Hepatitis B Virus Infection in Pregnant Women

Abstract

Objective To provide a review of the prevalence and characteristics of Hepatitis B viral infection (HBV) in pregnant women in a tertiary care centre. Methods We performed a retrospective chart review of pregnant women with Hepatitis B followed up in Obstetric Infectious Disease Clinic in Vall D'Hebron Hospital, Barcelona, from 2007 to 2015. Sociodemographic characteristics, HBV serological markers, HBV viral load, immunoprophylaxis and antiviral treatment, and obstetric and perinatal outcomes were analysed. Results 134 HBsAg-positive mothers were included. The prevalence was 1/208 deliveries (0.48%). Median age was 29 years (range of 17 to 45), slightly younger than the mean of our general pregnant women. 35.1% of women were Asian (mainly Chinese); 24.6% Caucasian, of which 33.3% was from Eastern Europe (mainly Romanian). With respect to serological markers: 16.42% (22/134) of women were HBeAg-positive and 61.19% (82/134) were HBeAg-negative. In 30 cases HBe-Ag was not determined during pregnancy because these women were not referred until delivery. Three women had coinfection with human immunodeficiency virus and received highly active antiretroviral treatment (HAART) from the beginning of pregnancy. Only six women started antiviral treatment during pregnancy. Five of them were HBeAg-positive with viral load >1x107; and the other one, even the viral load was 1x104, received treatment due to repeated amniodrainage for idiopathic polyhydramnios. There were no cases of acute hepatitis B noted during the study period. The treatment of choice was Tenofovir without any maternal or fetal complications. Only 113 women delivered in our institution. 62.7% were vaginal deliveries and 9.3% instrumental deliveries (forceps or spatula). 24% of mothers underwent cesarean section for other reasons but HBV infection. 72% of women started breastfeeding. All the 113 newborns received immune globulin and vaccine within the first 12 hours. The use of second vaccine was confirmed in 106 children (93.8%) and the third doses in 83 children (73.4%). No cases of vertical transmission were reported. Conclusions In our population, most HBsAg-positive pregnant women are inactive carriers. HBV vertical transmission is preventable through use of neonatal immunoprophylaxis and antiviral treatment in third trimester in mothers whose HBV viral load is greater than 1x106 copies/ml. Special attention will be focused in foreigner mothers children to reassure the second and third vaccine doses.