Maternal Hepatitis B Virus Infection Status And Pregnancy Outcomes:a Retrospective Case-control Study

Background:Being one of the major hepatitis B virus(HBV)infection epidemic area,China has 4%-10%of hepatitis B surface antigen(HBsAg)positive pregnant women approximately.The relationship between pregnancy and HBV infection is complex.Studies have shown that HBV infection may affect pregnancy outcomes through a variety of mechanisms.Currently,studies on the correlation between maternal HBV infection and adverse pregnancy outcomes are limited,and the results are inconsistent.Meanwhile,the effects of different levels of HBV-DNA loads on pregnancy outcomes has not been clarified,and few studies have investigated risk factors for adverse pregnancy outcomes in HBV infected pregnant woman.Objective:We conducted a retrospective case-control study to elucidate association between HBsAg status and pregnancy outcomes,look out risk factors of adverse outcomes in HBV infected pregnant women and explore the influence of different HBV-DNA levels on pregnancy outcomes.Methods:In this study,all the HBsAg positive pregnant women who met the inclusion and exclusion criteria from January 2010 to June 2021 were retrospectively included from the electronic medical record database of Qilu Hospital of Shandong University as the HBsAg-positive group,and HBsAg negative patients who met the same criteria in the same hospital at the same time were randomly selected as HBsAg-negative group.The ratio of patients in the two groups was 1:1.Demographic and clinical data of all patients enrolled in both HBsAg-positive group and HBsAg-negative groups were recorded.Continuous variables were compared using the Student’s t test and categorical variables were compared using the Chi-square test or Fisher exact test in univariate analysis.Multivariate logistic regression analysis was used to investigate association of HBsAg status with pregnancy outcomes and find associated factors for adverse pregnancy outcomes after adjusting for confounding variables.Results:Total of 1238 pregnant women were enrolled,of whom 619 were HBsAg-positive and another 619 were HBsAg-negative.Compared with HBsAg-negative pregnant women,HBsAg-positive women had a significantly higher risk of miscarriage(aOR=3.49,95%CI:1.71-7.12,P<0.01),pre-eclampsia(aOR=2.16,95%CI:1.08-4.29,P=0.028),prelabour rupture of membranes(aOR=1.69,95%CI:1.14-2.49,P=0.009),fetal distress(aOR=2.18,95%CI:1.24-3.84,P=0.007)and congenital malformation(aOR=4.34,95%CI:1.20-15.67,P=0.025).No differences were found in mode of delivery,stillbirth,preterm birth,post-term birth,gestational diabetes mellitus,intrahepatic cholestasis of pregnancy,gestational hypertension,postpartum haemorrhage,placenta praevia,placental abruption,intrauterine growth restriction,low birth weight and macrosomia.The neonatal birthweight,body length,head circumference,gender,Apgar score of 1st and 5th minute after birth were also no difference between the two groups.Logistic analysis showed that age,parity,albumin,prothrombin time and white blood cell were independent predictors for miscarriage;age,prenatal body mass index,creatinine and albumin were independent predictors for pre-eclampsia;cesarean history,albumin and red blood cell were independent predictors for prelabour rupture of membranes;cesarean history were independent predictors for fetal distress;age,parity and red blood cell were associated with congenital malformation.The incidence of adverse outcomes increased along with HBV-DNA loads,women with higher HBV-DNA loads were more likely to occur miscarriage(P=0.024),pre-eclampsia(P=0.037),and low birth weight(P=0.026).Conclusion:HBsAg-positive status was associated with adverse pregnancy outcomes,and higher HBV-DNA loads increased the risk of the latter.In clinic,it is necessary to closely monitor virus replication and liver function changes in HBV infected pregnant women,so as to guide the treatment and finally achieve the purpose of improving the outcomes of both mother and baby.