A Prospective Study on Fetomaternal Outcomes in Asymptomatic Chronic Hepatitis B Pregnant Women in a Tertiary Level Hospital

Abstract

Introduction: Hepatitis B surface Antigen (HBsAGg) prevalence among pregnant women in India is between 0.9-3.1%. The most important factor in determining the prevalence is transmission from asymptomatic chronic Hepatitis B Virus (HBV) mother to newborn. This study was done to observe antiviral treatment and fetomaternal outcome in asymptomatic HBV mothers. Aim: To study fetomaternal outcomes in asymptomatic chronic hepatitis B pregnant women. Materials and Methods: This prospective cohort study enrolled 125 HBsAg seropositive singleton pregnancy over a period of 18 months from October 2020 to March 2022 at Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India. Chronic Hepatitis B (CHB) was diagnosed when HBsAg, HBeAg or HBV DNA was present and IgM antiHBc was absent. Tenofovir was started in consultation with the Gastroenterologist in women with HBeAg positivity or with high HBV DNA titre ≥200,000 IU/mL or Alanine Transaminase (ALT)> two times the Upper Normal Limit (UNL). All women were followed with Liver Function Test (LFT) till delivery and six weeks postpartum and their fetomaternal outcome were noted. The p-value <0.05 was taken as significant. Descriptive statistics was analysed with Statistical Package for the Social Sciences (SPSS) version 17.0 software. Results: Tenofovir was started in 26 (20.8%) women. LFT flare was seen in 15.15% (15/99) women who were not on treatment and 0% in women on treatment. In women without treatment, log HBV DNA level was significantly increased while it was reduced in the women who received tenofovir and the reduction was significant (p-value <0.05). HBeAg was positive in 61.5% women on treatment and 0% in untreated women. No significant association was found in maternal outcomes i.e., Gestational Diabetes Mellitus (GDM), Antepartum Haemorrhage (APH), Preeclampsia, Premature Rupture Of Membrane (PROM), Preterm labour, Postpartum Haemorrhage (PPH) and High Dependency Unit (HDU) stay, in treated and untreated women. Foetal outcomes such as birth weight, APGAR score, Neonatal Intensive Care Unit (NICU) admission, prematurity, Foetal Growth Restriction (FGR) and neonatal jaundice also showed no significant association between antiviral treated and untreated women. Conclusion: There was no significant association of antiviral treatment with maternal and foetal outcome. Tenofovir is safe and reduces the LFT flare in CHB mothers. HBV DNA levels were reduced in treated women which may have reduced the incidence of Mother To Child Transmission (MTCT), which was not studied in the present study. HBeAg seropositivity and ALT >2 times the ULN can replace the need of HBV DNA titres for initiation of antiviral therapy in India.