Skip to main content

Advertisement

SpringerLink
Log in

Effects of antiviral therapy and drug withdrawal on postpartum hepatitis in pregnant women with chronic HBV infection

  • Original Article
  • Published:
Hepatology International Aims and scope Submit manuscript

Abstract

Objective

To investigate the effect of antiviral therapy and drug withdrawal on the incidence of hepatitis B after delivery in pregnant women with chronic hepatitis B virus (CHB) infection who received tenofovir disoproxil fumarate (TDF) treatment.

Methods

Eligible CHB pregnant women were enrolled, and received TDF at 32 weeks gestation. The drug was stopped immediately or at 6 weeks after delivery. The HBV biomarkers and clinical biochemical parameters were monitored during gestation and 24 weeks after delivery.

Results

There were 264 women completed the observation, including 96 untreated subjects in control group. Among 168 treated subjects, 131 cases stopped drug immediately after delivery and 37 cases delayed the drug withdrawal at 6 weeks after delivery. The incidence of postpartum hepatitis in control, immediate drug withdrawal, and delayed drug withdrawal were 28.1% (27/96), 23.7% (31/131), and 24.3% (9/37), showing no significant difference (χ2 = 0.607, p = 0.738). No factor was found to be associated with the occurrence of postpartum hepatitis. It’s noteworthy that 96.3% of postpartum hepatitis in control group and 92.3% of postpartum hepatitis in immediate drug withdrawal group occurred within 12 weeks after delivery. While in delayed drug withdrawal group, the rate of postpartum hepatitis occurred within 12 weeks after delivery was 77.7%.

Conclusion

Withdrawing antiviral drug immediately or at 6 weeks after delivery did not affect the incidence of postpartum hepatitis in CHB women, but delaying drug withdrawal might delay the onset of postpartum hepatitis.

Clinical trial registration number: NCT03214302.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Kafeero HM, Ndagire D, Ocama P, Kudamba A, Walusansa A, Sendagire H. Prevalence and predictors of hepatitis B virus (HBV) infection in east Africa: evidence from a systematic review and meta-analysis of epidemiological studies published from 2005 to 2020. Arch Public Health. 2021;79:167

    Article  Google Scholar 

  2. World Health O. Hepatitis B vaccines: WHO position paper, July 2017 - Recommendations. Vaccine. 2019;37:223–225

    Article  Google Scholar 

  3. Akoury T, Whetstone DR: Splenic Rupture. In: StatPearls. Treasure Island (FL), 2022.

  4. Sandmann L, Cornberg M. HCC and HBV reactivation-A preventable condition not to be missed. Hepatology. 2022;75:1075–1077

    Article  Google Scholar 

  5. Wang G, Duan Z. Guidelines for prevention and treatment of chronic hepatitis B. J Clin Transl Hepatol. 2021;9:769–791

    Google Scholar 

  6. Wang M, Wang Y, Feng X, Wang R, Wang Y, Zeng H, et al. Contribution of hepatitis B virus and hepatitis C virus to liver cancer in China north areas: experience of the Chinese National Cancer Center. Int J Infect Dis. 2017;65:15–21

    Article  Google Scholar 

  7. Zhou J, Sun H, Wang Z, Cong W, Wang J, Zeng M, Zhou W, et al. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (2019 Edition). Liver Cancer 2020;9:682–720.

  8. Terrault NA, Lok ASF, McMahon BJ, Chang KM, Hwang JP, Jonas MM, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67:1560–1599

    Article  Google Scholar 

  9. Nguyen MH, Wong G, Gane E, Kao JH, Dusheiko G. Hepatitis B Virus: Advances in prevention, diagnosis, and therapy. Clin Microbiol Rev 2020;33.

  10. Shah NJ, Aloysius MM, Sharma NR, Pallav K. Advances in treatment and prevention of hepatitis B. World J Gastrointest Pharmacol Ther. 2021;12:56–78

    Article  Google Scholar 

  11. Kushner T, Shaw PA, Kalra A, Magaldi L, Monpara P, Bedi G, et al. Incidence, determinants and outcomes of pregnancy-associated hepatitis B flares: A regional hospital-based cohort study. Liver Int. 2018;38:813–820

    Article  CAS  Google Scholar 

  12. Chang CY, Aziz N, Poongkunran M, Javaid A, Trinh HN, Lau DT, et al. Serum aminotransferase flares in pregnant and postpartum women with current or prior treatment for chronic hepatitis B. J Clin Gastroenterol. 2018;52:255–261

    Article  CAS  Google Scholar 

  13. Joshi SS, Coffin CS. Hepatitis B and pregnancy: virologic and immunologic characteristics. Hepatol Commun. 2020;4:157–171

    Article  Google Scholar 

  14. Yi W, Pan CQ, Li MH, Wan G, Lv YW, Liu M, et al. The characteristics and predictors of postpartum hepatitis flares in women with chronic hepatitis B. Am J Gastroenterol. 2018;113:686–693

    Article  CAS  Google Scholar 

  15. Liu J, Wang J, Jin D, Qi C, Yan T, Cao F, et al. Hepatic flare after telbivudine withdrawal and efficacy of postpartum antiviral therapy for pregnancies with chronic hepatitis B virus. J Gastroenterol Hepatol. 2017;32:177–183

    Article  CAS  Google Scholar 

  16. Nguyen V, Tan PK, Greenup AJ, Glass A, Davison S, Samarasinghe D, et al. Anti-viral therapy for prevention of perinatal HBV transmission: extending therapy beyond birth does not protect against post-partum flare. Aliment Pharmacol Ther. 2014;39:1225–1234

    Article  CAS  Google Scholar 

  17. Pan CQ, Duan Z, Dai E, Zhang S, Han G, Wang Y, et al. Tenofovir to prevent hepatitis B transmission in mothers with high viral load. N Engl J Med. 2016;374:2324–2334

    Article  CAS  Google Scholar 

  18. Jourdain G, Ngo-Giang-Huong N, Harrison L, Decker L, Khamduang W, Tierney C, et al. Tenofovir versus placebo to prevent perinatal transmission of hepatitis B. N Engl J Med. 2018;378:911–923

    Article  CAS  Google Scholar 

  19. Chang CY, Aziz N, Poongkunran M, Javaid A, Trinh HN, Lau D, et al. Serum alanine aminotransferase and hepatitis B DNA flares in pregnant and postpartum women with chronic hepatitis B. Am J Gastroenterol. 2016;111:1410–1415

    Article  CAS  Google Scholar 

  20. Chinese Society of Infectious Diseases CMA, Chinese Society of Hepatology CMA. The guidelines of prevention and treatment for chronic hepatitis B. version). Zhonghua Gan Zang Bing Za Zhi. 2019;2019(27):938–961

    Google Scholar 

  21. Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MM, Murad MH, American Association for the Study of Liver D. AASLD guidelines for treatment of chronic hepatitis B. Hepatology 2016;63:261–283.

  22. Tan HH, Lui HF, Chow WC. Chronic hepatitis B virus (HBV) infection in pregnancy. Hepatol Int. 2008;2:370–375

    Article  Google Scholar 

  23. Chen R, Zou J, Long L, Huang H, Zhang M, Fan X, et al. Safety and efficacy of tenofovir alafenamide fumarate in early-middle pregnancy for mothers with chronic hepatitis B. Front Med (Lausanne). 2021;8: 796901

    Article  Google Scholar 

  24. Sarin SK, Kumar M, Lau GK, Abbas Z, Chan HL, Chen CJ, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int. 2016;10:1–98

    Article  CAS  Google Scholar 

  25. European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L. EASL. Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;2017(67):370–398

    Google Scholar 

  26. Zhuang H. Prevention of mother-to-child transmission of hepatitis B virus. Zhonghua Gan Zang Bing Za Zhi. 2016;24:881–884

    CAS  Google Scholar 

  27. Lu Y, Zhu FC, Liu JX, Zhai XJ, Chang ZJ, Yan L, et al. The maternal viral threshold for antiviral prophylaxis of perinatal hepatitis B virus transmission in settings with limited resources: a large prospective cohort study in China. Vaccine. 2017;35:6627–6633

    Article  CAS  Google Scholar 

  28. Liu J, Xu B, Chen T, Chen J, Feng J, Xu C, et al. Presence of hepatitis B virus markers in umbilical cord blood: exposure to or infection with the virus? Dig Liver Dis. 2019;51:864–869

    Article  Google Scholar 

  29. Cheung KW, Seto MTY, Kan ASY, Wong D, Kou KO, So PL, et al. Immunoprophylaxis failure of infants born to hepatitis B carrier mothers following routine vaccination. Clin Gastroenterol Hepatol. 2018;16:144–145

    Article  Google Scholar 

  30. Yi W, Pan CQ, Hao J, Hu Y, Liu M, Li L, et al. Risk of vertical transmission of hepatitis B after amniocentesis in HBs antigen-positive mothers. J Hepatol. 2014;60:523–529

    Article  CAS  Google Scholar 

  31. Hou J, Wang G, Wang F, Cheng J, Ren H, Zhuang H, et al. Guideline of prevention and treatment for chronic hepatitis B (2015 Update). J Clin Transl Hepatol. 2017;5:297–318

    Article  Google Scholar 

  32. Marcellin P, Heathcote EJ, Buti M, Gane E, de Man RA, Krastev Z, et al. Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B. N Engl J Med. 2008;359:2442–2455

    Article  CAS  Google Scholar 

  33. Suoh M, Tamori A, Amano-Teranishi Y, Nakai T, Enomoto M, Kawasaki Y, et al. The administration of tenofovir disoproxil fumarate for pregnant Japanese women with chronic hepatitis B. Intern Med. 2020;59:205–210

    Article  Google Scholar 

  34. Chang ML, Liaw YF. Hepatitis B flares in chronic hepatitis B: pathogenesis, natural course, and management. J Hepatol. 2014;61:1407–1417

    Article  Google Scholar 

  35. Sirilert S, Tongsong T. Hepatitis B virus infection in pregnancy: immunological response, natural course and pregnancy outcomes. J Clin Med 2021;10.

Download references

Acknowledgements

The authors thank all study patients and staffs participating in the study.

Funding

This study was funded in part by the Beijing Hospitals Authority Clinical medicine Development of special funding support (No. XMLX 202127), National Science and Technology Major Project of China (No. 2017ZX10201201-001-006, 2017ZX10201201-002-006, 2018ZX10715-005-003-005), The Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (No. XXZ0302 and XXT28), Special Public Health Project for Capital Health Development (No. 2022-1-2172), Project supported by Beijing science and technology commission (No. Z211100002921059), and High-level Public Health Technical Personnel Training Program of Beijing Municipal Health Commission (No. 2022-3-050).

Author information

Authors and Affiliations

  1. Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China

    Minghui Li, Fangfang Sun, Xiaoyue Bi, Liu Yang, Tingting Jiang, Wen Deng, Yao Lu, Lu Zhang & Yao Xie

  2. Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, 100015, China

    Minghui Li, Yanjie Lin & Yao Xie

  3. Department of Gynecology and Obstetrics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China

    Wei Yi

Authors
  1. Minghui Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fangfang Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaoyue Bi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yanjie Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Liu Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tingting Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wen Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yao Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Wei Yi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yao Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ML and YX contributed to the study design and the data analysis. ML, WY, and YX contributed to the recruitment, enrolment, and assessment of participants, as well as data collection. LZ, YL, FS, YL, LY, and WD contributed to following up with the patients. XB, TJ, and LY managed all aspects of laboratory support. ML wrote the first draft of the manuscript. YX revised the manuscript. YX is the guarantor of the article. All authors approved the final version of the manuscript.

Corresponding authors

Correspondence to Wei Yi or Yao Xie.

Ethics declarations

Conflict of interest

Minghui Li, Fangfang Sun, Xiaoyue Bi, Yanjie Lin, Liu Yang, Tingting Jiang, Wen Deng, Yao Lu, Lu Zhang, Wei Yi and Yao Xie have no conflict of interest.

Ethics approval

This study was approved by the Ethics Committee of Beijing Ditan Hospital Affiliated to Capital University of Medical Sciences (Jing Di Lun Ke Zi 2017 No. 004-02), and was registered with Clinical Trials (NCT03214302).

Informed consent

These patients were fully informed of the risks and signed informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, M., Sun, F., Bi, X. et al. Effects of antiviral therapy and drug withdrawal on postpartum hepatitis in pregnant women with chronic HBV infection. Hepatol Int 17, 42–51 (2023). https://doi.org/10.1007/s12072-022-10412-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12072-022-10412-w

Keywords

Search

Navigation