medwireNews: Pregnant women with chronic hepatitis B virus (HBV) infection can experience flares in HBV DNA and serum alanine aminotransferase (ALT) levels during pregnancy and postpartum, research shows.
“Although flares are mostly asymptomatic and resolve spontaneously, some can be severe”, say the researchers who believe that “more frequent monitoring with HBV DNA and ALT measurement during late pregnancy and early postpartum may help identify women at risk for severe hepatitis flares or higher rate of mother-to-child HBV transmission.”
They conducted a review of 113 pregnancies in 101 women who presented at two community-based gastroenterology clinics and two tertiary medical centres in the USA between 1997 and 2015. Participants had not received antiviral treatment prior to pregnancy.
During pregnancy, an HBV DNA flare, defined as an increase of at least 2 log IU/mL, occurred in 9% of 90 pregnancies, while ALT levels spiked to five times the upper limit of normal or three times the baseline value in 6% of 112 pregnancies.
ALT flares were “generally asymptomatic”, although one instance was associated with hepatic decompensation that resolved following an emergency caesarean section and post-delivery entecavir treatment, say the study authors.
Noting that approximately half the observed ALT flares were initially detected at the second trimester or earlier, they write: “Clinicians should be aware that flares may begin as early as second trimester, so that they can make informed decisions on closer monitoring or initiation of antiviral therapy in a time-appropriate manner.”
After excluding women who initiated anti-HBV therapy during pregnancy, the team observed postpartum HBV DNA flares in 4% of 48 pregnancies, all in women with a low baseline viral load (HBV DNA ≤2000 IU/mL).
Postpartum ALT flares occurred in 10% of 51 pregnancies, primarily in the first 3 months after delivery, report Mindie Nguyen (Stanford University Medical Center, Palo Alto, California, USA) and collaborators in The American Journal of Gastroenterology.
“Further investigation is needed to help clinicians identify factors associated with flare and to manage [chronic HBV] during pregnancy”, they write.
“HBV DNA and ALT monitoring every 4–6 weeks during first and second trimesters, as well as every 4 weeks during third trimester, and at postpartum months 3 and 6 should be considered in women with [chronic HBV].”
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