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Aliasi-Sinai L, Worthington T, Lange M, Kushner T. Maternal-to-Child Transmission of Hepatitis B Virus and Hepatitis Delta Virus. Clin Liver Dis 2023; 27:917-935. [PMID: 37778777 DOI: 10.1016/j.cld.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Maternal-to-child transmission of hepatitis B virus (HBV) and hepatitis delta virus (HDV) can lead to the risk of progressive liver disease in infants, but fortunately effective interventions exist to decrease transmission. Counseling on the risk of maternal-to-child transmission, care pathways to decrease transmission, and the implications of HBV and HDV on pregnancy outcomes are the key components of caring for pregnant people living with HBV and HDV.
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Affiliation(s)
| | - Theresa Worthington
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marcia Lange
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, USA.
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Afraie M, Moradi G, Zamani K, Azami M, Moradi Y. The effect of hepatitis B virus on the risk of pregnancy outcomes: a systematic review and meta-analysis of cohort studies. Virol J 2023; 20:213. [PMID: 37710321 PMCID: PMC10500763 DOI: 10.1186/s12985-023-02182-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The effect of HBV on neonatal and maternal outcomes can create a basis for more accurate clinical decision-making. So, the aim of this meta-analysis is to detrmine the effect of chronic hepatitis B virus on the risk of pregnancy outcomes by combining cohort studies. METHODS International databases in this meta-analysis included the Cumulated Index to Nursing and Allied Health Literature (CINAHL), SPORT Discuss via the EBSCO interface, PubMed (Medline), Scopus, Web of Science, Embase, which were searched up to April 2023. All cohort studies reporting the risk ratio (RR) with a 95% confidence interval (CI) were included in the study. The quality assessment was done based on the Newcastle-Ottawa Scale (NOS). RESULTS Finally, thirty-five cohort studies were selected for meta-analysis. Outcomes of interest included pre-eclampsia, gestational diabetes, abortion, preterm birth, infant death, and other related outcomes. Results showed that the pooled RR for incident gestational diabetes in pregnant women with choronic hepatitis B infection was 1.16 (RR: 1.16; 95% CI 1.13-1.18; I-square: 92.89%; P value: 0.00). Similarly, the association between the presence of hepatitis B infection in pregnant women and the occurrence of pre-eclampsia was 1.10 (RR: 1.10; 95% CI 1.04-1.16; I-square: 92.06%; P value: 0.00). The risk of preterm delivery in pregnant women with hepatitis B infection was 1.17 times that of pregnant women without hepatitis B infection (RR: 1.17; 95% CI 1.14-1.20; I-squared: 94.32%; P value: 0.00). CONCLUSION This meta-analysis found that hepatitis B infection during pregnancy may be associated with an increased risk of gestational diabetes, preterm delivery, pre-eclampsia, and eclampsia. However, confirmation of this association, as well as the specific biological pathways involved in the association between HBV infection and pregnancy outcomes, requires further investigation.
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Affiliation(s)
- Maryam Afraie
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ghobad Moradi
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Kamran Zamani
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mobin Azami
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Weng M, Wang J, Yin J, Ren W, Wei C, Yang W, He H. Effects of HBsAg carriers on pregnancy complications in pregnant women: a retrospective cohort study. Front Med (Lausanne) 2023; 10:1166530. [PMID: 37293299 PMCID: PMC10246503 DOI: 10.3389/fmed.2023.1166530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/03/2023] [Indexed: 06/10/2023] Open
Abstract
Objective Hepatitis B virus (HBV) infection is a major health threat worldwide, especially in developing countries. We aimed to investigate the impact of hepatitis B carrier on pregnancy complications in pregnant women, in China. Methods This retrospective cohort study was conducted by using data from the EHR system of Longhua District People's Hospital in Shenzhen, China, from January 2018 to June 2022. Binary logistic regression was used to evaluate the relationship between HBsAg carrier status and pregnancy complications and pregnancy outcomes. Results The study included 2095 HBsAg carriers (exposed group) and 23,019 normal pregnant women (unexposed group). Pregnant women in the exposed group were older than the pregnant women in the unexposed group (29 (27,32) vs. 29 (26,32), p < 0.001). In addition, the incidence of some adverse pregnancy complications in the exposure group was lower than that in the unexposed group, including hypothyroidism of pregnancy (adjusted odds ratio [aOR], 0.779; 95% confidence interval [CI], 0.617-0.984; p = 0.036), hyperthyroidism of pregnancy (aOR, 0.388; 95% CI, 0.159-0.984; p = 0.038), pregnancy induced hypertension (aOR, 0.699; 95% CI, 0.551-0.887; p = 0.003), antepartum hemorrhage (aOR, 0.294; 95% CI, 0.093-0.929; p = 0.037). However, compared with the unexposed group, the exposed group had a higher risk of lower birth weight (aOR, 1.12; 95% CI, 1.02-1.23; p = 0.018) and intrahepatic cholestasis of pregnancy (aOR, 2.888, 95% CI, 2.207-3.780; p < 0.001). Conclusion The prevalence rate of HBsAg carriers in pregnant women in Longhua District of Shenzhen was 8.34%. Compared with normal pregnant women, HBsAg carriers have a higher risk of ICP, a lower risk of gestational hypothyroidism and PIH, and a lower birth weight of their infants.
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Affiliation(s)
- Mengqing Weng
- School of Information and Management, Guangxi Medical University, Nanning, China
| | - Jie Wang
- Department of Gynaecology, Longhua District People's Hospital, Shenzhen, China
- Medical Records Library, Longhua District People's Hospital, Shenzhen, China
| | - Jingfeng Yin
- Medical Records Library, Longhua District People's Hospital, Shenzhen, China
| | - Wenning Ren
- School of Information and Management, Guangxi Medical University, Nanning, China
| | - Caiping Wei
- School of Life Sciences, Central South University, Changsha, China
| | - Wenshan Yang
- Medical Records Library, Longhua District People's Hospital, Shenzhen, China
| | - Huimin He
- School of Information and Management, Guangxi Medical University, Nanning, China
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Xiong Y, Liu C, Wei W, Huang S, Wang J, Qi Y, Zou K, Tan J, Sun X. The impact of biparental hepatitis B virus infection on pregnancy outcomes in patients undergoing assisted reproductive technology treatment: a systematic review and meta-analysis. Arch Gynecol Obstet 2022; 306:1253-1266. [PMID: 35551455 DOI: 10.1007/s00404-022-06586-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 04/15/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the association between biparental hepatitis B virus (HBV) infection (hepatitis B surface antigen [HBsAg] seropositivity) and pregnancy outcomes in patients undergoing assisted reproductive technology (ART) treatment, including clinical pregnancy rate (CPR) and live birth rate (LBR). METHODS We searched various literature databases from the earliest date available until May 20, 2021, including PubMed, Embase, Medline, Web of Science, Scopus, CNKI, and Wangfang. Four patterns of biparental HBV infection for pregnancy outcomes following ART were synthesized separately by using random-effects model. We also performed subgroup analyses (matched or unmatched) and two forms of sensitivity analysis. RESULTS A total of 25 retrospective cohort studies, involving more than 19,269 couples, were included. Maternal and paternal HBV co-infection (crude relative risk [cRR]: 0.58, 95% confidence interval: 0.28-1.23), either maternal or paternal infection (cRR: 1.05, 0.88-1.24), maternal HBV infection alone (cRR: 0.96, 0.79-1.16), or paternal HBV infection alone (cRR: 1.02, 0.91-1.13) were not associated with significant reductions in CPR at per woman level. These patterns of infection were also not significantly associated with decreased LBR at per woman level. However, paternal HBV infection alone reduced CPR (adjusted odds ratio: 0.54, 0.33-0.86) and LBR (cRR: 0.52, 0.28-0.99) at per cycle level. Subgroup analyses and sensitivity analyses were mostly consistent with the primary results. CONCLUSIONS Paternal HBV infection alone probably decrease CPR after ART at per cycle level. However, maternal HBV infection was not associated with reductions in CPR and LBR in women undergoing ART at per woman level.
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Affiliation(s)
- Yiquan Xiong
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
| | - Chunrong Liu
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
| | - Wei Wei
- Department of First Convalescent, Dujiangyan Special Crew Sanatorium of PLA Air Force, Dujiangyan, 611830, China
| | - Shiyao Huang
- Sichuan Evidence-Based Medicine Center of Traditional Chinese Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Jing Wang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
| | - Yana Qi
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
| | - Kang Zou
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
| | - Jing Tan
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China. .,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China.
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China. .,NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China.
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Kumar M, Abbas Z, Azami M, Belopolskaya M, Dokmeci AK, Ghazinyan H, Jia J, Jindal A, Lee HC, Lei W, Lim SG, Liu CJ, Li Q, Al Mahtab M, Muljono DH, Niriella MA, Omata M, Payawal DA, Sarin SK, Ségéral O, Tanwandee T, Trehanpati N, Visvanathan K, Yang JM, Yuen MF, Zheng Y, Zhou YH. Asian Pacific association for the study of liver (APASL) guidelines: hepatitis B virus in pregnancy. Hepatol Int 2022; 16:211-253. [PMID: 35113359 DOI: 10.1007/s12072-021-10285-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/06/2021] [Indexed: 12/11/2022]
Abstract
Hepatitis B virus (HBV) infection still remains a major public health issue in the Asia-Pacific region. Most of the burden of HBV-related disease results from infections acquired in infancy through perinatal or early childhood exposure to HBV in Asia-Pacific. Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These APASL guidelines provide a comprehensive review and recommendations based on available evidence in the literature, for the management of females with HBV infection through every stage of pregnancy and postpartum. These also address the concerns, management challenges, and required follow-up of children born to hepatitis B-positive mothers.
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Affiliation(s)
- Manoj Kumar
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India.
| | - Zaigham Abbas
- Department of Medicine, Ziauddin University Hospital, Karachi, Pakistan
| | - Milad Azami
- Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | | | - A K Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Hasmik Ghazinyan
- Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, China
| | - Ankur Jindal
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
| | - Han Chu Lee
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Wei Lei
- Hepatopancreatobiliary Center, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Seng Gee Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chun-Jen Liu
- Department of Internal Medicine and Hepatitis Research Center, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Qiang Li
- Division of Liver Diseases Jinan Infectious Disease Hospital, Shandong University, Jinan, China
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Madunil Anuk Niriella
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Colombo, Sri Lanka
| | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan
- University of Tokyo, Tokyo, Japan
| | - Diana A Payawal
- Fatima University Medical Center Manila, Manila, Philippines
| | - Shiv K Sarin
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India.
| | - Olivier Ségéral
- French Agency for Research on AIDS and Viral Hepatitis, University of Health Science, Phnom Penh, Cambodia
| | - Tawesak Tanwandee
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nirupma Trehanpati
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Kumar Visvanathan
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Jin Mo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Man-Fung Yuen
- Li Shu Fan Medical Foundation Professor in Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yingjie Zheng
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Y H Zhou
- Department of Laboratory Medicine, Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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Lao TT. Obstetric implications of maternal chronic hepatitis B virus infection. EXPLORATION OF MEDICINE 2021. [DOI: 10.37349/emed.2021.00064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Antenatal screening for hepatitis B surface antigen seropositivity is widely adopted to identify pregnant women with chronic hepatitis B virus (HBV) infection in order to target their newborn infants for combined passive-active neonatal immunization to prevent the maternal-to-child transmission of HBV. It is less certain whether the presence of chronic HBV infection in these largely asymptomatic women could impact their pregnancy outcome. There is now gathering information in the literature, though sometimes conflicting, on the obstetric implications of chronic HBV infection. The conflicting data is most probably related to confounding factors such as the immunological phase of chronic HBV infection, viral genotype and activity, presence of hepatic inflammation and other co-existing liver disorders such as non-alcoholic fatty liver disease, and coinfection with other virus such as hepatitis C virus and micro-organisms, which are usually not examined, but which could have made significant influence on the occurrence of many of the pregnancy complications and adverse fetal and neonatal outcome. For pregnancy complications, the evidence suggests association with increased gestational diabetes mellitus, preterm birth, intrahepatic cholestasis of pregnancy, caesarean delivery, and postpartum haemorrhage, probably increased placental abruption and prelabour rupture of the membranes, and no effect or a reduction in the hypertensive disorders of pregnancy, especially preeclampsia. For perinatal outcome, there may be increased miscarriage and fetal malformations, and increase in both low birthweight and large-for-gestational age/macrosomic infants, as well as increased intrauterine fetal demise/stillbirth and fetal distress. However, most studies have not elaborated on the mechanisms or explanations of many of the adverse outcomes. Taken together, maternal chronic HBV infection increases the risk of adverse obstetric outcome overall, but further prospective studies are warranted to elucidate the reasons and mechanisms of, and with a view to mitigate, these adverse obstetric outcomes.
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Affiliation(s)
- Terence T. Lao
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Sirilert S, Tongsong T. Hepatitis B Virus Infection in Pregnancy: Immunological Response, Natural Course and Pregnancy Outcomes. J Clin Med 2021; 10:jcm10132926. [PMID: 34210105 PMCID: PMC8267880 DOI: 10.3390/jcm10132926] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 01/02/2023] Open
Abstract
This review aimed to provide an update on the impact of pregnancy on the natural course of hepatitis B virus (HBV) infection and also on the impact of HBV infection on adverse pregnancy outcomes, including mother-to-child transmission (MTCT). For the literature review, original research articles, review articles, and guidelines were narratively reviewed and comprehensively validated. The databases of PubMed, EMBASE, and CINAHL were carefully searched for articles in English on topics related to HBV infection, pregnancy, and vertical transmission from 1960 to May 2021. Immunological changes during pregnancy such as suppression of Th1 response and induction of Th2 immunity lead to an impaired immune reaction to HBV and stimulate viral activity along with the reduction of CD8 T cells to escape immune detection. The impact of pregnancy on the natural course of chronic HBV infection seems to be minimal, while pregnancy can increase morbidity and mortality in the case of advanced HBV hepatitis or cirrhosis. Importantly, hepatitis flare or alanine aminotransferase (ALT) flare can occur during pregnancy and is more common during the postpartum period due to the interaction between HBV and the immune response. Interestingly, the impact of HBV infection on adverse pregnancy outcomes is more serious than ever thought. Updated evidence indicates that pregnancies with chronic HBV infection increase the risk of preterm birth and gestational diabetes, especially in cases of positive hepatitis e antigen (HBeAg).
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Miyakawa M, Yoshida LM, Nguyen HAT, Takahashi K, Le TH, Yasunami M, Ariyoshi K, Dang DA, Moriuchi H. Hepatitis B virus infection among pregnant mothers and children after the introduction of the universal vaccination program in Central Vietnam. Sci Rep 2021; 11:8676. [PMID: 33883610 PMCID: PMC8060295 DOI: 10.1038/s41598-021-87860-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/23/2021] [Indexed: 01/15/2023] Open
Abstract
A birth cohort study was conducted in Khan Hoa Province, central Vietnam between 2009 and 2012 to determine the seroprevalence of hepatitis B virus (HBV) in pregnant women and their children, and associated risk factors. We enrolled 1987 pregnant women with their babies at the birth phase, and 12.6% (95% confidence interval [CI]: 11.1-14.0) of mothers were hepatitis B surface antigen (HBsAg)+. At 2-year follow-up phase, 1339 (67.4%) children were enrolled of whom 76.6% completed hepatitis B vaccines (HepB) and 1.9% (95% CI: 1.2-2.7) were HBsAg+. When mothers were hepatitis B e antigen (HBeAg)+, 28.3% of children have got infected even with complete HepB. HBV infection in mothers, hepatitis B surface antibody (anti-HBs antibody) below the seroprotective level in children, and mothers with pre-pregnancy low body mass index were associated with HBV infection in children. Meanwhile, HBV infection in children, older maternal age, no or incomplete doses of HepB, and boys were associated with anti-HBs antibody below the seroprotective level in children. Our birth cohort study determined a low rate of congenital HBV infection and associated risk factors in Vietnam, however further studies are needed to advance prevention including anti-viral therapy in pregnant women at high risk.
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Affiliation(s)
- Masami Miyakawa
- Department of Pediatrics, Nagasaki University Hospital, Nagasaki University, Nagasaki, 852-8102, Japan
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, 852-8523, Japan.
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8102, Japan.
| | | | - Kensuke Takahashi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Tho Huu Le
- Khanh Hoa Provincial Health Service Department, Nha Trang, 650000, Vietnam
| | - Michio Yasunami
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Duc-Anh Dang
- National Institute of Hygiene and Epidemiology, Hanoi, 100000, Vietnam
| | - Hiroyuki Moriuchi
- Department of Pediatrics, Nagasaki University Hospital, Nagasaki University, Nagasaki, 852-8102, Japan
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8102, Japan
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Oltean I, Tran J, Lawrence S, Ruschkowski BA, Zeng N, Bardwell C, Nasr Y, de Nanassy J, El Demellawy D. Impact of SARS-CoV-2 on the clinical outcomes and placental pathology of pregnant women and their infants: A systematic review. Heliyon 2021; 7:e06393. [PMID: 33688585 PMCID: PMC7923950 DOI: 10.1016/j.heliyon.2021.e06393] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/18/2020] [Accepted: 02/25/2021] [Indexed: 01/08/2023] Open
Abstract
Pregnant women are susceptible to viral infections due to physiological changes such as cell-mediated immunity. No severe adverse pregnancy or neonatal outcomes have been consistently reported in 2019 novel coronavirus disease (COVID-19) positive pregnancy cases. There are controversies around the role of COVID-19 in pregnancy. A systematic review was conducted to examine clinical maternal and neonatal clinical outcomes. Studies were included if they reported SARS-CoV-2 infection among pregnant women and/or COVID-19 positive neonates as validated by positive antibody testing or viral testing using polymerase chain reaction. Case series, case reports, case-control studies, and comparative studies were included. Eight hundred and thirty-seven records were identified, resulting in 525 records for level I screening. Forty-one were included after full-text review. Results suggest elevated rates of intensive care unit (ICU) admission, gestational diabetes, preeclampsia, C-sections, pre-term birth, and C-reactive protein (CRP) in comparison to pregnant women without SARS-CoV-2. Careful monitoring of pregnancies with SARS-CoV-2 is recommended.
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Affiliation(s)
- Irina Oltean
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, K1H 8L1, Canada
| | - Jason Tran
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5 Canada
| | - Sarah Lawrence
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, K1H 8L1, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5 Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, K1H 8L1, Canada
| | | | - Na Zeng
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5 Canada
| | - Cameron Bardwell
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5 Canada
| | - Youssef Nasr
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5 Canada
| | - Joseph de Nanassy
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, K1H 8L1, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5 Canada
- Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, K1H 8L1, Canada
| | - Dina El Demellawy
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, K1H 8L1, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5 Canada
- Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, K1H 8L1, Canada
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10
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Zhang Y, Chen J, Liao T, Chen S, Yan J, Lin X. Maternal HBsAg carriers and pregnancy outcomes: a retrospective cohort analysis of 85,190 pregnancies. BMC Pregnancy Childbirth 2020; 20:724. [PMID: 33238912 PMCID: PMC7687687 DOI: 10.1186/s12884-020-03257-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/15/2020] [Indexed: 11/27/2022] Open
Abstract
Background Nowadays, a positive HBV carrier status is common among pregnant women, especially in endemic areas (such as China), little is known about the impact of maternal HBV infection on the risk of adverse pregnancy outcomes. Pregnant women with HBV infection often develop obstetric complications, such as pregnancy-induced hypertension (PIH) syndrome, postpartum hemorrhage, and gestational diabetes mellitus (GDM), and their infants often exhibit neonatal complications. Methods This study undertook a retrospective cohort analysis to explore the association of HBV carrier status with adverse pregnancy outcomes. A cohort of 85,190 women including 9699 HBsAg-positive and 73,076 HBsAg-negative pregnancies was retrospectively analyzed. Results It’s found that HBsAg-positive pregnancies may result in higher risk of various maternal outcomes such as ICP (OR 3.4,95%CI 2.80 to 4.13), postpartum hemorrhage (OR 1.16,95%CI 1.00 to 1.34). Interestingly, there was a decreased risk of Preeclampsia (OR 0.91,95%CI 0.87 to 0.96), premature rupture of membrane (OR 0.91,95%CI 0.87 to 0.96) and gestational hypertension (OR 0.828,95%CI 0.701 to 0.978). And in vaginal delivery subgroup analysis, It’s found that the HBsAg-positive group had a higher risk of placental abruption (OR, 1.44; 95% CI, 1.16–1.79). Conclusions The present results suggest that compared with HBV positive pregnancies were more likely to be ICP and postpartum hemorrhage. HBV-positive pregnant women underwent vaginal delivery were more likely to have placental abruption and premature birth compared with HBV-negative women. Obstetricians should be aware of ICP, postpartum hemorrhage, placental abruption and premature birth in HBV-positive pregnant women.
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Affiliation(s)
- Yulong Zhang
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Jiacheng Chen
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Tingting Liao
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Siwen Chen
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Jianying Yan
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, China.
| | - Xiaoqian Lin
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, China
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11
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Acute-on-Chronic Liver Failure in Pregnant Patients with Chronic Hepatitis B: A Retrospective Observational Case Series Study. Gastroenterol Res Pract 2020; 2020:9831687. [PMID: 32849869 PMCID: PMC7441429 DOI: 10.1155/2020/9831687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/24/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Acute-on-chronic liver failure (ACLF) is common in patients with end-stage liver disease and chronic hepatitis B (CHB) or hepatitis B virus- (HBV-) related cirrhosis. To date, no uniform definition and management strategy are available for ACLF. Although a considerable number of studies on ACLF has been published, there are few reports on ACLF in pregnant women with CHB. This study retrospectively reviewed five patients who were diagnosed with ACLF during pregnancy in the past 10 years. We aimed at investigating their clinical characteristics, treatment, biochemical test results, and maternal and fetal outcomes. RESULTS Asthenia, anorexia, and jaundice were the main initial clinical manifestations in these patients during the second or third trimester of pregnancy. All patients received antiviral therapy. None of the pregnant women died after treatment. Patient #4 was treated with an artificial liver support system, and patients #2 and #5 underwent transfusion therapy. The acute insult in all patients was HBV DNA reactivation. Except for patient #3, who chose an actively induced vaginal delivery because of intrauterine fetal demise, the remaining four patients underwent a preterm delivery via a cesarean section. The four neonates were alive, although all were small for gestational age. CONCLUSION Asthenia, anorexia, and jaundice during mid-late pregnancy should be immediately investigated. Before and during the pregnancy, hepatologists or obstetricians should actively screen pregnant women with CHB for HBV DNA status and alanine aminotransferase levels. Reactivation of HBV replication in pregnant women with CHB may lead to ACLF, especially in multiparous women. Once ACLF is diagnosed, antiviral therapy should be considered as soon as possible to protect maternal and fetal health.
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12
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Lao TT. Hepatitis B - chronic carrier status and pregnancy outcomes: An obstetric perspective. Best Pract Res Clin Obstet Gynaecol 2020; 68:66-77. [PMID: 32312688 DOI: 10.1016/j.bpobgyn.2020.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 12/12/2022]
Abstract
Antenatal screening for hepatitis B surface antigen (HBsAg) only identifies women with hepatitis B virus (HBV) infection for neonatal immunoprophylaxis. It does not reflect the phase of chronic infection, viral genotype and activity, hepatic inflammation, or other co-existing liver disorders. Coinfection with other viruses and micro-organisms may also be present. These factors in various combinations can impact pregnancy outcomes, and they are probably responsible for the conflicting literature on this issue. Pregnancy complications may interact with maternal HBV infection and hepatitis flares, leading to serious and lethal complications. Hepatitis flares are common especially postpartum, and they are unpredictable and unpreventable with antiviral treatment. Evidence on the association between HBsAg seropositivity with gestational diabetes mellitus, preterm birth, increased foetal growth, and reduced pregnancy hypertensive disorders is stronger than other adverse pregnancy outcomes. Baseline assessment of liver function, and viral markers and activity, can delineate the truly high-risk pregnancies for close monitoring.
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Affiliation(s)
- Terence T Lao
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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13
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Oskovi Kaplan ZA, Ozgu-Erdinc AS. Prediction of Preterm Birth: Maternal Characteristics, Ultrasound Markers, and Biomarkers: An Updated Overview. J Pregnancy 2018; 2018:8367571. [PMID: 30405914 PMCID: PMC6199875 DOI: 10.1155/2018/8367571] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 08/09/2018] [Accepted: 09/10/2018] [Indexed: 01/01/2023] Open
Abstract
There is not a single or combined screening method for preterm birth with high sensitivity which will truly identify the women at risk for preterm birth while also with high specificity to prevent unnecessary interventions and high treatment costs. Measurement of cervical length is the most cost-effective method that is used in clinical practice. Bedside tests have also been developed for detecting markers like fetal fibronectin, insulin-like growth factor binding protein-1 (IGFBP-1), interleukin-6, and placental alpha-macroglobulin-1. Taking the maternal history, health condition, and sociodemographical factors into consideration is recommended. Ultrasound markers apart from cervical length measurements as uterocervical angle and placental strain ratio are studied. Investigations on metabolomics, proteomics, and microRNA profiling have brought a new aspect on this subject. Maybe in the future, with clear identification of women at true risk for preterm birth, development of more effective preventive strategies will not be unfeasible.
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Affiliation(s)
- Zeynep Asli Oskovi Kaplan
- University of Health Sciences, Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, Ankara, Turkey
| | - A. Seval Ozgu-Erdinc
- University of Health Sciences, Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, Ankara, Turkey
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14
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Maraolo AE, Gentile I, Buonomo AR, Pinchera B, Borgia G. Current evidence on the management of hepatitis B in pregnancy. World J Hepatol 2018; 10:585-594. [PMID: 30310536 PMCID: PMC6177570 DOI: 10.4254/wjh.v10.i9.585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/26/2018] [Accepted: 06/09/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) infection is one of the main public health problems across the globe, since almost one third of the world population presents serological markers of contact with the virus. A profound impact on the epidemiology has been exerted by universal vaccination programmes in many countries, nevertheless the infection is still widespread also in its active form. In the areas of high endemicity (prevalence of hepatitis B surface antigen positivity > 7%), mother-to-child transmission represents the main modality of infection spread. That makes the correct management of HBV in pregnancy a matter of utmost importance. Furthermore, the infection in pregnancy needs to be carefully assessed and handled not only with respect to the risk of vertical transmission but also with respect to gravid women health. Each therapeutic or preventive choice deserves to be weighed upon attentively. On many aspects evidence is scarce or controversial. This review will highlight the latest insights into the paramount steps in managing HBV in pregnancy, with particular attention to recommendations from recent guidelines and data from up-do-date research syntheses.
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Affiliation(s)
- Alberto Enrico Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Antonio Riccardo Buonomo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Biagio Pinchera
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Guglielmo Borgia
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
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15
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Shi TL, Huang LJ, Xiong YQ, Zhong YY, Yang JJ, Fu T, Lei XF, Chen Q. The risk of herpes simplex virus and human cytomegalovirus infection during pregnancy upon adverse pregnancy outcomes: A meta-analysis. J Clin Virol 2018; 104:48-55. [DOI: 10.1016/j.jcv.2018.04.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/13/2018] [Accepted: 04/24/2018] [Indexed: 12/12/2022]
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16
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Huang QT, Zhong M. Maternal hepatitis B virus infection and risk of preterm birth in China. LANCET GLOBAL HEALTH 2018; 5:e563-e564. [PMID: 28495254 DOI: 10.1016/s2214-109x(17)30175-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/23/2017] [Indexed: 01/04/2023]
Affiliation(s)
- Qi-Tao Huang
- Division of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Mei Zhong
- Division of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
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17
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Ma X, Sun D, Li C, Ying J, Yan Y. Chronic hepatitis B virus infection and preterm labor(birth) in pregnant women-an updated systematic review and meta-analysis. J Med Virol 2018; 90:93-100. [PMID: 28851115 DOI: 10.1002/jmv.24927] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 08/18/2017] [Indexed: 12/17/2022]
Abstract
We aimed to explore whether maternal chronic hepatitis B virus (HBV) infection certainly affects preterm labor (birth) in pregnant women. Four databases were systematically searched up to May 31, 2017, without language restriction. Any study was included if it clearly defined exposure to chronic HBV infection, reported risk of preterm labor or birth in pregnant women, and reported relative risks (RRs) or odds ratios (ORs) or provided data for estimation. RRs (or ORs) with 95% confidence intervals were pooled using random-effects models. Statistical heterogeneity was assessed with Cochran's Q statistic and I2 statistic. Twenty-two observational studies involving 6 141 146 pregnant women (three prospective cohort studies, n = 1 116 799; 15 retrospective cohort studies, n = 5 022 513 and four case-control studies, n = 1834) were included. The risk of preterm labor was significantly intensified with chronic HBV infection compared with uninfected women, with substantial heterogeneity. Chronic HBV infection was also significantly associated with a 16% increase in the risk of preterm birth, with substantial heterogeneity. The risk of preterm birth significantly increased by 21% in HBsAg+/HBeAg+ pregnant women compared with uninfected pregnant women. Chronic HBV infection intensifies the risk of preterm labor and birth in pregnant women, but this conclusion should be interpreted with caution given the possibility of residual confounding and be confirmed by well-designed studies in the future.
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MESH Headings
- Adult
- Case-Control Studies
- Databases, Factual
- Female
- Hepatitis B, Chronic/complications
- Hepatitis B, Chronic/epidemiology
- Hepatitis B, Chronic/virology
- Humans
- Infant, Newborn
- Infectious Disease Transmission, Vertical/statistics & numerical data
- Observational Studies as Topic
- Obstetric Labor, Premature/epidemiology
- Obstetric Labor, Premature/etiology
- Obstetric Labor, Premature/virology
- Pregnancy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/virology
- Premature Birth/etiology
- Prospective Studies
- Retrospective Studies
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Affiliation(s)
- Xiaosong Ma
- Department of Infection, People's Hospital of Xuyi, Xuyi, Jiangsu, P.R. China
| | - Dehong Sun
- Department of Gastroenterology, People's Hospital of Xuyi, Xuyi, Jiangsu, P.R. China
| | - Chuansheng Li
- Department of Infection, People's Hospital of Xuyi, Xuyi, Jiangsu, P.R. China
| | - Jie Ying
- Department of Infection, People's Hospital of Xuyi, Xuyi, Jiangsu, P.R. China
| | - Youde Yan
- Department of Infection, The First Affiliated Hospital of Nanjing Medical University and Jiangsu Province Hospital, Nanjing, Jiangsu, P.R. China
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18
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Cui AM, Shao JG, Li HB, Shen Y, Chen ZX, Zhang S, Bian ZL, Qin G, Cheng XY. Association of chronic hepatitis B virus infection with preterm birth: our experience and meta-analysis. J Perinat Med 2017; 45:933-940. [PMID: 27875320 DOI: 10.1515/jpm-2016-0201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/14/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To assess the association of chronic hepatitis B virus (HBV) infection with preterm birth (PTB). METHODS A cohort of 20,498 pregnant women (497 HBV carriers with 20,001 non-HBV controls) with normal alanine aminotransferase (ALT) levels was selected from the Obstetrics & Gynecology Hospital of Nantong University. The clinical parameters and PTB incidence were compared between HBV carriers and non-HBV subjects. For the meta-analysis, we searched the PubMed, Ovid and Cochrane Library databases for studies comparing PTB incidence between individuals with chronic HBV infection and non-HBV subjects. RESULTS HBV carriers were slightly older and had slightly higher ALT levels within normal limits. The body mass index, education and history of pregnancy between HBV carrier and non-HBV groups were comparable. PTB incidence was not associated with HBV carrier status [relative risk (RR) 0.98, 95% confidence interval (CI) 0.71-1.37] in our cohort. However, the meta-analysis involving eight published studies and our study revealed a significant association between chronic HBV infection and PTB incidence (pooled RR 1.26, 95% CI 1.19-1.33). CONCLUSION While maternal HBV carriers did not have a higher incidence of PTB in our cohort, the meta-analysis indicates that individuals with chronic HBV infection appeared to be at risk of PTB as a whole.
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19
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Zhuang X, Cui AM, Wang Q, Cheng XY, Shen Y, Cai WH, Li HB, Zhang S, Qin G. Liver Dysfunction during Pregnancy and Its Association of With Preterm Birth in China: A Prospective Cohort Study. EBioMedicine 2017; 26:152-156. [PMID: 29174520 PMCID: PMC5832609 DOI: 10.1016/j.ebiom.2017.11.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/04/2017] [Accepted: 11/16/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Liver dysfunction is common in pregnancy but its association with adverse pregnancy outcomes such as preterm birth (PTB) remains unclear. METHODS A prospective cohort of HBV-infected or uninfected pregnant women attending antenatal care was recruited at Nantong Maternal and Child Health Hospital between January 1, 2012, and June 30, 2016. Liver function tests (LFTs) were monitored through pregnancy. The primary outcomes were PTB and very PTB (delivery prior 37 and 32weeks' gestation respectively). Poisson regression was used to estimate adjusted risk ratios (RR) for women with HBV infection and LFT abnormalities. RESULTS Among 36,755 pregnant women (1,113 HBV carriers and 35,642 non-HBV subjects), 3,519 (9.57%) had abnormal LFTs. The commonest cause for liver dysfunction during pregnancy was non-alcoholic fatty liver diseases (NAFLD, 51.3%). Abnormal aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT) and two folds upper limit of normal total bilirubin (RR and 95%CI: 2.73, 1.30-5.76; 2.24, 1.35-3.31; 2.01, 1.22-3.31 respectively), rather than HBsAg positivity, were identified as independent risk factors for preterm birth. Besides, GGT abnormality was associated with increased risk of very PTB. CONCLUSIONS We suggest that surveillance of LFTs among pregnant women should be warranted, given the increased risk of PTB.
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Affiliation(s)
- Xun Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Nantong, China
| | - Ai-Min Cui
- Department of Obstetrics and Gynaecology, Nantong Maternal and Child Health Hospital Affiliated to Nantong University, Nantong, China
| | - Qin Wang
- Department of Nursing, Nantong Health College of Jiangsu Province, Nantong, China
| | - Xiao-Yan Cheng
- Department of Obstetrics and Gynaecology, Nantong Maternal and Child Health Hospital Affiliated to Nantong University, Nantong, China
| | - Yi Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Nantong, China
| | - Wei-Hua Cai
- Department of Nursing, Nantong Health College of Jiangsu Province, Nantong, China
| | - Hai-Bo Li
- Department of Clinical Laboratory, Nantong Maternal and Child Health Hospital Affiliated to Nantong University, Nantong, China
| | - Sheng Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Nantong, China
| | - Gang Qin
- Center for Liver Diseases, Nantong Third People's Hospital Affiliated to Nantong University, Nantong, China..
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20
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Li YT, Lin CS. Prevention of mother-to-child transmission of hepatitis B virus: Research progress and controversy. Shijie Huaren Xiaohua Zazhi 2017; 25:2672-2680. [DOI: 10.11569/wcjd.v25.i30.2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) infection is a global health problem. Mother-to-child transmission (MTCT, also known as vertical transmission) is the main cause of chronic HBV infection. Although combined active and passive immunization has greatly reduced the vertical transmission of HBV, about 8%-10% of newborns still acquire HBV infection, especially those from hepatitis B e antigen (HBeAg) positive mothers. Previous studies have shown that high levels of HBV DNA and positive HBeAg in serum of pregnant woman may be related to the vertical transmission of HBV. Thus, the prevention of MTCT of HBV has always been a practical question that clinicians must face and urgently needs to solve. However, there is still much controversy over the following aspects: indications of antiviral therapy, drug choice, timing of initiating and ending of antiviral agents, postpartum breast-feeding and so on. This review focuses on the consensus and controversy regarding the prevention of the vertical transmission of HBV.
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Affiliation(s)
- Yi-Ting Li
- Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-sen University; Guangdong Key Laboratory of Liver Disease Research, Guangzhou 510630, Guangdong Province, China
| | - Chao-Shuang Lin
- Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-sen University; Guangdong Key Laboratory of Liver Disease Research, Guangzhou 510630, Guangdong Province, China
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21
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Dengue virus infection during pregnancy increased the risk of adverse fetal outcomes? An updated meta-analysis. J Clin Virol 2017; 94:42-49. [DOI: 10.1016/j.jcv.2017.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 01/11/2023]
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22
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Cholongitas E, Tziomalos K, Pipili C. Management of patients with hepatitis B in special populations. World J Gastroenterol 2015; 21:1738-1748. [PMID: 25684938 PMCID: PMC4323449 DOI: 10.3748/wjg.v21.i6.1738] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 10/27/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
The development of effective nucleos(t)ide analogs (NAs) against hepatitis B virus (HBV) has improved the outcome of patients with chronic hepatitis B (CHB). This review updates issues related to the management of CHB patients included in special populations. Entecavir (ETV) and tenofovir (TDF) represent the currently recommended first-line NAs in patients with HBV decompensated cirrhosis. The combination of HBV immunoglobulin (usually for a finite duration) and NA is considered the standard of care for prophylaxis against HBV recurrence after liver transplantation. TDF is the best choice for hemodialysis patients and in patients with chronic kidney disease with nucleoside resistance. ETV and telbivudine are the preferred options in naïve renal transplant recipients and with low viremia levels, respectively. All hepatitis B surface antigen (HBsAg)-positive candidates should be treated with NAs before renal transplantation to achieve undetectable HBV DNA at the time of transplantation. Conventional interferon or NAs can also be used in children, on the basis of well-established therapeutic indication. Pregnant women at high risk of perinatal transmission could be treated with lamivudine, telbivudine or TDF in the last trimester of pregnancy. HBsAg-positive patients under immunosuppression should receive NA pre-emptively (regardless of HBV DNA levels) up to 12 mo after its cessation. In HBsAg negative, anti-HBc positive patients under immunosuppression, further studies are needed to form a final conclusion; however, it seems that anti-HBV prophylaxis is justified in such patients with hematological diseases and/or for those receiving rituximab-containing regimens, regardless of their anti-HBs or serum HBV DNA status.
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