Abstract
BackgroundChinese population has a high prevalence of chronic hepatitis B virus (HBV) infection, the impact of which on pregnancy outcome remains controversial. A single-center retrospective cohort study was performed in Kunming, a multi-ethnic city in south-western China to examine this issue.MethodsThe singleton pregnancies delivering at ≥28 weeks gestation under our care in 2005–2017 constituted the study cohort. Maternal characteristics and pregnancy outcome were compared between mothers with and without seropositivity for hepatitis B surface antigen (HBsAg) determined at routine antenatal screening.ResultsAmong the 49,479 gravidae in the cohort, the 1624 (3.3%) HBsAg seropositive gravidae had a lower incidence of nulliparity (RR 0.963, 95% CI 0.935–0.992) and having received tertiary education (RR 0.829, 95% CI 0.784–0.827). There was no significant difference in the medical history, pregnancy complications, or labor or perinatal outcome, except that HBV carriers had significantly lower incidence of labor induction (RR 0.827, 95% CI 0.714–0.958) and of small-for-gestational age (SGA) infants (RR 0.854, 95% CI 0.734–0.994). On regression analysis, maternal HBV carriage was independently associated with spontaneous labor (aRR 1.231, 95% CI 1.044–1.451) and reduced SGA infants (aRR 0.842, 95% CI 0.712–0.997).ConclusionsOur 3.3% prevalence of maternal HBV infection was around the lower range determined in the Chinese population. The association with spontaneous labor and reduced SGA infants could have helped to promote the perpetuation of the infection through enhanced survival of the offspring infected at birth, thus explaining the high prevalence in the Chinese population.
Highlights
Chinese population has a high prevalence of chronic hepatitis B virus (HBV) infection, the impact of which on pregnancy outcome remains controversial
There were no difference in mean maternal age, incidence of Advanced maternal age (AMA), height, weight, Body mass index (BMI) or overweight gravidae between the hepatitis B surface antigen (HBsAg) seropositive and seronegative women, but the HBsAg seropositive women had a slightly but significantly higher mean gestational weight gain, a slightly but significantly lower incidence of nulliparity (RR 0.963, 95% CI 0.935–0.992), and women who received tertiary education (RR 0.829, 95% CI 0.784–0.827, Table 1)
When the pregnancy outcomes were compared between the two groups, no difference in the incidence of either chronic hypertension or pre-gestational diabetes, or in pregnancy complications, could be found (Table 2)
Summary
Chinese population has a high prevalence of chronic hepatitis B virus (HBV) infection, the impact of which on pregnancy outcome remains controversial. There is even a suggestion that maternal HBV infection is associated with enhanced fetal growth, as reduced small-for-gestational age (SGA) infants [9, 12], and increased birthweight and incidence of large-for-gestational age (LGA) as well as macrosomic infants [13,14,15] have been reported. These observations would be compatible with the notion that chronic HBV infection has co-evolved with humans without jeopardizing pregnancy outcome so as to ensure transmission to successive generations. The reason(s) for the conflicting and contradicting observations remains unclear, but as these reports were based on different racial/ethnic groups in different locations, one possible factor could have been racial/ethnic differences among the different studies
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