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Postpartum hepatic flares common among women with HBV

In an Australian cohort of pregnant women with hepatitis B virus, 25% experienced postpartum hepatic flares, and women positive for the hepatitis B e antigen were more likely to experience a flare vs. those who were negative for the infection, according to study data.  

“HBV infection is predominantly an immune-mediated disease, but it remains unclear whether the changes in immune activity during pregnancy and postpartum impact the activity of the disease; particularly whether flares occur postpartum due to immune reconstitution,” the researchers wrote.

Among a cohort of 126 pregnant women with HBV, researchers collected and analyzed clinical data during early and late stages of pregnancy, as well as between 6 and 12 weeks and 12 months postpartum. Of 126 women, 27 experienced postpartum flare and were included in the final analyses.

Alanine aminotransferase levels were highest in the first trimester of pregnancy compared with the second trimester (P=.02) and highest in the second trimester compared with the third trimester (P=.01). Among the mothers who experienced a flare, an increase in ALT levels was apparent compared with mothers in the nonflare group. Of all women who experienced postpartum flares, only two did not return to normal ALT levels by 12 months postpartum.

Univariate analysis showed younger age, HBeAg status and gravida and parity were independently associated with the occurrence of a flare, according to the research. Multivariate analysis showed (HBeAg) to not be a major factor in predicting flares postpartum (P=.051).

At birth, all infants received 100 IU of hepatitis B immunoglobulin and were vaccinated within 24 hours of delivery. Seven patients received lamivudine as antiviral therapy near the end of their pregnancy (between 30 and 35 weeks) to reduce perinatal transmission. Of these patients, four had a postpartum flare, two did not and the other was lost to follow-up, according to the research. When tested at age 9 to 12 months, 99% of children (79/80) were negative for HBsAg.

“Pregnancy is associated with changes in the immune system, which has the potential to impact on the natural history of immune-mediated conditions such as chronic HBV infection,” the researchers wrote. “This may manifest as postpartum hepatic flares, which are common, occasionally severe and usually asymptomatic, but usually settle within 12 months.

“Clinicians need to be aware of this phenomenon so women at the highest risk can be appropriately identified for close monitoring in the postnatal period,” they concluded.

Disclosure: The researchers report no relevant financial disclosures.