Incidence, determinants and outcomes of pregnancy‐associated hepatitis B flares: A regional hospital‐based cohort study

Kushner, Tatyana; Shaw, Pamela A.; Kalra, Ankush; Magaldi, L.; Monpara, Pooja; Bedi, Gurneet; Krok, Karen L.; Centkowski, Sierra; Dalldorf, Katherine; D’Souza, J.; Marzio, Dina Halegoua-De; Goldberg, David S.; Trooskin, Stacey; Levine, Lisa D.; Srinivas, Sindhu K.; Forde, Kimberly A.; Re, Vincent Lo

doi:10.1111/liv.13594

Cited by 36 publications

(36 citation statements)

References 25 publications

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“…Studies showed 5.2%-9% of HBV carriers could have ≥2 log 10 increase in DNA levels during pregnancy. 17,18 A mean 0.4 log 10 increase in late pregnancy or in the early postpartum period was observed. 16 However, significant change in the antenatal viral load was not demonstrated in other studies; 19,20 our finding was consistent with the latter in that the viral load did not change significantly during pregnancy.…”

Section: Discussionmentioning

confidence: 92%

“…Previous evidence on the change of HBV DNA levels throughout pregnancy was conflicting. Studies showed 5.2%‐9% of HBV carriers could have ≥2 log 10 increase in DNA levels during pregnancy . A mean 0.4 log 10 increase in late pregnancy or in the early postpartum period was observed .…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies evaluating the risk of immunoprophylaxis failure from maternal viral load did not specify the timing of viral load quantification or the use of postpartum samples . Since pregnancy is an immunomodulated state, to avoid rejection of the fetal allograft, the dynamic immune and hormonal changes throughout pregnancy may affect the activity of HBV replication . In this study, we aimed to evaluate the correlation of HBV DNA level at earlier gestations (before 22 weeks) with the levels found at 28‐30 weeks.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8] Since pregnancy is an immunomodulated state, to avoid rejection of the fetal allograft, the dynamic immune and hormonal changes throughout pregnancy may affect the activity of HBV replication. [16][17][18][19][20] In this study, we aimed to evaluate the correlation of HBV DNA level at earlier gestations (before 22 weeks) with the levels found at 28-30 weeks. We also investigated the clinical predictive factors for high viral load (>6 log 10 IU/mL) at 28-30 weeks.…”

Section: Introductionmentioning

confidence: 99%

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Optimal timing of hepatitis B virus DNA quantification and clinical predictors for higher viral load during pregnancy

Cheung

Seto

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Authorities publish recommendations on the hepatitis B virus (HBV) viral load threshold to initiate antiviral treatment but the timing of quantification during pregnancy is not well defined. HBV DNA levels in pregnancy women at 28‐30 weeks predict the risk of immunoprophylaxis failure. This study compared and evaluated the correlation between HBV DNA levels before 22 and 28‐30 weeks’ gestation. Clinical predictive factors for HBV DNA >6, 7 and 8 log10 IU/mL were studied. Material and methods A retrospective analysis of HBV DNA levels of women <22 and 28‐30 weeks of gestation was carried out in 352 pregnant HBV carriers. HBV DNA was examined using the COBAS TaqMan HBV Monitor Test coupled with the COBAS Ampliprep extraction system (Both Roche Diagnostics, Branchburg, NJ, USA). Results A strong positive correlation was found between the viral loads of women <22 weeks (mean 16.7 weeks) and 28‐30 weeks of gestation, which was independent of the viral load level and gestational age of quantification (r = 0.942, P < 0.001). Univariate analysis showed that positive hepatitis B e antigen (HBeAg), maternal age <35 years old and body mass index ≤21 kg/m2 were associated with a higher mean viral load at 28‐30 weeks of gestation (P < 0.05). These factors were also associated with a higher chance of viral load >6, 7 and 8 log10 IU/mL at 28‐30 weeks (P < 0.05). In multiple regression analysis, only the viral load of <22 weeks and positive HBeAg remained predictive of a higher mean viral load at 28‐30 weeks of gestation (P < 0.05). The receiver operating characteristic curve showed that the HBV DNA of <22 weeks was an excellent predictor for different viral load cut‐offs at 28‐30 weeks. The area under curve was 0.986, 0.998 and 0.994 for viral load 6, 7 and 8 log10 IU/mL, respectively. Conclusions HBV DNA quantification should be performed before 22 weeks of gestation. Viral load cut‐offs similar to those at 28 weeks can be used to determine immunoprophylaxis failure at earlier gestation. Maternal positive HBeAg status was associated with a higher chance of viral load >6, 7 or 8 log10 IU/mL.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Optimal timing of hepatitis B virus DNA quantification and clinical predictors for higher viral load during pregnancy

Cheung

Seto

et al. 2019

Acta Obstet Gynecol Scand

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“…The reported rates of ALT flares postpartum are variable owing to different definitions of ALT flare, patient characteristics, and antiviral therapy (Table ). Studies from our group (N = 138; 60% Asian, 30% African) and other retrospective studies conducted in the United States and Australia (N = ~100; ~80% Asian) have reported hepatic flares during late pregnancy and early postpartum, even in the absence of antiviral treatment . ALT flares are reported to be more common in HBeAg+ carriers versus women with HBeAg− CHB.…”

Section: Epidemiology Of Hbv and Mtctmentioning

confidence: 59%

Hepatitis B and Pregnancy: Virologic and Immunologic Characteristics

Joshi

Coffin

2020

Hepatol Commun

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The hepatitis B virus (HBV) is an important human pathogen. Unvaccinated infants infected through mother-to-child transmission (MTCT) are at >95% risk of developing serum hepatitis B surface antigen-positive chronic hepatitis B (CHB). Despite complete passive-active HBV immunoprophylaxis, approximately 10% of infants born to mothers who are highly viremic develop CHB, and thus maternal treatment with nucleos(t)ide analogs (tenofovir disoproxil fumarate, lamivudine, or telbivudine) is recommended in the third trimester of pregnancy to reduce MTCT risk. Viral rebound usually occurs after stopping treatment and, in the context of maternal immunologic reconstitution postpartum, can also precipitate host immune-mediated hepatic (biochemical) flares. In this article, we review the epidemiology of HBV MTCT, discuss management and potential mechanisms of HBV vertical transmission, and highlight recent studies on virologic and immunologic aspects of hepatitis B in pregnancy and postpartum. (Hepatology Communications 2020;4:157-171).The global prevalence of CHB (serum HBsAg+) is 3.6%, with the highest prevalence in Africa (8.8%) and the Western Pacific (5.2%). More than 75% of individuals with CHB worldwide are found in the Asia Pacific

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The management of hepatitis B virus in pregnancy

Chan

2020

Clinical Dilemmas in Viral Liver Disease

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Incidence, determinants and outcomes of pregnancy‐associated hepatitis B flares: A regional hospital‐based cohort study

Abstract: Pregnancy-associated hepatitis B flare occurred in 14% during pregnancy and 16% post-delivery and rarely led to hepatic decompensation. Positive HBeAg was the main risk factor identified. Women did not have adequate HBV monitoring or follow-up during pregnancy.

Cited by 36 publications

References 25 publications

Optimal timing of hepatitis B virus DNA quantification and clinical predictors for higher viral load during pregnancy

Optimal timing of hepatitis B virus DNA quantification and clinical predictors for higher viral load during pregnancy

Hepatitis B and Pregnancy: Virologic and Immunologic Characteristics

The management of hepatitis B virus in pregnancy

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