childhood exposure to HBV in Asia-Pacific. Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These APASL guidelines provide a comprehensive review and recommendations based on available evidence in the literature, for the management of females with HBV infection through every stage of pregnancy and postpartum. These also address the concerns, management challenges, and required follow-up of children born to hepatitis B-positive mothers.

Symptomatic COVID-19 in Pregnancy: Hospital Cohort Data between May 2020 and April 2021, Risk Factors and Medicolegal Implications

“…By virtue of such findings, a positive SARS-CoV-2 assay on amniotic fluid or placenta alone is not enough to provide a reliable level of confirmatory proof as to actual in-utero infection. As far as the contamination of umbilical cord blood is concerned, that is thought to possibly take place because of cross-contamination with maternal blood during sample collection, or blood cells from the mother getting into the fetal bloodstream through the placenta over the course of gestation, or most commonly, maternal blood cells getting into fetal circulation during labor, due to contractions of the uterus [ 43 , 44 , 45 ]. In light of such dynamics, confirmatory testing via fetal/neonatal peripheral blood sample or testing of another sterile or non-sterile sample is needed in addition to PCR.…”

A cautionary note to hepatitis B e antigen (HBeAg)‐negative test results in pregnant women in an area prevalent of HBeAg‐negative chronic hepatitis B

“…In addition, individuals carrying these mutations with high HBV DNA levels are still at risk of developing severe liver diseases 35 . It is also worth noting that compared to HBV DNA, HBeAg has a high sensitivity (99.1% [95% CI 61.8–100]), but low specificity (55.7% [95% CI: 34.0–75.5]) for predicting the risk of MTCT 5,36 . According to three major liver societies—the Asia Pacific Association for the Study of the Liver, the European Association for the Study of the Liver, and the American Association for the Study of Liver Diseases—e‐CHB, referred to as “phase 4” or “immune‐active CHB,” is characterized by the absence of serum HBeAg, persistent or fluctuating moderate to high levels of serum HBV DNA, and persistent or fluctuating elevated ALT values (6.…”

Maternal Hepatitis B Virus Infection and Pregnancy Outcomes of Freeze-Thaw Embryo Transfer

“…1 Infection with HBV has been linked to a higher risk of miscarriage and preterm birth in natural pregnancies. 2 However, its effects on assisted reproductive technology, especially freeze-thaw embryo transfer (FET), are uncertain. 3 Previous research has not explored the association between HBV infection and pregnancy outcomes in FET.…”