Handan ALAY, Melek ŞAHİNER, Emine PARLAK

Maternal Kronik Hepatit B Virüs Enfeksiyonu Gebelik ve Fetal Riskleri Artırıyor Mu?

Amaç: Dünyada 400 milyondan fazla kişi Hepatit B virüs (HBV)’ü ile enfektedir. Hepatit B virüs enfeksiyonun gebeler üzerindeki etkisi açık değildir. Gebelikte Kronik HBV varlığının gestasyonel diyabet, antepartum hemoraji, erken doğum tehdidi, yenidoğan sarılığı, düşük doğum ağırlığı gibi maternal ve fetal riskleri artırdığı belirtilmektedir. Bu çalışmanın amacı HBV’nün gebelik ve fetal riskler üzerine etkilerini araştırmaktır. Gereç-Yöntem: 2014-2017 yılları arasında hastanemizde canlı doğum yapan HBV ile enfekte 301 gebe ve bebeği vaka grubu; aynı yıllarda rastgele seçilen, hastanemizde canlı doğum yapan HBV ile enfekte olmayan gebeler ve bebekleri kontrol grubu olarak çalışmamıza dahil edildi. Retrospektif olarak hasta dosyalarından doğum şekli, abortus, preeklampsi, gestasyonel diyabet, antepartum hemoraji, fetal distres, gebelik haftası, doğum ağırlığı, intrauterin gelişme geriliği(IUGR) gibi maternal ve fetal sonuçları analiz edildi. Bulgular: Çalışmaya dahil edilen 301 HBsAg pozitif gebe kadının 189(%62,8)’inin doğum şekli normal vajinal doğum olup, 4(%1,3)’ü diyabet, 2(%0,7)’i preeklampsi, 82(%27,2)’inde abortus öyküsü ve 5(%1,7)’inde plesanta dekolmanı mevcuttu. HBsAg negatif hastalarla arasında istatistisel olarak anlamlı fark tespit edilmedi(p>0,05). HBsAg(+) annenin 6(%2) bebeğinde IUGR ve 12(%40)’ında fetal distres vardı. HBsAg(+) anne bebeklerinde fetal distres varlığını istatistiksel olarak anlamlı fark tespit ettik(p:0,036). Sonuç: Yapılmış bir çok çalışmada HBV enfeksiyonunun maternal ve fetal komplikasyonları artırdığı gösterilmiş olmasına rağmen çalışmamızda yalnızca fetal distres riskini anlamlı olarak bulduk. Çalışmamızda dikkat çeken nokta HBV varlığının hekimin doğum şekline karar vermesini etkilemediğini gördük.

Anahtar Kelimeler:

gebelik, fetal, risk, hepatit B enfeksiyonu

Does Maternal Chronic Hepatitis B Virus Infection Increase Pregnancy and Fetal Risks?

Aim: More than 400 million people worldwide are infected with the hepatitis B virus (HBV). The effect of HBV infection on pregnant women is unclear. The presence of chronic HBV in pregnancy has been reported to increase such maternal and fetal risks as gestational diabetes, antepartum hemorrhage, prematurity, neonatal jaundice, and low birth weight. The purpose of this study was to investigate the effects of HBV on pregnancy and fetal risks.Materials-Methods: Three hundred and one pregnant women infected with HBV and giving live birth in our hospital in 2014-2017, and their babies, were enrolled as the case group, while randomly selected pregnant women giving live birth in our hospital and not infected with HBV, and their babies, were included as the control group. Maternal and fetal outcomes such as type of delivery, miscarriage, re-eclampsia, gestational diabetes, antepartum hemorrhage, fetal distress, gestational weeks, and intrauterine growth restriction (IUGR) were analyzed retrospectively from patients’ records.Results: Delivery was by the normal vaginal route in 189 (62.8%) of the 301 HBsAg-positive women in the study, while diabetes was present in 4 (1.3%), pre-eclampsia in 2 (0.7%), a history of miscarriage in 82 (27.2%), and placental detachment in 5 (1.7%). No statistically significant difference was determined between these and the HBsAg-negative women (p>0.05). IUGR was present in the babies of 6 (2%) of HBsAg(+) mothers, and fetal distress in 12 (40%). The presence of fetal distress was significantly higher in the babies of HBsAg(+) mothers (p:0.036). Conclusion: Although several studies have shown that HBV infection increases maternal and fetal risks, only the risk of fetal distress was significant in our study. The noteworthy finding of our study is that the presence of HBV did not affect the physician’s decision regarding type of delivery.

Keywords:

pregnancy, fetal, risk, hepatitis B infection,

PDF

___

1. McMahon BJ (2005) Epidemiology and natural history of hepatitis B. Semin Liver Dis 25 Suppl 1: 3–8.
2. Sarin SK, Kumar M (2010) Epidemiology, Screening, and Natural History of Chronic Hepatitis B Infection. In: Shetty K, Wu GY, editors. Chronic Viral Hepatitis 2nd ed. Lippincott, Williams, and Wilkins (Philadelphia): Humana Press. pp. 185–241.
3. Jonas MM. Hepatitis B and pregnancy: an underestimated issue. Liver International 2009; 29 Suppl 1: 133-139.
4. Tosun S. Viral hepatitlerin ülkemizde değişen epidemiyolojisi. ANKEM Derg. 2013;27:128-34.
5. Tse KY, Ho LF, Lao T. The impact of maternal HBsAg carrier status on pregnancy outcomes: a case-control study. J Hepatol. 2005;43:771-5.
6. Reddick KL, Jhaveri R, Gandhi M, James AH, Swamy GK. Pregnancy outcomes associated with viral hepatitis. J Viral Hepat. 2011;18:e394-8.
7. Safir A, Levy A, Sikuler E, Sheiner E. Maternal hepatitis B virus or hepatitis C virus carrier status as an independent risk factor for adverse perinatal outcome. Liver Int. 2010;30:765-70.
8. Wong S, Chan LY, Yu V, Ho L. Hepatitis B carrier and perinatal outcome in singleton pregnancy. Am J Perinatol 1999; 16: 485- 488.
9. Tan J, Liu X, Mao X, Yu J, Chen M, Li Y, Sun X. HBsAg positivity during pregnancy and adverse maternal outcomes: a retrospective cohort analysis. J Viral Hepat. 2016 Oct;23(10):812-9.
10. Lapinski TW, Stepaniuk J, Tomasiewicz K, Lebenstejn D, Kulikowski M, Flisiak R. Effect of hepatitis B virüs infection on the course of pregnancy and newborns’ health status. Clinical and Experimantal Hepatology 2015;3:112-116.
11. Dwedi M, Misra SP, Misra V, et al. Seroprevalence of hepatitits B infection during pregnancy and risk of perinatal transmission. Indian J Gastroenterol 2011;30:66-71.
12. Zou H, Chen Y, Duan Z, Zhang H, Pan C. Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg positive mothers. J Viral Hepat. 2012;13(2):18-25.
13. Han GR, Xu CL, Zhao W, Yang YF. Management of chronic hepatitis B in pregnancy. World J Gastroenterol. 2012; 18(33): 4517-21.
14. Yang J, Zeng XM, Men YL, Zhao LS. Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virüs a systematic review. Virol J. 2008;5:100.
15. Pan JO, Zou HB, Chen Y, Zhang X, Zhang H, Li J, Duan Z. Cesarean section reduces perinatal transmission of hepatitis B virüs infection from hepatitis B surface antigen-positive women to their infants. Clin Gastroenterol Hepatol. 2013;11:1349-55.
16. Liu CP, Zeng YL, Zhou M, Chen LL, Hu R, Wang L, Tang H. Factors assosiated with mother to child transmission of hepatitis B virüs despite immunoprophylaxis. Intern Med. 2015;54:711-6.
17. Hu Y, Chen Y, Wen J, Xu C, Zhang S, Xu B, Zhou YH. Effect of elective cesarean section on the risk of mother to child transmission of hepatitis B virüs. BMC Pregnancy Childbird. 2013;13:119.