Incidence, determinants and outcomes of pregnancy-associated hepatitis B flares: A regional hospital-based cohort study

Tatyana Kushner, Pamela A. Shaw, Ankush Kalra, Lora Magaldi, Pooja Monpara, Gurneet Bedi, Karen Krok, Sierra Centkowski, Katherine Dalldorf, Julia D'souza, Dina Halegoua-De Marzio, David S. Goldberg, Stacey Trooskin, Lisa D. Levine, Sindhu K. Srinivas, James D. Lewis, Kimberly A. Forde, Vincent Lo Re

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Abstract

Background & Aims: There is limited knowledge about hepatitis B virus (HBV) flare among pregnant women. We evaluated the incidence, determinants and outcomes of HBV flare in a multicultural cohort of pregnant HBV-infected women in the United States. Methods: We performed a retrospective cohort study of pregnant hepatitis B surface antigen-positive women cared for at hospital-based clinics of 4 medical centres in Southeastern Pennsylvania from 2006 to 2015. The main outcome was incident HBV flare (alanine aminotransferase [ALT] ≥2 times upper limit of normal) during pregnancy or within 6 months after delivery. Among patients with flare, we determined development of jaundice (total bilirubin ≥2.5 mg/dL) and hepatic decompensation. Multivariable logistic regression was used to estimate odds ratios (ORs) of HBV flare for risk factors of interest, including timing of flare (during pregnancy versus post-delivery), nulliparity, younger age, HBV e antigen (HBeAg) status, and lack of anti-HBV therapy. Results: Among 310 pregnant predominantly African HBV-infected women with 388 pregnancies, the incidence of HBV flare was 14% (95% CI, 10-18%) during pregnancy and 16% (95% CI, 11-24%) post-delivery. Jaundice developed in 12% and hepatic decompensation in 2%. Positive HBeAg was associated with HBV flare (OR, 2.55; 95% CI, 1.04-6.20). HBV DNA was measured in 55% of patients, and only 50% were referred for HBV specialty care. Conclusions: Pregnancy-associated hepatitis B flare occurred in 14% during pregnancy and 16% post-delivery and rarely led to hepatic decompensation. Positive HBeAg was the main risk factor identified. Women did not have adequate HBV monitoring or follow-up during pregnancy.

Original languageEnglish (US)
Pages (from-to)813-820
Number of pages8
JournalLiver International
Volume38
Issue number5
DOIs
StatePublished - May 2018

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Pregnancy Outcome
Hepatitis B
Hepatitis B virus
Incidence
Pregnancy
Hepatitis B e Antigens
Jaundice
Liver
Odds Ratio
Hepatitis B Surface Antigens
Parity
Alanine Transaminase
Bilirubin
Pregnant Women
Cohort Studies
Retrospective Studies
Logistic Models

All Science Journal Classification (ASJC) codes

  • Hepatology

Cite this

Kushner, T., Shaw, P. A., Kalra, A., Magaldi, L., Monpara, P., Bedi, G., ... Lo Re, V. (2018). Incidence, determinants and outcomes of pregnancy-associated hepatitis B flares: A regional hospital-based cohort study. Liver International, 38(5), 813-820. https://doi.org/10.1111/liv.13594
Kushner, Tatyana ; Shaw, Pamela A. ; Kalra, Ankush ; Magaldi, Lora ; Monpara, Pooja ; Bedi, Gurneet ; Krok, Karen ; Centkowski, Sierra ; Dalldorf, Katherine ; D'souza, Julia ; Halegoua-De Marzio, Dina ; Goldberg, David S. ; Trooskin, Stacey ; Levine, Lisa D. ; Srinivas, Sindhu K. ; Lewis, James D. ; Forde, Kimberly A. ; Lo Re, Vincent. / Incidence, determinants and outcomes of pregnancy-associated hepatitis B flares : A regional hospital-based cohort study. In: Liver International. 2018 ; Vol. 38, No. 5. pp. 813-820.
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title = "Incidence, determinants and outcomes of pregnancy-associated hepatitis B flares: A regional hospital-based cohort study",
abstract = "Background & Aims: There is limited knowledge about hepatitis B virus (HBV) flare among pregnant women. We evaluated the incidence, determinants and outcomes of HBV flare in a multicultural cohort of pregnant HBV-infected women in the United States. Methods: We performed a retrospective cohort study of pregnant hepatitis B surface antigen-positive women cared for at hospital-based clinics of 4 medical centres in Southeastern Pennsylvania from 2006 to 2015. The main outcome was incident HBV flare (alanine aminotransferase [ALT] ≥2 times upper limit of normal) during pregnancy or within 6 months after delivery. Among patients with flare, we determined development of jaundice (total bilirubin ≥2.5 mg/dL) and hepatic decompensation. Multivariable logistic regression was used to estimate odds ratios (ORs) of HBV flare for risk factors of interest, including timing of flare (during pregnancy versus post-delivery), nulliparity, younger age, HBV e antigen (HBeAg) status, and lack of anti-HBV therapy. Results: Among 310 pregnant predominantly African HBV-infected women with 388 pregnancies, the incidence of HBV flare was 14{\%} (95{\%} CI, 10-18{\%}) during pregnancy and 16{\%} (95{\%} CI, 11-24{\%}) post-delivery. Jaundice developed in 12{\%} and hepatic decompensation in 2{\%}. Positive HBeAg was associated with HBV flare (OR, 2.55; 95{\%} CI, 1.04-6.20). HBV DNA was measured in 55{\%} of patients, and only 50{\%} were referred for HBV specialty care. Conclusions: Pregnancy-associated hepatitis B flare occurred in 14{\%} during pregnancy and 16{\%} post-delivery and rarely led to hepatic decompensation. Positive HBeAg was the main risk factor identified. Women did not have adequate HBV monitoring or follow-up during pregnancy.",
author = "Tatyana Kushner and Shaw, {Pamela A.} and Ankush Kalra and Lora Magaldi and Pooja Monpara and Gurneet Bedi and Karen Krok and Sierra Centkowski and Katherine Dalldorf and Julia D'souza and {Halegoua-De Marzio}, Dina and Goldberg, {David S.} and Stacey Trooskin and Levine, {Lisa D.} and Srinivas, {Sindhu K.} and Lewis, {James D.} and Forde, {Kimberly A.} and {Lo Re}, Vincent",
year = "2018",
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Kushner, T, Shaw, PA, Kalra, A, Magaldi, L, Monpara, P, Bedi, G, Krok, K, Centkowski, S, Dalldorf, K, D'souza, J, Halegoua-De Marzio, D, Goldberg, DS, Trooskin, S, Levine, LD, Srinivas, SK, Lewis, JD, Forde, KA & Lo Re, V 2018, 'Incidence, determinants and outcomes of pregnancy-associated hepatitis B flares: A regional hospital-based cohort study', Liver International, vol. 38, no. 5, pp. 813-820. https://doi.org/10.1111/liv.13594

Incidence, determinants and outcomes of pregnancy-associated hepatitis B flares : A regional hospital-based cohort study. / Kushner, Tatyana; Shaw, Pamela A.; Kalra, Ankush; Magaldi, Lora; Monpara, Pooja; Bedi, Gurneet; Krok, Karen; Centkowski, Sierra; Dalldorf, Katherine; D'souza, Julia; Halegoua-De Marzio, Dina; Goldberg, David S.; Trooskin, Stacey; Levine, Lisa D.; Srinivas, Sindhu K.; Lewis, James D.; Forde, Kimberly A.; Lo Re, Vincent.

In: Liver International, Vol. 38, No. 5, 05.2018, p. 813-820.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incidence, determinants and outcomes of pregnancy-associated hepatitis B flares

T2 - A regional hospital-based cohort study

AU - Kushner, Tatyana

AU - Shaw, Pamela A.

AU - Kalra, Ankush

AU - Magaldi, Lora

AU - Monpara, Pooja

AU - Bedi, Gurneet

AU - Krok, Karen

AU - Centkowski, Sierra

AU - Dalldorf, Katherine

AU - D'souza, Julia

AU - Halegoua-De Marzio, Dina

AU - Goldberg, David S.

AU - Trooskin, Stacey

AU - Levine, Lisa D.

AU - Srinivas, Sindhu K.

AU - Lewis, James D.

AU - Forde, Kimberly A.

AU - Lo Re, Vincent

PY - 2018/5

Y1 - 2018/5

N2 - Background & Aims: There is limited knowledge about hepatitis B virus (HBV) flare among pregnant women. We evaluated the incidence, determinants and outcomes of HBV flare in a multicultural cohort of pregnant HBV-infected women in the United States. Methods: We performed a retrospective cohort study of pregnant hepatitis B surface antigen-positive women cared for at hospital-based clinics of 4 medical centres in Southeastern Pennsylvania from 2006 to 2015. The main outcome was incident HBV flare (alanine aminotransferase [ALT] ≥2 times upper limit of normal) during pregnancy or within 6 months after delivery. Among patients with flare, we determined development of jaundice (total bilirubin ≥2.5 mg/dL) and hepatic decompensation. Multivariable logistic regression was used to estimate odds ratios (ORs) of HBV flare for risk factors of interest, including timing of flare (during pregnancy versus post-delivery), nulliparity, younger age, HBV e antigen (HBeAg) status, and lack of anti-HBV therapy. Results: Among 310 pregnant predominantly African HBV-infected women with 388 pregnancies, the incidence of HBV flare was 14% (95% CI, 10-18%) during pregnancy and 16% (95% CI, 11-24%) post-delivery. Jaundice developed in 12% and hepatic decompensation in 2%. Positive HBeAg was associated with HBV flare (OR, 2.55; 95% CI, 1.04-6.20). HBV DNA was measured in 55% of patients, and only 50% were referred for HBV specialty care. Conclusions: Pregnancy-associated hepatitis B flare occurred in 14% during pregnancy and 16% post-delivery and rarely led to hepatic decompensation. Positive HBeAg was the main risk factor identified. Women did not have adequate HBV monitoring or follow-up during pregnancy.

AB - Background & Aims: There is limited knowledge about hepatitis B virus (HBV) flare among pregnant women. We evaluated the incidence, determinants and outcomes of HBV flare in a multicultural cohort of pregnant HBV-infected women in the United States. Methods: We performed a retrospective cohort study of pregnant hepatitis B surface antigen-positive women cared for at hospital-based clinics of 4 medical centres in Southeastern Pennsylvania from 2006 to 2015. The main outcome was incident HBV flare (alanine aminotransferase [ALT] ≥2 times upper limit of normal) during pregnancy or within 6 months after delivery. Among patients with flare, we determined development of jaundice (total bilirubin ≥2.5 mg/dL) and hepatic decompensation. Multivariable logistic regression was used to estimate odds ratios (ORs) of HBV flare for risk factors of interest, including timing of flare (during pregnancy versus post-delivery), nulliparity, younger age, HBV e antigen (HBeAg) status, and lack of anti-HBV therapy. Results: Among 310 pregnant predominantly African HBV-infected women with 388 pregnancies, the incidence of HBV flare was 14% (95% CI, 10-18%) during pregnancy and 16% (95% CI, 11-24%) post-delivery. Jaundice developed in 12% and hepatic decompensation in 2%. Positive HBeAg was associated with HBV flare (OR, 2.55; 95% CI, 1.04-6.20). HBV DNA was measured in 55% of patients, and only 50% were referred for HBV specialty care. Conclusions: Pregnancy-associated hepatitis B flare occurred in 14% during pregnancy and 16% post-delivery and rarely led to hepatic decompensation. Positive HBeAg was the main risk factor identified. Women did not have adequate HBV monitoring or follow-up during pregnancy.

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