Clara Van Ommen1, Arianne Albert2, Melica Nourmoussavi3, Reka Gustafson4,5, Elizabeth Brodkin6, Martin Petric7, Mel Krajden7, Jane A Buxton4, Mark Bigham4, Neora Pick8, Richard A Schreiber9, Christopher H Sherlock7, Deborah Money10, Eric M Yoshida8, Julianne van Schalkwyk10. 1. Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 2. Women's Health Research Institute, Vancouver, British Columbia, Canada. 3. Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada. 4. School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. 5. Office of the Medical Health Officer, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada. 6. Office of the Medical Health Officer, Fraser Health Authority, Surrey, British Columbia, Canada. 7. Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 8. Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 9. Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada. 10. Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
BACKGROUND: We examined changes in hepatitis B virus (HBV) viral loads (VLs) in pregnancy, their association with hepatitis B e antigen (HBeAg), and the associated infant outcomes. METHODS: We prospectively followed 132 mothers positive for hepatitis B surface antigen (HBsAg) and their 135 infants from 2011 to 2015 in Vancouver, British Columbia. Outcome measures included association between maternal HBeAg and high (>200,000 IU/mL) or low (≤200,000 IU/mL) HBV VL, changes in HBV VL through pregnancy, infant HBsAg status, and infant completion of the HBV vaccination series. RESULTS: f the 91 participants with an available HBV VL, 13 (14.3%) had an HBV VL of more than 200,000 IU/mL. Of 59 participants with paired HBeAg and HBV VL in pregnancy, 6 had an HBV VL of more than 200,000 IU/mL; of interest, 2 of the 6 (33.3%) were HBeAg-negative. Thirty-eight participants had HBV VL results at both mid-trimester and delivery. For these 38 participants, Wilcoxon signed-ranks test for paired data found that an HBV VL remained stable (p = .58). We observed no perinatal transmissions. However, 20.7% of infants did not have a documented complete HBV vaccination series, 20.0% did not have post-vaccination HBsAg testing completed, and 18% did not have anti-HBs titres measured by age 12 months. CONCLUSIONS: Our study demonstrates that HBeAg and HBV VL are not reliably predictive of each other. This supports the improved predictive value of VL measurement in pregnancy to risk stratify pregnant patients to offer antiviral treatment when indicated and further minimize the risk of perinatal transmission.
BACKGROUND: We examined changes in hepatitis B virus (HBV) viral loads (VLs) in pregnancy, their association with hepatitis B e antigen (HBeAg), and the associated infant outcomes. METHODS: We prospectively followed 132 mothers positive for hepatitis B surface antigen (HBsAg) and their 135 infants from 2011 to 2015 in Vancouver, British Columbia. Outcome measures included association between maternal HBeAg and high (>200,000 IU/mL) or low (≤200,000 IU/mL) HBV VL, changes in HBV VL through pregnancy, infant HBsAg status, and infant completion of the HBV vaccination series. RESULTS: f the 91 participants with an available HBV VL, 13 (14.3%) had an HBV VL of more than 200,000 IU/mL. Of 59 participants with paired HBeAg and HBV VL in pregnancy, 6 had an HBV VL of more than 200,000 IU/mL; of interest, 2 of the 6 (33.3%) were HBeAg-negative. Thirty-eight participants had HBV VL results at both mid-trimester and delivery. For these 38 participants, Wilcoxon signed-ranks test for paired data found that an HBV VL remained stable (p = .58). We observed no perinatal transmissions. However, 20.7% of infants did not have a documented complete HBV vaccination series, 20.0% did not have post-vaccination HBsAg testing completed, and 18% did not have anti-HBs titres measured by age 12 months. CONCLUSIONS: Our study demonstrates that HBeAg and HBV VL are not reliably predictive of each other. This supports the improved predictive value of VL measurement in pregnancy to risk stratify pregnant patients to offer antiviral treatment when indicated and further minimize the risk of perinatal transmission.
Authors: Julie van Schalkwyk; Melica Nourmoussavi; Andrea Massey; Reka Gustafson; Elizabeth Brodkin; Martin Petric; Mel Krajden; Simon Dobson; Jane Buxton; Mark Bigham; Neora Pick; Rick Schreiber; Christopher H Sherlock; Deborah Money; Eric M Yoshida Journal: Can J Gastroenterol Hepatol Date: 2014-11
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