Clinical study on liver function, virology, serological changes and the safety of drug withdrawal in pregnant women who are chronic HBV carriers during pregnancy and postpartum
10.3760/cma.j.issn.1007-3418.2019.04.005
- VernacularTitle: 慢性HBV携带孕妇妊娠期及产后肝功能、病毒学、血清学变化及停药安全性的临床研究
- Author:
Xiaoxiao WANG
1
;
Junfeng LU
;
Yali WU
;
Lina MA
;
Yi JIN
;
Zhenhuan CAO
;
Shan REN
;
Yali LIU
;
Yanhong ZHENG
;
Xinyue CHEN
Author Information
1. Department of International Medical, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
- Publication Type:Journal Article
- Keywords:
Hepatitis B;
Therapy;
Pregnant women who are chronic HBV carriers;
Hepatitis flares;
Drug withdrawal safety
- From:
Chinese Journal of Hepatology
2019;27(4):261-266
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To observe the changes of liver function, virology and serology and the safety of drug withdrawal in pregnant women who are chronic hepatitis B virus (HBV) carriers.
Methods:A prospective clinical cohort was established to enroll pregnant women who are chronic HBV carriers and they were divided into the nucleoside/nucleotide analogs (NAs) intervention group and the non-NAs intervention group according to patients' wishes. Liver function, HBV DNA and HBV serological markers were detected at gestation, postpartum 6 weeks, 12 weeks, 24 weeks, 36 weeks and 48 weeks.
Results:351 patients were enrolled, 320 in the NAs intervention group and 31 in the non-NAs intervention group. The proportion of postpartum hepatitis flares in both groups was higher than that in pregnancy (39.4% vs 12.5%, P < 0.001; 38.7% vs 3.2%, P = 0.001). Six weeks postpartum was the peak period of hepatitis flares, and 96.0% (121/126) of the hepatitis flares occurred within 24 weeks postpartum. At 6 weeks postpartum, there were 6 cases of alanine aminotransferase (ALT) ≥ 10 times upper limit of normal (ULN) in the NAs intervention group. The rate of the hepatitis flare after drug withdrawal was 16.7% (34/203).
Conclusion:Regardless of the presence or absence of NAs intervention, pregnant women who are chronic HBV carriers have a certain proportion of hepatitis flares during pregnancy and postpartum, and the hepatitis flare even have a tendency to be severe. Therefore, drug withdrawal after delivery is not always safe, which requires close observation and classification. At 6 weeks postpartum, the incidence of hepatitis flares was high, and those who meet the treatment indications can get better therapeutic effects if given appropriate treatment. The vast majority (96%) of postpartum hepatitis flares occur within 24 weeks, so it is recommended to follow up to at least 24 weeks postpartum after discontinuation.
