Clinical course and perinatal transmission of chronic hepatitis B during pregnancy: A real-world prospective cohort study

Abstract

Objective: To determine the clinical course and perinatal transmission of chronic hepatitis B during pregnancy in a real life setting.

Methods: A total of 221 singleton pregnant women with detectable HBV-DNA levels (≥10³ copies/mL) were enrolled during January 2011 to June 2015. Forty-three high viraemic patients (≥10⁶ copies/mL) received telbivudine in the 2^nd or 3^rd trimester according to their intention, while 89 high viraemic and 79 low viraemic (≥10³ and <10⁶ copies/mL) patients were the control cohorts. Primary endpoint was the pregnancy outcomes and secondary endpoint the perinatal transmission including intrauterine infection, immunoprophylaxis failure and occult infection.

Results: In all, 209 patients completed pregnancy with 209 infants, while 2 in telbivudine-treated cohort had unexplained late stillbirths. Twenty-nine (70.7%) of telbivudine-treated patients and 3 (3.4%) of untreated high viraemic controls achieved undetectable HBV-DNA levels prior delivery. At 7 months postpartum, immunoprophylaxis failure was significantly lower (2.4%) in telbivudine-treated cohort, compared with 16.9% and 10.1% in untreated high and low viraemic cohorts, respectively.

Conclusions: Low viraemic patients may also need antiviral therapy since they bear moderate risk for perinatal transmission of HBV. However, more multicenter, large-scale studies are required before antepartum antiviral therapy is routinely recommended in patients with detectable viral loads.

Keywords: Hepatitis B virus; Occult infection; Perinatal transmission; Pregnancy; Telbivudine.