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Published online: 2021-07-16
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Adverse pregnancy outcomes and mother-to-child transmission in patients with hepatitis B virus infection and intrahepatic cholestasis of pregnancy

Chong Zhang, Hong Wei, Yun-Xia Zhu
DOI: 10.5603/GP.a2021.0110
·
Pubmed: 34541645

open access

Ahead of Print
ORIGINAL PAPERS Obstetrics
Published online: 2021-07-16

Abstract

Objectives: The aim of this study was to investigate adverse pregnancy outcomes (APOs) and mother-to-child transmission (MTCT) of intrahepatic cholestasis in pregnancy (ICP) in hepatitis B virus infection (HBV) patients. Material and methods: We performed a retrospective study at Beijing Youan Hospital in China from January 2010 through May 2017. A total of 232 patients were enrolled, including 106 HBV-infected ICP patients (Group H + C), 20 ICP patients (Group C) and 106 HBV-infected patients (Group H). Characteristics, APOs and MTCT rate of HBV were compared between groups. Group H + C was subdivided into 3 groups according to total bile acid (TBA) values and gestational age at diagnosis (GA). APOs were also compared within Group H + C according to TBA values and GA. Results: There was no difference in live birth delivery mode and APOs between Groups H + C and C. Compared with Groups H, no difference was in live birth and MTCT rates of HBV. However, cesarean section delivery and APOs rates were higher in Group H+C (p < 0.05). Compared with Group H, adverse maternal outcomes such as postpartum hemorrhage and premature birth were more likely to occur in Group H + C (p < 0.001). Adverse fetal outcomes, the proportions of amniotic fluid reaching III degrees (AFIII), NICU admission, neonatal asphyxia and SGA were significantly higher among Group H + C than Group H (p < 0.05). Contamination of the AFIII rate increased with increasing TBA (p < 0.05). The rate of preterm birth and small for gestational age (SGA) was more common in GA 28–32 w compared with GA < 28 w and > 33 w (p < 0.01). Conclusions: H + C patients had more APOs than HBV patients, but the difference was not significant when compared with ICP patients. Although we did not find any difference in MTCT rate between H + C and HBV patients, active treatment to prevent neonatal asphyxia and HBV infection should be considered. Therefore, it is necessary to emphasize maternal and fetal monitoring during pregnancy and delivery.

Abstract

Objectives: The aim of this study was to investigate adverse pregnancy outcomes (APOs) and mother-to-child transmission (MTCT) of intrahepatic cholestasis in pregnancy (ICP) in hepatitis B virus infection (HBV) patients. Material and methods: We performed a retrospective study at Beijing Youan Hospital in China from January 2010 through May 2017. A total of 232 patients were enrolled, including 106 HBV-infected ICP patients (Group H + C), 20 ICP patients (Group C) and 106 HBV-infected patients (Group H). Characteristics, APOs and MTCT rate of HBV were compared between groups. Group H + C was subdivided into 3 groups according to total bile acid (TBA) values and gestational age at diagnosis (GA). APOs were also compared within Group H + C according to TBA values and GA. Results: There was no difference in live birth delivery mode and APOs between Groups H + C and C. Compared with Groups H, no difference was in live birth and MTCT rates of HBV. However, cesarean section delivery and APOs rates were higher in Group H+C (p < 0.05). Compared with Group H, adverse maternal outcomes such as postpartum hemorrhage and premature birth were more likely to occur in Group H + C (p < 0.001). Adverse fetal outcomes, the proportions of amniotic fluid reaching III degrees (AFIII), NICU admission, neonatal asphyxia and SGA were significantly higher among Group H + C than Group H (p < 0.05). Contamination of the AFIII rate increased with increasing TBA (p < 0.05). The rate of preterm birth and small for gestational age (SGA) was more common in GA 28–32 w compared with GA < 28 w and > 33 w (p < 0.01). Conclusions: H + C patients had more APOs than HBV patients, but the difference was not significant when compared with ICP patients. Although we did not find any difference in MTCT rate between H + C and HBV patients, active treatment to prevent neonatal asphyxia and HBV infection should be considered. Therefore, it is necessary to emphasize maternal and fetal monitoring during pregnancy and delivery.

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Keywords

adverse pregnancy outcomes; mother-to-child transmission; intrahepatic cholestasis in pregnancy; hepatitis B virus infection

About this article
Title

Adverse pregnancy outcomes and mother-to-child transmission in patients with hepatitis B virus infection and intrahepatic cholestasis of pregnancy

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Research paper

Published online

2021-07-16

DOI

10.5603/GP.a2021.0110

Pubmed

34541645

Keywords

adverse pregnancy outcomes
mother-to-child transmission
intrahepatic cholestasis in pregnancy
hepatitis B virus infection

Authors

Chong Zhang
Hong Wei
Yun-Xia Zhu

References (32)
  1. Turunen K, Helander K, Mattila KJ, et al. Intrahepatic cholestasis of pregnancy is common among patients' first-degree relatives. Acta Obstet Gynecol Scand. 2013; 92(9): 1108–1110.
  2. Floreani A, Caroli D, Lazzari R, et al. Intrahepatic cholestasis of pregnancy: new insights into its pathogenesis. J Matern Fetal Neonatal Med. 2013; 26(14): 1410–1415.
  3. Lavanchy D. Worldwide epidemiology of HBV infection, disease burden, and vaccine prevention. J Clin Virol. 2005; 34(Suppl 1): S1–S3.
  4. Jonas MM. Hepatitis B and pregnancy: an underestimated issue. Liver Int. 2009; 29(Suppl 1): 133–139.
  5. Chen CJ, Iloeje UH, Yang HI. Long-term outcomes in hepatitis B: the REVEAL-HBV study. Clin Liver Dis. 2007; 11(4): 797–816, viii.
  6. Liu Xh, He J. Pay more attention to standardizing the diagnosis and treatment of intrahepatic cholestasis of pregnancy [article in Chinese]. Zhonghua Fu Chan Ke Za Zhi. 2011; 46(5): 321–323.
  7. Chacko KR, Wolkoff AW. Intrahepatic cholestasis of pregnancy: new diagnostic insights. Ann Hepatol. 2017; 16(2): 176–178.
  8. Arrese M, Reyes H. Intrahepatic cholestasis of pregnancy: a past and present riddle. Ann Hepatol. 2006; 5(3): 202–205.
  9. Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol. 2009; 15(17): 2049–2066.
  10. Zhou F, He MM, Liu ZF, et al. Expression of corticotrophin-releasing hormone and its receptor in patients with intrahepatic cholestasis of pregnancy. Placenta. 2013; 34(5): 401–406.
  11. Hu Y, Ding YL, Yu L. The impact of intrahepatic cholestasis of pregnancy with hepatitis B virus infection on perinatal outcomes. Ther Clin Risk Manag. 2014; 10: 381–385.
  12. Lammert F, Marschall HU, Matern S. Intrahepatic cholestasis of pregnancy. Curr Treat Options Gastroenterol. 2003; 6(2): 123–132.
  13. Marschall HU. Management of intrahepatic cholestasis of pregnancy. Expert Rev Gastroenterol Hepatol. 2015; 9(10): 1273–1279.
  14. Germain AM, Kato S, Carvajal JA, et al. Bile acids increase response and expression of human myometrial oxytocin receptor. Am J Obstet Gynecol. 2003; 189(2): 577–582.
  15. Israel EJ, Guzman ML, Campos GA. Maximal response to oxytocin of the isolated myometrium from pregnant patients with intrahepatic cholestasis. Acta Obstet Gynecol Scand. 1986; 65(6): 581–582.
  16. Wikström Shemer E, Marschall HU, Ludvigsson JF, et al. Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study. BJOG. 2013; 120(6): 717–723.
  17. Lammert F, Marschall HU, Glantz A, et al. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol. 2000; 33(6): 1012–1021.
  18. Arrese M, Reyes H. Intrahepatic cholestasis of pregnancy: a past and present riddle. Ann Hepatol. 2006; 5(3): 202–205.
  19. Lee RH, Goodwin TM, Greenspoon J, et al. The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population. J Perinatol. 2006; 26(9): 527–532.
  20. Lee RH, Kwok KM, Ingles S, et al. Pregnancy outcomes during an era of aggressive management for intrahepatic cholestasis of pregnancy. Am J Perinatol. 2008; 25(6): 341–345.
  21. Rook M, Vargas J, Caughey A, et al. Fetal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy in a Northern California cohort. PLoS One. 2012; 7(3): e28343.
  22. Gorelik J, Harding SE, Shevchuk AI, et al. Taurocholate induces changes in rat cardiomyocyte contraction and calcium dynamics. Clin Sci (Lond). 2002; 103(2): 191–200.
  23. Zecca E, De Luca D, Baroni S, et al. Bile acid-induced lung injury in newborn infants: a bronchoalveolar lavage fluid study. Pediatrics. 2008; 121(1): e146–e149.
  24. Sepúlveda WH, González C, Cruz MA, et al. Vasoconstrictive effect of bile acids on isolated human placental chorionic veins. Eur J Obstet Gynecol Reprod Biol. 1991; 42(3): 211–215.
  25. Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatology. 2004; 40(2): 467–474.
  26. Geenes V, Chappell LC, Seed PT, et al. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology. 2014; 59(4): 1482–1491.
  27. Kondrackiene J, Beuers U, Zalinkevicius R, et al. Predictors of premature delivery in patients with intrahepatic cholestasis of pregnancy. World J Gastroenterol. 2007; 13(46): 6226–6230.
  28. Mei Y, Gao L, Lin Y, et al. Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy with dichorionic diamniotic twin pregnancies. J Matern Fetal Neonatal Med. 2017; 29(13): 1–5.
  29. Chen DS. Hepatitis B vaccination: The key towards elimination and eradication of hepatitis B. J Hepatol. 2009; 50(4): 805–816.
  30. Wen WH, Chang MH, Zhao LL, et al. Mother-to-infant transmission of hepatitis B virus infection: significance of maternal viral load and strategies for intervention. J Hepatol. 2013; 59(1): 24–30.
  31. Xu WM, Cui YT, Wang L, et al. Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study. J Viral Hepat. 2009; 16(2): 94–103.
  32. Han GR, Cao MK, 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 Hepatol. 2011; 55(6): 1215–1221.

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