Bir eğitim ve araştırma hastanesinde hastanesinde takip edilen Hepatit B ile enfekte gebelerin değerlendirilmesi

Abstract

Amaç: Kronik hepatit B önemli bir sağlık sorunudur. İmmünoprofilaksiye rağmen, anneden çocuğa hepatit B virüs (HBV) bulaşı yüksek oranda viremi olan annelerin % 1-10' unda görülür. Gebelerin bu nedenle HBsAg pozitifliği yönünden taranması ve takibi önerilir. Bu çalışmada kliniğimizde izlenen hepatit B ile enfekte gebe kadınların yönetimi ve tedavisi değerlendirildi.

Gereç ve Yöntemler:  Çalışmaya 85 HBV ile enfekte gebe dahil edildi. Gebeler, gebelik süresince ve doğum sonrasında periyodik olarak takip edildi. Üç aylık aralıklarla hastaların HBV-DNA ve karaciğer fonksiyon testleri değerlendirildi. 

Bulgular: Hastaların yaş ortalaması 29,04±5,6 (17-38) yaş, başvuru sırasındaki gebelik haftası ortalaması 17,39±9,3 (5-38) idi. Hastaların 14’ ü (%16,4) gebelik sırasında yapılan taramalarla HbsAg pozitif olduğunu öğrendi. Gebelerin 25’inde (%29,4) Anti-HAV IgG pozitifti. Onüç hastaya (%15,3) antiviral tedavi başlandı. Onüç (%15,3) hastaya tedavi başlandı, tedavi başlanan hastaların 12’ si (%92,3) tenofovir disoproksil fumarat alırken, bir hasta telbivudin almaktaydı.  Hiçbir hastada tedaviye bağlı yan etki gözlenmedi. Bebeklerin doğum sonrası takiplerinde antiviral tedavi ile ilişkili problemler izlenmedi. Takibi yapılabilen 25 (%29,4) bebeğin hiçbirinde HbsAg pozitifliği saptanmadı. 

Sonuç: Hepatit B bulaşında önemli bir yol olan vertikal bulaşların engellenmesi için, gebelik taramalarının ve gebelerin yakın takibinin yapılması gerekmektedir.

Keywords

• Gebelik,yenidoğan,hepatit B,antiviral tedavi

Evaluation of hepatitis b ınfected pregnants followed at a research and training hospital

Abstract

Aim: Chronic hepatitis B is an important health problem. Despite immunoprophylaxis, hepatitis B virus (HBV) transmission from mother to child is seen in 1-10% of mothers with high rates of viremia. Therefore, screening and follow-up of pregnant women is recommended for HBsAg positivity. 

Material and Methods: In this study, the management and treatment of hepatitis B infected pregnant women were evaluated in our clinic. 85 HBV infected pregnant women were included in the study. The pregnant women were followed periodically during pregnancy and after delivery. HBV-DNA and liver function tests were evaluated at three-month intervals. Results : The mean age of the patients was 29.04 ± 5.6 years (range, 17-38 years), and the mean gestational age at admission was 17.39 ± 9.3 (5-38). 14 of the patients (16.4%) learned that HbsAg was positive by screening during pregnancy. Anti-HAV IgG was positive in 25 (29.4%) of the pregnant women. Thirteen patients (15.3%) underwent antiviral therapy. Thirteen (15.3%) patients were started on treatment and 12 (92.3%) patients received tenofovir disoproxil fumarate and one patient was receiving telbivudine. No side effect was observed in any patient. There were no problems about infants, associated with antiviral treatment in the postpartum period. There were no HbsAg positivity in 25 (29.4%) infants.

Conclusion: In order to prevent vertical transmission, which is an important pathway in the transmission of hepatitis B, it is necessary to follow up pregnancy screenings and pregnant women closely.

Keywords

• Pregnancy,newborn,hepatitis B,antiviral treatment

References

1. 1. http://www.who.int/news-room/fact-sheets/detail/hepatitis-b, erişim 01/12/2018.
2. 2. Hyams K. Risk of cronicity following acute hepatitis B virus infection: a review. Clin Infect Dis 1995; 20: 992-1000.
3. 3. Szmuness W, Steven CE, Harley E, Zang E, Oleszko W, William D, Sadovsky R et al. Hepatitis B vaccine: demostration of efficacy in controlled clinical trial in aahigh-risk population in United States. N Engl J Med 1980; 303: 833-41.
4. 4. Francis D, Hadler S, Thompson S, Maynard J, Ostrow D, Altman N, Braff E et al. The preventation of hepatitis B with vaccine. Report of the Centre for Disease Control multi-center efficacy trial among homosexuel men. Ann Intern Med 1982; 97: 362-66.
5. 5. Pan CQ, Duan ZP, Bhamidimarri KR, et al. An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clin J Gastroenterol Hepatol 2012; 10: 452–59.
6. 6. Stevens CE, Beasley RP, Tsui J et al. Vertical transmission of hepatitis B antigen in Taiwan. N Engl J Med 1975; 292:771–4.
7. 7. Ngui SL, O’Connell S, Eglin RP et al. Low detection rate and maternal provenance of hepatitis B virus S gene mutants in cases of failed postnatal immunoprophylaxis in England and Wales. J Infect Dis 1997; 176:1360–65.
8. 8. Han G-R, Cao M-K, Zhao W et al. A prospective and open label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection. J Hepatology 2011; 55: 1215–21.

9. 9. Han GR, Xu CL, ZhaoW, Yang YF. Management of chronic hepatitis B in pregnancy. World J Gastroenterol 2012; 18: 4517–21.
10. 10. Pan CQ, Han GR, Jiang HX et al. Telbivudine prevents vertical transmission from HBeAg-positive women with chronic hepatitis B. Clin Gastroenterol 2012; 10:520–6.
11. 11. Terrault NA, Bzowej NH, Chang KM et al. AASLD practice guidelines for the treatment of hepatitis B. Hepatology 2016; 63: 261–83.
12. 12. Tram TT. Hepatitis B in pregnancy. CID 2016; 62: 314-17.
13. 13. Terrault NA, Bzowej NH, Chang KM et al. AASLD practice guidelines for the treatment of hepatitis B. Hepatology 2016; 63: 261–83.
14. 14. Toy M, Onder FO, Wörmann T et al. Age- and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: A systematic review. BMC Infect Dis 2011; 12: 337.
15. 15. Hamdani-Belghiti S, Bouazzaou NL. Mother-child transmission of hepatitis B virus. State of the problem and prevention. Arch Pediatr 2000; 7: 879–882.
16. 16. Shi Z, Yang Y, Wang H et al. Breastfeeding of newborns by mothers carrying hepatitis B virus: A meta-analysis and systematic review. Arch Pediatr Adolesc Med 2011; 165: 837–46.
17. 17. Wu J, Hwang L, Goodman K, Beasley R. Hepatitis B vaccination in high-risk infants: 10 year follow-up. J Infect Dis 199; 179:1319-25.
18. 18. Saho Z, Zhang L, Xu J, Xu D, Men K, Zhang J, Cui H et al. Mother-to-infant transmission of hepatitis B virus: a Chinese experience. J Med Virol 2011; 83: 791-5.
19. 19. Shi Z, Li X, Ma L, yang Y. Hepatitis B immunglobulin injection in pregnancy to interrupt hepatitis B virus mother-to-child transmission - a meta-analysis. Int J Infect Dis 2010; 14: 622-34.
20. 20. Deng M, Zhou X, Gao S, Yang S, Wang B, Chen H, Ruan B. The effects of telbivudine in late pregnancy to prevent intarauterine transmission of the hepatitis B virus: a systematic review and meta-analysis. Virol J 2012; 9: 185.
21. 21. Gibb D, Kizito H, Russell E, Chidziva E, Zalwango E, Nalumeya R, Spyer M et al. Pregnancy and infant outcome among HIV-infected taking long-term ART with and without tenofovir in DART trail. PloS Med 2012; 9: e1001217.
22. 22. Pan C, Mi L, Bunchorntavakul C, Karsdon J, Huang W, Singhvi G, Ghany M et al. Tenofovir disoproroxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women: a case series. Dig Dis Sci 2012; 57: 2423-29.