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Clinical and virological predictors of hepatic flares in pregnant women with chronic hepatitis B
  1. Michelle Giles1,2,3,
  2. Kumar Visvanathan3,4,
  3. Sharon Lewin1,5,
  4. Scott Bowden6,
  5. Stephen Locarnini6,
  6. Tim Spelman1,
  7. Joe Sasadeusz1,7
  1. 1Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
  2. 2Department of Infectious Diseases, the Royal Women's Hospital, Melbourne, Victoria, Australia
  3. 3Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
  4. 4Department of Medicine, St. Vincents Hospital, University of Melbourne, Melbourne, Victoria, Australia
  5. 5Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia
  6. 6Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
  7. 7Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
  1. Correspondence to Dr Michelle Giles, Infectious Diseases Unit, Alfred Hospital, Level 2 Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia; m.giles{at}alfred.org.au

Abstract

Background Unique immunological changes occur during pregnancy; the impact of which, on virological and biochemical markers of hepatitis B infection is not well established. Rapid changes in the immunological profile post partum and consequent rebound of the inflammatory response may result in hepatic flares.

Methods Women with chronic hepatitis B were recruited during pregnancy into this observational study. Demographic and clinical data were collected together with virological and biochemical parameters at two time points during pregnancy (early and late) and two time points post partum (between 6 weeks and 12 weeks and at 12 months). Outcomes analysed included changes in HBV DNA, hepatitis B e antigen (HBeAg) status and flares of hepatitis.

Results One hundred and twenty-six women were recruited. Twenty-seven women out of 108 with postpartum bloods (25%) met our definition of a postpartum flare (ALT range 38–1654). Using univariate analysis HBeAg status, younger age, gravida and parity were associated with a flare. On multivariate analysis HBeAg positivity at baseline fell just outside of statistical significance in predicting a postpartum flare (p=0.051).

Conclusions 25% of women with chronic hepatitis B will demonstrate increased liver inflammation in the postpartum period. This is usually asymptomatic and resolves spontaneously. This is more likely if the woman is HBeAg-positive at baseline (2.56 times the risk), although flares also commonly occur in HBeAg-negative women.

  • HEPATITIS B
  • CHRONIC VIRAL HEPATITIS
  • INFLAMMATION
  • LIVER DISEASE IN PREGNANCY

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