Int J Med Sci 2020; 17(2):170-175. doi:10.7150/ijms.38410

Research Paper

Pregnancy Outcome of Women with Chronic Hepatitis B who Discontinued Antiviral Treatment before or in the Early Pregnancy

Xuesong Gao1, Xuefei Duan1, Haodong Cai2, Yuhong Hu3, Min Liu3, Kai Kang3, Mingfang Zhou3, Dong Fu3, Wei Yi3✉

1. Department of General Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
2. Hepatology clinic, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
3. Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.

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Citation:
Gao X, Duan X, Cai H, Hu Y, Liu M, Kang K, Zhou M, Fu D, Yi W. Pregnancy Outcome of Women with Chronic Hepatitis B who Discontinued Antiviral Treatment before or in the Early Pregnancy. Int J Med Sci 2020; 17(2):170-175. doi:10.7150/ijms.38410. Available from http://www.medsci.org/v17p0170.htm

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Abstract

Background: The aim of this study was to describe biochemical, virological features and Mother-to child-transmission (MTCT) rate in chronic hepatitis B (CHB) women who stopped antiviral therapy before or in the early pregnancy.

Methods: This was a single-center, retrospective study. Forty-three CHB women who stopped treatment before or in the early pregnancy and 103 CHB women with tenofovir disoproxil fumarate (TDF) treatment throughout pregnancy were enrolled. The virological and biochemical flares during pregnancy and postpartum period were studied. MTCT rates were also compared.

Results: During pregnancy, ALT flares (43.9% vs 1.0%) and viral rebound (31.7% vs 0) were more common in women who stopped treatment (P<0.001). Postpartum ALT flares were less frequent in women with treatment than those stopped treatment (0 vs 6/35, P = 0.001). The birth defect rate in the mothers who stopped treatment did not statistically differ from that of mothers treated throughout pregnancy (4.9 % vs 3.9 %, P = 1.000). There were no significant differences of gestational complications between the two groups, except intrahepatic cholestasis of pregnancy (12.2% vs 0, P = 0.002). The rate of MTCT in mothers who discontinued treatment was higher (2.4% vs 0, P = 0.285), although there was no statistically significant.

Conclusion: ALT flares were common in mothers who discontinued antiviral therapy. Thus, these pregnant women should be monitored closely. Cessation of treatment was not recommended although no hepatic failure was observed. Larger studies are needed to evaluate the safety of discontinuation before pregnancy.

Keywords: chronic hepatitis B, pregnancy complications, infant, antiviral agents, alanine transaminase