The impact of maternal HBeAg carries status and elevated ALT values on adverse outcomes: a population-based cohort study in 198,049 pregnancies

Abstract

Background: Hepatitis B virus (HBV) infection is a common public health problem, and maternal HBV infection can cause adverse outcomes in both mothers and fetuses. However, the influence of hepatitis B e antigen (HBeAg) serostatus on obstetric outcomes is not well established. This study aims to investigate the prevalence trend of maternal HBV infection in China, and its impact on obstetric outcomes. Methods: This retrospective cohort study used data from an established population-based pregnancy registry (REPRESENT) in Xiamen, China. Maternal hepatitis B surface antigen (HBsAg) and HBeAg serostatus were regularly tested at the first antenatal visits. Multivariable regression was conducted to evaluate the impact of maternal HBV infection on maternal and neonatal outcomes. Results: From January 2015 to March 2019, 198,049 pregnancies were included. The overall prevalence of HBsAg + HBeAg + was 2.26% and has decreased during these years (relative risk 0.59, 95% CI 0.54–0.65). Compared to HBsAg-HBeAg- pregnancies, maternal HBsAg + HBeAg- was associated with a higher risk of intrahepatic cholestasis of pregnancy (ICP) (adjusted odds ratio 3.43, 95% CI 2.94-4.00) and cesarean section (1.04, 1.01–1.08). HBsAg + HBeAg + was further associated with a higher risk of ICP (3.44, 2.64–4.48), fetal distress (1.33, 1.05–1.67), and preterm birth (1.37, 1.04–1.81). In addition, subgroup analysis indicated that abnormal alanine aminotransferase status at the first antenatal visit may exacerbate the impact of maternal HBV infection on maternal and neonatal outcomes. Conclusion: The prevalence of maternal HBsAg + HBeAg + serostatus is still high, but has decreased over time. Given its significant adverse effects, prenatal screening for HBsAg and HBeAg should be performed. Clinical trial number: Not applicable.