Hepatitis B in pregnancy

Abstract

ObjectiveVertical transmission of the hepatitis B virus (HBV) is the commonest mode of infection and can be prevented with immunoprophylaxis of the infant and antiviral therapy in the mother. Our aim was to review a cohort of subjects with HBV in pregnancy to determine the prevalence of active disease or high HBV-DNA levels that required treatment to prevent transmission, and to review the management of mothers and infants.MethodsA retrospective case-note review was conducted of all the HBV-infected pregnant women and their infants who attended the Newcastle obstetric services from 2007 to 2011.ResultsThere were 113 pregnancies in 81 women (median age 28 years; 15% hepatitis B e antigen (HBeAg) positive) during 2007–11. 71% of mothers were first diagnosed with HBV during pregnancy. The mothers were born in 28 different countries. 69% of mothers had an HBV-DNA level less than 2000 IU/mL and 13% had HBV-DNA levels greater than 1.0×107 IU/mL so would be eligible for antiviral therapy to prevent transmission to the infant. 9% had active eAg-positive HBV and 3% had active eAg-negative HBV requiring treatment. All infants born to HBeAg-positive mothers received hepatitis B immunoglobulin (HBIG) appropriately and 76% of infants received a full HBV vaccination course. One infant born to an HBeAg-negative mother was hepatitis B surface antigen positive 1 year post-delivery.ConclusionsOne in six women had active HBV requiring treatment or high HBV-DNA levels that would benefit from antiviral treatment to reduce the transmission risk. HBIG was administered appropriately but completion of the vaccination course was suboptimal.

Prevention and Management of Viral Hepatitis in Pregnancy

“…3,7,20,26 In a recent retrospective review of all pregnancies infected with HBV from 2007 to 2011 in a single United Kingdom hospital, 71% of mothers were first diagnosed during pregnancy. 27 Thus, pregnancy provides a unique opportunity for screening and identification of HBV in a population that serves as a viral reservoir for future generations.…”

Hepatitis B During Pregnancy in Endemic Areas: Screening, Treatment, and Prevention of Mother-to-Child Transmission

“…However, restoration of the CMI function occurs during the postpartum period, and studies have reported higher than expected HBeAg seroconversion rates [24] and higher than normal rates of alanine aminotransferase (ALT) during the initial postpartum period in HBVinfected women [23,[25][26][27][28][29]. While most hepatic flares have been mild and resolved spontaneously [25], a small number of case reports indicate severe hepatitis flares leading to hepatic decompensation during the peripartum period [29]. Some experts have suggested that HBV DNA and ALT should be monitored every 4-6 weeks during the first and second trimesters, every 4 weeks during the third trimester, and at postpartum months 3 and 6 in women with CHB [29].…”

Association of PNPLA3 I148M Variant With Chronic Viral Hepatitis, Autoimmune Liver Diseases and Outcomes of Liver Transplantation

“…Moreover, virus assembly is drastically impaired when the interaction of HCV core protein with LDs is prevented ( 43 ). The PNPLA3 I148M variant has been shown to be associated with lipid metabolism in many chronic liver diseases and over 90% of the PNPLA3 protein are located in LDs in hepatocytes ( 44 ). A recent study demonstrated that the I148M variant increased LD development and functions ( 45 ), indicating that the I148M variant may play a role in CHC-associated steatosis through this virus-induced pathway ( 39 ), although this possible mechanism needs to be further investigated.…”