ABSTRACT FINAL ID: 1779
TITLE: Incidence, Determinants, and Outcomes of Pregnancy-Associated Hepatitis B Flares: A Regional Hospital-Based Cohort Study
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Background: There is limited knowledge on hepatitis B virus (HBV) flares among pregnant women. Small studies with mostly Asian patients have described HBV flares in up to 50% of pregnant chronic HBV-infected women predominantly in the postpartum period, with cases resulting in severe hepatocellular injury and death. We determined the incidence, determinants, and outcomes of HBV flare in a multi-center US-based cohort of pregnant HBV-infected women.
Methods: We performed a retrospective cohort study of pregnant women that were HBsAg+ and received care at one of the following hospital-based clinics: the University of Pennsylvania, Thomas Jefferson University, Drexel University, and Penn State Hershey Medical Center from 2006-2015. Primary outcomes measured during pregnancy and up until 6 months after delivery included: 1) HBV flare (ALT ≥2 times upper limit of normal [ULN]); 2) jaundice (total bilirubin ≥2.5 mg/dL), and 3) hepatic decompensation. Weighted multivariable logistic regression was used to evaluate risk factors associated with HBV flares, including nulliparity, age ≤35 years, positive HBV e antigen (HBeAg), and lack of use of anti-HBV therapy.
Results: We identified 310 women with 388 pregnancies. Nearly half of subjects (49%) were black, with nearly 25% (n=75) reporting a country of origin in Africa. Of 312 pregnancies with pre-partum ALT measured, 42 (13%; 95% CI, 10-18%) developed HBV flare during pregnancy, and of 135 pregnancies with post-partum ALT measured, 22 (16%; 95% CI, 11-24%) developed a flare after delivery. Incident jaundice occurred during 7 pregnancies, but only 1 patient developed hepatic decompensation (i.e., ascites) post-partum. Positive HBeAg was a risk factor for HBV flare (adjusted OR, 2.90; 95% CI, 1.02-8.21). Most HBV care measures, including measurements of HBV DNA, serologies, and liver function, as well as referral to HBV specialty care occurred in less than 50% of pregnancies examined.
Conclusions: Fewer than 20% of HBV-infected pregnant women developed HBV flare during pregnancy or within 6 months post-partum, and flares occurred at similar rates pre- and post-delivery. The majority of HBV flares were subclinical, and hepatic decompensation events were rare. HBeAg+ status was the strongest risk factor for HBV flare. Assessment of HBV laboratory measures and referral to specialty care were uncommon among the patients in the cohort.