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

Abstract

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.

Chronic hepatitis B infection and the risk of gestational diabetes: a cross‐sectional study

“…A subsequent meta-analysis published in 2018 reported similar findings. 19 Our study, which includes large numbers of women born across all regions of the world also shows an association between HBV and GDM, but, consistent with the systematic review, not in women from North-East Asia where the prevalence of both HBV and GDM is high.…”

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

“…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.…”

“…By reviewing the possible causal mechanisms reported from previously published studies, we constructed a DAG framework for the effects of maternal HBsAg carrier status on the occurrence of selected APOs (Figure ). The prepregnancy BMI is substituted by maternal weight before pregnancy and height, as this parameter does not normally exist .…”

Chronic Maternal Hepatitis B Virus Infection and Pregnancy Outcome - A Single Center Study in Kunming, China

“…These observations would be compatible with the notion that chronic HBV infection has co-evolved with humans without jeopardizing pregnancy outcome so as to ensure transmission to successive generations. On the other hand, there are also studies which found associations with preterm birth (PTB) [10,13,[16][17][18][19][20][21], pregnancy hypertensive disorders (PHD) [13,15], gestational diabetes mellitus (GDM) [22][23][24][25], low-birthweight (LBW) infants [17,26,27], asphyxia [28], and intrauterine fetal death (IUFD) and stillbirth (SB) [13,17]. The reason(s) for the con icting and contradicting observations remains unclear, but as these reports were based on different racial/ethnic groups in different locations, one possible factor could have been racial/ethnic differences among the different studies.…”