Maternal Hepatitis B Infection Burden, Comorbidity and Pregnancy Outcome in a Low-Income Population on the Myanmar-Thailand Border: A Retrospective Cohort Study.

Marieke Bierhoff,Aye Kyi Win,Nay Win Tun,Tobias Brummaier,Laurence Thielemans,Marcus Rijken,Mary Ellen Gilder,François Nosten,Arunrot Keereevijitt,Borimas Hanboonkunupakarn,Chaisiri Angkurawaranon,Cindy S Chu,Verena Ilona Carrara,Michele Van Vugt,Rose Mcgready,Kanlaya Sriprawat,Aung Myat Min,Elsi Win

doi:10.1155/2019/8435019

Abstract

Objectives Hepatitis B virus (HBV) was believed to have minimal impact on pregnancy outcomes apart from the risk of perinatal transmission. In more recent years, there have been reports of adverse associations, most consistently preterm birth (PTB), but this is in the context of high rates of caesarean section. The aim of this study was to explore the association of HBV on pregnancy outcomes in marginalized, low-income populations on the Myanmar-Thailand border. Methods HBsAg positive (+) point of care rapid detection tests results were confirmed by immunoassays. Women with a confirmed HBsAg status, HIV- and syphilis-negative at first antenatal care screening, singleton fetus and known pregnancy outcome (Aug-2012 to Dec-2016) were included. Logistic regression analysis was used to evaluate associations between HBV group (controls HBsAg negative, HBsAg+/HBeAg-, or HBsAg+/HBeAg+) and pregnancy outcome and comorbidity. Results Most women were tested, 15,046/15,114 (99.6%) for HBV. The inclusion criteria were not met for 4,089/15,046 (27.2%) women due mainly to unavailability of pregnancy outcome and nonconfirmation of HBsAg+. In evaluable women 687/11,025 (6.2%) were HBsAg+, with 476/11,025 (4.3%) HBsAg+/HBeAg- and 211/11,025 (1.9%) were HBsAg+/HBeAg+. The caesarean section rate was low at 522/8,963 (5.8%). No significant associations were observed between pregnancy comorbidities or adverse pregnancy outcomes and HBV status. Conclusions The results highlight the disease burden of HBV in women on the Myanmar-Thailand border and support original reports of a lack of significant associations with HBsAg+ irrespective of HBeAg status, for comorbidity, and pregnancy outcomes in deliveries supervised by skilled birth attendants.

Highlights

Hepatitis B virus (HBV) infection is hyperendemic in Southeast Asia
A high burden of HBV (8.3%) infection in refugees and migrant pregnant women on the Myanmar-Thailand border as well as factors associated with infection for the period of August 2012 and April 2014 has been reported [18]. In this retrospective study we aimed to examine the association of HBV infection with coinfection, pregnancy morbidity, and pregnancy outcomes, including caesarean section, by expanding upon the previous cohort presenting data from August 2012 to December 2016, and previously unpublished data on pregnancy outcomes
The majority of women who presented to Shoklo Malaria Research Unit (SMRU) antenatal care (ANC) between August 2012 and December 2016, 15,046/15,115 (99.6%), were tested for HBV infection (Figure 1)

Summary

Introduction

Hepatitis B virus (HBV) infection is hyperendemic in Southeast Asia. It is assumed that about 75-80% of the estimated 240 million HBV carriers globally live in this region [1]. In mothers who are HBeAg positive (+) and at highest risk of transmitting HBV, Hepatitis B immunoglobulins (HBIG) should be routinely provided if women give birth or in the case of homebirth the infant should be presented to a clinic where this specialized vaccination is available before 72 hours of life [4, 5]. This prophylactic regimen is often not given in low-income countries (LIC) because of cost, complexity of production, and need for a reliable cold chain [6]. Health care systems in LIC struggle to respond to the significant burden of communicable infections in pregnancy and routine HBV testing is not always available [7]

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Conclusion