Maternal hepatitis B surface antigen status and incidence of pre‐eclampsia

Abstract

The relationship between chronic hepatitis B virus (HBV) infection with atherosclerosis and cardiovascular disorders remains unclear, and the impact of maternal HBV infection on the development of pregnancy-induced hypertension (PIH) and pre-eclampsia (PE) is also controversial. This retrospective cohort study was conducted to examine the relationship between maternal hepatitis B surface antigen (HBsAg) status with PIH and PE in singleton pregnancies that delivered at 24 weeks of gestation and beyond. Among the 86 537 cases in the cohort, 10% were HBsAg positive, and overall 2.0% had PIH, of whom 56.3% developed PE. HBsAg-positive women had higher weight and body mass index (BMI), but lower incidences of advanced age, nulliparity, PIH (1.6% vs 2.0%, P = 0.007) and PE (0.8% vs 1.1%, P = 0.005). On multiple logistic regression analysis adjusting for the effects of nulliparity, advanced age, high BMI, and underlying renal, cardiac and autoimmune diseases, HBsAg carriage was associated with significantly reduced incidence of PIH (aOR 0.79, 95% CI 0.66-0.95) and PE (aOR 0.71, 95% CI 0.56-0.91). Our results indicate that maternal HBsAg carriage is independently associated with reduced PE. As chronic HBV infection alters the immune response of the individual, our observation could be related to enhanced maternal immunotolerance of the foetus and hence a reduction in the incidence of PE. The implications of our findings on the long-term health outcome of the infected women, from cardiovascular morbidity to malignancies, warrant further studies.

A meta-analysis of the association between gestational diabetes mellitus and chronic hepatitis B infection during pregnancy

“…For economic, psychological and other reasons, GDM screening is conducted using a risk factor-based selective screening approach in most countries rather than universal screening. These differences in strategies did not seem to affect the non-significant association between CHB infection and the risk of GDM [12-14,16,17], which was further supported by our sub-group and meta-regression analysis. Only one out of the ten homogenous studies reported a positive association between CHB infection and the risk of GDM [7].…”

“…Two studies each were conducted in Thailand [8,9] and Iran [10,11], one in Germany [12], the United States [13], and mainland China [15], and the other seven in Hong Kong, China [3-7,16,17]. All fourteen were hospital-based retrospective cohort studies.…”

“…This difference can be explained by the fact that the replacement of the Australian standard for GDM diagnosis with the WHO standard would have resulted in the inclusion of individuals with impaired glucose tolerance into the GDM group. Routinely, pregnant women will receive the same screening and are subjected to the same diagnostic criteria in the same study regardless of CHB infection status, so issues of this type seem to play insignificant roles in most of the studies [3,5,8,9,13,14,16,17]. Future studies should use a universal screening strategy together with the new diagnostic criteria established for GDM.…”

Chronic Hepatitis B Infection is Associated with Decreased Risk of Preeclampsia: A Meta-Analysis of Observational Studies

“…Second, most of the articles included in the meta-analysis were conducted in Asia, only one in America and one in Europe. In addition, one study performed by Lao TT and his colleague [14] in Asian accounting for a 48% weight was contributing the most to the analysis. Therefore, the results of this analysis should be interpreted with caution.…”

Lack of association between Toxoplasma gondii infection and hypertensive disorders in pregnancy: a case–control study in a Northern Mexican population

“…On the other hand, some studies have not found an association of preeclampsia with infection with cytomegalovirus [13,14], Chlamydia pneumonia , Herpes simplex virus 2 [14], or respiratory tract infection [15]. HBsAg carriage [16] has even been found to be associated with a reduced incidence of preeclampsia.…”