Clinical features and outcome of acute hepatitis B in pregnancy

Abstract

BackgroundThe impact of pregnancy on the clinical course of acute hepatitis B (AHB) is still largely unclear, mainly because most studies have not included matched controls. This study was conducted to investigate the clinical features and outcome of AHB in pregnancy using matched controls.MethodsConsecutive AHB inpatients who were admitted to Jinan Infectious Disease Hospital, Jinan, between January 2006 and December 2010 were evaluated and followed. Demographic data, clinical manifestations, and results of laboratory tests were compared between pregnant patients and age and sex matched non-pregnant patients at admission, discharge, and final follow-up.ResultsA total of 618 AHB inpatients were identified during the study period. 22 pregnant patients and 87 age and sex matched non-pregnant patients were enrolled in this study. Prodromal fever was less common (0% vs. 20.7%, P = 0.02), serum alanine aminotransferase levels were significantly lower, and HBsAg > 250 IU/mL rate and serum bilirubin levels were significantly higher in pregnant patients than in non-pregnant patients. After a mean (range) of 7(5.2-8.3) months follow-up, 18.2% pregnant patients and 4.6% non-pregnant patients were still HBsAg positive (P = 0.03). For pregnant patients, the relative risk (95% confidence interval) of HBsAg positive at the end of follow-up was 4.6 (1.1-20.2). The median (95% confidence interval) days of HBsAg seroclearance form disease onset in pregnant and non-pregnant patients were 145.0 (110.5-179.5) and 80.0 (62.6-97.4), respectively.ConclusionsThe HBsAg loss and seroconversion were delayed and lower in pregnant patients. Pregnancy might be a possible risk of chronicity following acute HBV infection.

Acute Viral Hepatitis B with a Severe Clinical Course in Pregnancy: A Case Report

“…Acute HBV infection becomes chronic in 5-10% of adults, and approximately 1% of patients may develop acute liver failure (10). In a study, 22 pregnant women were compared with 87 non-pregnant women with acute HBV infection and no difference was found between the two groups in terms of risk of fulminant hepatic failure (11). In another study investigating the etiologic causes of fulminant hepatic failure in 52 pregnant patients, the most common cause was found to be acute hepatitis B following hepatitis E (10).…”

Urticarial exanthema due to hepatitis B in a pregnant woman, mimicking a polymorphic eruption of pregnancy

“…The course of HBV infection in pregnant women is similar to that in the rest of the adult population, except for a lower frequency of fever and lower seroconversion, which can lead to greater chronicity . The cutaneous manifestations of the acute infection in adults are diverse and widespread, and include urticaria, maculopapular eruptions, leucocytoclastic vasculitis, papular–purpuric gloves‐and‐socks syndrome, erythema multiforme and Gianotti–Crosti syndrome.…”

“…The course of HBV infection in pregnant women is similar to that in the rest of the adult population, except for a lower frequency of fever and lower seroconversion, which can lead to greater chronicity. 2 The cutaneous manifestations of the acute infection in adults are diverse and widespread, and include urticaria, 3 maculopapular eruptions, 4 leucocytoclastic vasculitis, 4 papular-purpuric gloves-and-socks syndrome, 5 erythema multiforme 6 and Gianotti-Crosti syndrome 7 . These lesions may be accompanied by fever, arthritis or arthralgia (serum-like sickness), and the presence of immune complexes containing HBsAg in the vascular walls has been reported 3 although, as in our case, positive direct immunofluorescence findings are not consistent.…”

Acute painless hepatitis in pregnancy--a cause for concern?

“…The clinical course of acute HBV is not thought to be altered by pregnancy, but there may be an increased risk of developing chronic infection. 10 Furthermore, acute HBV in pregnancy may be associated with low birth weight and prematurity. 11 12 The main clinical concern related to acute HBV infection during pregnancy is the increased rate of vertical transmission.…”