Perinatal hepatitis B: update & recommendations

Chronic hepatitis B virus (HBV) infection in pregnancy

BACKGROUND

Hepatitis B is a considerable disease burden among Asians. Little is known about its disease behaviour in pregnant women.

METHODS

Clinical, laboratory and radiological data of pregnant and peri-partum females with chronic hepatitis B virus (HBV) infection who were seen between years 1999 and 2004 were studied. Their progress was documented up to 6 months post-partum. This was compared with the age-matched and HBe status-matched, non-pregnant, female patients with chronic HBV infection, who were consecutively selected from the department's registry as controls (ratio 1 mother: 4 non-pregnant controls), over the corresponding period.

RESULTS

A total of 35 mothers and 140 controls were studied. Mean age of patients was 30.7 +/- 3.6 years. Majority of mothers (74.3%) presented during pregnancy itself. 1st:2nd:3rd trimester presentation = 20.0%:48.6%:5.7%. Majority (65.7%) were positive for HBe antigen (HBeAg) at the time of presentation. About 57.1% mothers had a clinical event in the form of alanine transferase (ALT) elevation and/or loss of HBeAg vs 28.8% among controls (P = 0.002). Among HBeAg-positive subjects, more mothers (14.3%) than controls (2.2%) had resultant HBeAg loss (P = 0.02). Among HBeAg negative subjects, more mothers than controls had serum ALT elevations in the post-partum period (P = 0.007). Overall, more mothers had elevated ALT levels than controls, regardless of their HBeAg status. Neither mothers nor control subjects decompensated clinically, neither required liver transplantation nor died during the study period.

CONCLUSIONS

Pregnancy is associated with serum ALT elevation and HBeAg loss in patients with chronic HBV infection in the peri-partum period.

A program to educate woman who test positive for the hepatitis B virus during the perinatal period

This computerized patient education program targeted the woman's self-identified learning needs and educated her about etiology, prognosis, and risk of transmission to the infant and other contacts. The educational program is an 18-page color slide presentation intended to be viewed jointly by the nurse and patient during a home visit. It uses strategies known to be effective for women with low literacy skills; the nurse uses this as an adjunct teaching tool to traditional one-on-one verbal instruction. Because many women who test positive for hepatitis B surface antigen during the perinatal period lack basic knowledge regarding the hepatitis B virus, it is essential that nurses teach this important information to at-risk populations.