Does Maternal Chronic Hepatitis B Virus Infection Increase Pregnancy and Fetal Risks?

Yıl 2019, Cilt: 3 Sayı: 3, 208 - 212, 31.12.2019

Handan Alay , Melek Şahiner Emine Parlak

https://doi.org/10.34084/bshr.634572

Öz

Aim:
More than 400 million people worldwide are infected with the hepatitis B virus
(HBV). The effect of HBV infection on pregnant women is unclear. The presence
of chronic HBV in pregnancy has been reported to increase such maternal and
fetal risks as gestational diabetes, antepartum hemorrhage, prematurity,
neonatal jaundice, and low birth weight. The purpose of this study was to
investigate the effects of HBV on pregnancy and fetal risks.

Materials-Methods: Three hundred and one pregnant women infected with HBV
and giving live birth in our hospital in 2014-2017, and their babies, were
enrolled as the case group, while randomly selected pregnant women giving live
birth in our hospital and not infected with HBV, and their babies, were
included as the control group. Maternal
and fetal outcomes such as type of delivery, miscarriage, re-eclampsia, gestational diabetes, antepartum
hemorrhage, fetal distress, gestational
weeks, and intrauterine growth restriction (IUGR) were analyzed retrospectively
from patients’ records.

Results: Delivery was by the normal vaginal route in
189 (62.8%) of the 301 HBsAg-positive women in the study, while diabetes was
present in 4 (1.3%), pre-eclampsia in 2 (0.7%), a history of miscarriage in 82
(27.2%), and placental detachment in 5 (1.7%). No statistically significant
difference was determined between these and the HBsAg-negative women
(p>0.05). IUGR was present in the babies of 6 (2%) of HBsAg(+) mothers, and
fetal distress in 12 (40%). The presence of fetal distress was significantly
higher in the babies of HBsAg(+) mothers (p:0.036).

Conclusion: Although several studies
have shown that HBV infection increases maternal and fetal risks, only the risk
of fetal distress was significant in our study. The noteworthy finding of our
study is that the presence of HBV did not affect the physician’s decision
regarding type of delivery.

Anahtar Kelimeler

pregnancy, fetal, risk, hepatitis B infection

Maternal Kronik Hepatit B Virüs Enfeksiyonu Gebelik ve Fetal Riskleri Artırıyor Mu?

Öz

Amaç:
Dünyada 400 milyondan fazla kişi Hepatit B virüs (HBV)’ü ile enfektedir.
Hepatit B virüs enfeksiyonun gebeler üzerindeki etkisi  açık değildir. Gebelikte Kronik HBV
varlığının gestasyonel diyabet, antepartum hemoraji, erken doğum tehdidi,
yenidoğan sarılığı, düşük doğum ağırlığı gibi maternal ve fetal riskleri
artırdığı belirtilmektedir. Bu çalışmanın amacı HBV’nün gebelik ve fetal
riskler üzerine etkilerini araştırmaktır.

Gereç-Yöntem:
2014-2017 yılları arasında hastanemizde
canlı doğum yapan HBV ile enfekte 301 gebe ve bebeği vaka grubu; aynı
yıllarda  rastgele seçilen, hastanemizde
canlı doğum  yapan HBV ile enfekte
olmayan gebeler ve bebekleri kontrol grubu olarak  çalışmamıza dahil edildi. Retrospektif
olarak hasta dosyalarından doğum şekli, abortus,
preeklampsi, gestasyonel diyabet, antepartum hemoraji, fetal distres, gebelik haftası, doğum
ağırlığı, intrauterin gelişme
geriliği(IUGR) gibi maternal ve fetal sonuçları analiz edildi.

Bulgular:
Çalışmaya dahil edilen 301 HBsAg pozitif gebe
kadının 189(%62,8)’inin doğum şekli normal vajinal doğum olup, 4(%1,3)’ü
diyabet, 2(%0,7)’i preeklampsi, 82(%27,2)’inde abortus öyküsü ve 5(%1,7)’inde
plesanta dekolmanı mevcuttu. HBsAg negatif hastalarla arasında istatistisel
olarak anlamlı fark tespit edilmedi(p>0,05). HBsAg(+) annenin 6(%2)
bebeğinde IUGR ve 12(%40)’ında fetal distres vardı. HBsAg(+) anne bebeklerinde
fetal distres varlığını istatistiksel olarak anlamlı fark tespit
ettik(p:0,036).

Sonuç:
Yapılmış bir çok çalışmada HBV enfeksiyonunun
maternal ve fetal komplikasyonları artırdığı gösterilmiş olmasına rağmen
çalışmamızda yalnızca fetal distres riskini anlamlı olarak bulduk. Çalışmamızda
dikkat çeken nokta HBV varlığının hekimin doğum şekline karar vermesini
etkilemediğini gördük.

Anahtar Kelimeler

gebelik, fetal, risk, hepatit B enfeksiyonu

Kaynakça

• 1. McMahon BJ (2005) Epidemiology and natural history of hepatitis B. Semin Liver Dis 25 Suppl 1: 3–8.
• 2. Sarin SK, Kumar M (2010) Epidemiology, Screening, and Natural History of Chronic Hepatitis B Infection. In: Shetty K, Wu GY, editors. Chronic Viral Hepatitis 2nd ed. Lippincott, Williams, and Wilkins (Philadelphia): Humana Press. pp. 185–241.
• 3. Jonas MM. Hepatitis B and pregnancy: an underestimated issue. Liver International 2009; 29 Suppl 1: 133-139.
• 4. Tosun S. Viral hepatitlerin ülkemizde değişen epidemiyolojisi. ANKEM Derg. 2013;27:128-34.
• 5. Tse KY, Ho LF, Lao T. The impact of maternal HBsAg carrier status on pregnancy outcomes: a case-control study. J Hepatol. 2005;43:771-5.
• 6. Reddick KL, Jhaveri R, Gandhi M, James AH, Swamy GK. Pregnancy outcomes associated with viral hepatitis. J Viral Hepat. 2011;18:e394-8.
• 7. Safir A, Levy A, Sikuler E, Sheiner E. Maternal hepatitis B virus or hepatitis C virus carrier status as an independent risk factor for adverse perinatal outcome. Liver Int. 2010;30:765-70.
• 8. Wong S, Chan LY, Yu V, Ho L. Hepatitis B carrier and perinatal outcome in singleton pregnancy. Am J Perinatol 1999; 16: 485- 488.
• 9. Tan J, Liu X, Mao X, Yu J, Chen M, Li Y, Sun X. HBsAg positivity during pregnancy and adverse maternal outcomes: a retrospective cohort analysis. J Viral Hepat. 2016 Oct;23(10):812-9.
• 10. Lapinski TW, Stepaniuk J, Tomasiewicz K, Lebenstejn D, Kulikowski M, Flisiak R. Effect of hepatitis B virüs infection on the course of pregnancy and newborns’ health status. Clinical and Experimantal Hepatology 2015;3:112-116.
• 11. Dwedi M, Misra SP, Misra V, et al. Seroprevalence of hepatitits B infection during pregnancy and risk of perinatal transmission. Indian J Gastroenterol 2011;30:66-71.
• 12. Zou H, Chen Y, Duan Z, Zhang H, Pan C. Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg positive mothers. J Viral Hepat. 2012;13(2):18-25.
• 13. Han GR, Xu CL, Zhao W, Yang YF. Management of chronic hepatitis B in pregnancy. World J Gastroenterol. 2012; 18(33): 4517-21.
• 14. Yang J, Zeng XM, Men YL, Zhao LS. Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virüs a systematic review. Virol J. 2008;5:100.
• 15. Pan JO, Zou HB, Chen Y, Zhang X, Zhang H, Li J, Duan Z. Cesarean section reduces perinatal transmission of hepatitis B virüs infection from hepatitis B surface antigen-positive women to their infants. Clin Gastroenterol Hepatol. 2013;11:1349-55.
• 16. Liu CP, Zeng YL, Zhou M, Chen LL, Hu R, Wang L, Tang H. Factors assosiated with mother to child transmission of hepatitis B virüs despite immunoprophylaxis. Intern Med. 2015;54:711-6.
• 17. Hu Y, Chen Y, Wen J, Xu C, Zhang S, Xu B, Zhou YH. Effect of elective cesarean section on the risk of mother to child transmission of hepatitis B virüs. BMC Pregnancy Childbird. 2013;13:119.