HBsAg positivity during pregnancy and adverse maternal outcomes: a retrospective cohort analysis

Abstract

Hepatitis B virus infection characterized by HBsAg positivity during pregnancy is a well-recognized issue in developing countries, but the association between HBsAg positivity and adverse maternal outcomes remains uncertain. To examine the association between HBsAg positivity during pregnancy and adverse maternal outcomes, a retrospective cohort study was conducted in Sichuan province, China. Deliveries were recorded from six hospitals between 1 January 2009 and 31 December 2010. Pre-eclampsia, gestational diabetes mellitus (GDM), postpartum haemorrhage (PPH), intrahepatic cholestasis, Caesarean section and placenta previa were prespecified adverse maternal outcomes. We used two multivariate logistic regression models to assess the association between HBsAg positivity and adverse maternal outcomes. In total, 948 (4.2%) pregnant women were HBsAg positive from 22 374 deliveries. Pregnant women with positive HBsAg had higher risk of GDM (aOR1.41, 95%CI 1.15-1.74), PPH (1.44, 1.13-1.83), intrahepatic cholestasis (1.74, 1.40-2.16) and Caesarean section (1.24, 1.06-1.45). No statistical associations were found between HBsAg positivity and pre-eclampsia (1.36, 0.94-1.97), and placenta previa (1.21, 0.87-1.67). HBsAg positivity during pregnancy was associated with higher risk of multiple adverse maternal outcomes. Although the causality has yet to be established, efforts may be warranted in routine care, particularly in those with high risk for adverse maternal outcomes, given the volume population infected with HBsAg. Future studies are needed to establish causality and examine the impact of HBeAg on the adverse outcomes.

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

“…After screening the title and abstract, 88 reports were potentially eligible. Finally, 23 studies, including 21 full reports and two conference abstracts published after 1999, were eligible after full‐text screening . The flow chart of included studies is presented in Figure .…”

“…All were cohort studies, of which four were prospective cohort studies and nineteen had retrospective cohort study design, although three were self‐claimed as case‐control studies (Table ). The sources of data used for these studies included medical records and computerized databases of hospitals, National Inpatient Registry Sample, Swedish Medical Birth Register . Five were multicentre studies …”

“…The sources of data used for these studies included medical records and computerized databases of hospitals, National Inpatient Registry Sample, Swedish Medical Birth Register . Five were multicentre studies …”

“…In total, 28 829 individuals HBsAg positive were identified among 3 529 223 pregnant women. The median sample size was 11 916, and 16 studies had sample size larger than 1000 . One study reported as a conference abstract did not report the number of patients included .…”

“…One study reported as a conference abstract did not report the number of patients included . The majority of studies were conducted in Asia and Oceania (eight in Hong Kong, three in Mainland China, three in Thailand, two in Iran, one in Israel and one in Australia), and the other five were conducted in America and Europe …”