Abstract
This review aimed to provide an update on the impact of pregnancy on the natural course of hepatitis B virus (HBV) infection and also on the impact of HBV infection on adverse pregnancy outcomes, including mother-to-child transmission (MTCT). For the literature review, original research articles, review articles, and guidelines were narratively reviewed and comprehensively validated. The databases of PubMed, EMBASE, and CINAHL were carefully searched for articles in English on topics related to HBV infection, pregnancy, and vertical transmission from 1960 to May 2021. Immunological changes during pregnancy such as suppression of Th1 response and induction of Th2 immunity lead to an impaired immune reaction to HBV and stimulate viral activity along with the reduction of CD8 T cells to escape immune detection. The impact of pregnancy on the natural course of chronic HBV infection seems to be minimal, while pregnancy can increase morbidity and mortality in the case of advanced HBV hepatitis or cirrhosis. Importantly, hepatitis flare or alanine aminotransferase (ALT) flare can occur during pregnancy and is more common during the postpartum period due to the interaction between HBV and the immune response. Interestingly, the impact of HBV infection on adverse pregnancy outcomes is more serious than ever thought. Updated evidence indicates that pregnancies with chronic HBV infection increase the risk of preterm birth and gestational diabetes, especially in cases of positive hepatitis e antigen (HBeAg).
Highlights
In the past decades, hepatitis B virus (HBV) infection has been studied extensively.the studies of the natural course of the infection during pregnancy are relatively limited, in spite of the fact that maternal-to-child transmission is the main transmission in many parts of the world
This review focuses on transplacental infection, natural course, and pregnancy outcomes, including mother-to-child transmission
Immunological changes induced by pregnancy probably modify the natural course of HBV infection and especially tend to increase hepatitis flare
Summary
Hepatitis B virus (HBV) infection has been studied extensively. the studies of the natural course of the infection during pregnancy are relatively limited, in spite of the fact that maternal-to-child transmission is the main transmission in many parts of the world. Several studies suggest that HBV can increase adverse outcomes, such as intrahepatic cholestasis of pregnancy, gestational diabetes, and preterm birth. Chronic hepatitis B virus (HBV) infection affects more than 290 million people worldwide, causing a wide range of health problems, e.g., hepatitis, cirrhosis, hepatic failure, and hepatocellular carcinoma (HCC), leading to 887,000 deaths per year worldwide, in spite of the current availability of an HBV vaccine. The GHSS calls for the elimination of viral hepatitis as a public health threat by 2030 (reducing new infections by 90% and mortality by 65%) [4]. This target is unlikely to be achieved with the existing strategy. In addition to capacity of implementation of birth-dose vaccine and the coverage of three doses, prenatal care with assessment of viral loads and HBeAg, and the use of antiviral therapy in selected pregnant women should be strongly considered
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