| BACKGROUND AND AIM:Hepatitis B virus(HBV)infection is an important global public health problem.The World Health Organization(WHO)proposes to eliminate viral hepatitis by 2030.In China,the main route of HBV transmission is mother-to-child transmission(MTCT).Both domestic and foreign hepatitis B guidelines recommend that pregnant women with high HBV DNA load receive antiviral treatment in the second and third trimesters to block the MTCT of HBV.Previous studies showed that antiviral therapy during pregnancy did not increase the risk of maternal and infant adverse events,but there are limited safety data in large-sample clinical studies.Pregnant women with chronic HBV infection also have the problem of abnormal liver function during pregnancy.At present,the mechanism of abnormal liver function during pregnancy remains unclear and risk factors of abnormal liver function are controversial.Therefore,we analyzed the clinical data of pregnant women with HBV infection in Nanfang hospital in the past 5 years to explore the efficacy and safety of antiviral treatment during pregnancy,summarize the clinical characteristics of abnormal liver function in pregnant women with chronic HBV infection,clarify the factors affecting abnormal liver function during pregnancy and analyze the influence of abnormal liver function during pregnancy on mothers and infants.METHODS:A single-center retrospective study was conducted.We selected pregnant women with chronic HBV infection who had undergone an early pregnancy check-up and were hospitalized for delivery at Nanfang Hospital from January 2015 to December 2019 as the subjects,and collected the data of general demographic characteristics,pregnancy and childbirth,hepatitis B related history,hepatitis B related biochemical and virological test results,the use of antiviral drugs and neonatal conditions.The comparison between groups was statistically analyzed by t-test or chi-square test.Univariate and multivariate logistic regression analysis were used to predict the risk factors of abnormal liver function.RESULTS:1.In our study,971 pregnant women with chronic HBV infection were enrolled,of which 363 were HBeAg positive and 361 had HBV DNA≥2x105 IU/ml;.2.During pregnancy,318 cases received antiviral treatment,and 653 cases did not receive antiviral treatment.The HBV DNA level of pregnant women in the antiviral treatment group decreased by 3log10 IU/ml,and the HBV DNA of pregnant women in the non-antiviral treatment group did not significantly decrease.There was no significant difference in the incidence of adverse events between the two groups of pregnant women(p>0.05).3.153 cases(15.76%)of pregnant women had abnormal liver function during pregnancy,of which 126 cases occurred before 28 weeks of pregnancy.Most of them have mild to moderate elevation of ALT.HBV DNA level,HBeAg status and thyroid disease during pregnancy are the influencing factors of abnormal liver function during pregnancy in pregnant women with chronic HBV infection.4.The proportion of pregnant women with thyroid disease during pregnancy,elevated bile acid during pregnancy and premature delivery in the abnormal liver function group was higher than that in the normal liver function group,and the difference between the groups was statistically significant(p<0.05).CONCLUSIONS:1.Antiviral therapy in pregnant women with chronic HBV infection during pregnancy to reduce the viral load is effective and safe for both mothers and newborns.2.Abnormal liver function of pregnant women with chronic HBV infection during pregnancy is related to the occurrence of pregnant women with thyroid disease during pregnancy,elevated bile acid during pregnancy,and premature birth.Attention should be paid to screening of related complications.3.Pregnant women with positive HBeAg,high viral load(≥2×105 IU/ml)and thyroid disease during pregnancy are more likely to experience ALT elevation,and their liver function needs to be closely monitored. |
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