Clinical characteristics and efficacy evaluation of antiviral therapy in pregnant women with chronic hepatitis B virus infection

Abstract

BACKGROUND During pregnancy, decreased maternal liver blood supply and increased load metabolism make woman susceptible to hepatitis attack. Severe cases often develop liver failure, leading to coagulation mechanism abnormality, bleeding and infection, fetal distress, premature delivery, stillbirth, etc. Therefore, high attention to the treatment and management of pregnant women with chronic hepatitis B virus (HBV) infection is the key to reducing the mother-to-child transmission of HBV, representing an important issue of concern for clinical medical personnel. Therefore, the early diagnosis and treatment of hepatitis attack during pregnancy are particularly important. AIM To observe the clinical characteristics of HBV in pregnant women and evaluate the efficacy of antiviral therapy. METHODS A total of 180 pregnant women with chronic HBV infection who visited Yuyao Maternal and Child Health Center of Zhejiang Province from February 2017 to June 2019 were selected as study subjects. Liver function was tested every 4 to 12 wk during pregnancy, and HBV serum markers were checked to determine whether there was hepatitis attack during pregnancy. For those with a definite diagnosis, tibivudine was given orally at a dose of 600 mg once per day. The clinical characteristics, alanine aminotransferase (ALT), HBV serum markers, and HBV DNA changes in pregnant women with chronic HBV infection were recorded. ALT recovery rate, HBV DNA and hepatitis B e antigen (HBeAg) negative conversion rate, and HBeAg seroconversion rate after antiviral treatment at different time points during pregnancy were also recorded. RESULTS Of the 180 pregnant women with chronic HBV infection included in this study, 48 (26.67%) had hepatitis attacks during pregnancy. The average age was 32.3 ± 2.4 years. The duration of hepatitis attacks ranged from 6 to 34 wk, with an average of 20.3 ± 7.8 wk. The mean value of ALT was 224.95 ± 19.6 U/L. Compared with pregnant women without hepatitis attack during pregnancy, ALT and HBV DNA changes were significant (P < 0.05), and hepatitis B surface antigen and HBeAg quantification were significantly reduced (P < 0.05). For hepatitis attacks during pregnancy, with the extension of treatment time, ALT recovery rate, HBV DNA negative conversion rate, HBeAg negative conversion rate, and HBeAg seroconversion rate had varying degrees of rise. Especially at 36 wk after treatment, the ALT recovery rate was 100.0%, HBV DNA negative conversion rate was 72.92%, HBeAg negative conversion rate was 41.67%, and HBeAg seroconversion rate was 37.5%, which were significantly higher than those at 6 wk, 12 wk, and 24 wk of treatment (P< 0.05). CONCLUSION Hepatitis attacks in pregnant women with chronic HBV infection usually occur in the second trimester.