Effect Of Antiviral Therapy On Dregnancy Outcome Of Pregnant Women With High Viral Load Of Hepatitis B Virus

Objective:To explore the effect of antiviral therapy on pregnancy outcome of pregnant women with high viral load of hepatitis b virusThe research methods:All cases were collected from 2014-2017 in Shanghai public health clinical center.According to the prevention and control of chronic hepatitis b guideline update(2015 edition),2 180 cases of hepatitis b surface antigen positive pregnant womenwere analyzed.Among 2 180 cases,570 cases received antiviral treatment were further analyzed for the metabolism of total bile acid and pregnancy outcomes.All patients are excluded from other acute and chronic diseases that may affect pregnancy outcome or affect TBA metabolism,such as diabetes,hypertension,thyroid disease,other hepatobiliary diseases and malignant tumors.We fully informed patients about the informations,including their diseases meeting the indications of antiviral treatment,the positive role of antiviral drugs and the possible of adverse reactions.The patients decided whether accept the antiviral treatment or not.Signed informed consent.Among them,there were 196 cases of antiviral treatment and 374 cases without antiviral treatment.These casesdivided into four groups:abnormal transaminase antiviral group 74 cases(group A),liver function is normal,maternal and child block group 122 cases(group B),transaminase abnormalities not antiviral group 138 cases(group C),liver function is normal,no maternal and child block group and 236 cases(group D).In the following text,the name of the four groups were shortened as the anti-virus group(group A),the mother and child block group(group B),the non-antiviral group(group C),and the unmother-to-child block group(group D).Both group A and group B were treated with fumaric acid tenofovir(wei ruide 300mg/L)or tibifazine(subev 600mg/L)in 24-28 weeks,with 1 treatment per day.When liver function was abnormal,it was also treated with glutathione tablet and compound glycyrrhizin tablet,and the liver function was normal.When TBA was elevated,it was treated with adenosine disulfonate and ursodeoxycholic acid.At least 1 liver function test per month was established in the first trimester of pregnancy,and 4 days after delivery(24 hours before delivery).Observe transaminase and TB A situation.Comparative analysis using antiviral therapy(group A and group B)and antiviral therapy group(group C,D)pregnant women associates to second liver metabolism and pregnancy outcomes(cesarean delivery rate,amniotic fluid contamination,oligohydramnios,premature rupture of membrane,fetal distress,premature birth,low birth weight,macrosomia,neonatal asphyxia,neonatal hepatitis B virus(HBV)infection,transaminase after often turn,viruses,virus down).Results:delivery1.Abnormal transaminase1.1There was no significant difference in the mean age(28.2+3.6vs.28.5+4.8),mean viral load(7.2+0.52 vs.7.15+0.46),HBeAg positive rate(60/74)vs.78.2%(108/138),P>0.05.1.2 the incidence of abnormal TBA during pregnancy in the antiviral group was similar to that in the non-antiviral group(59.4%vs.55.0%),with no significant difference in P>0.05.The incidence of TBA abnormality(i.e.,TBA 0-10umol/L)was significantly lower in the antiviral group than in the non-antiviral group(27.0%vs.60.8%).6.7%vs.21.7%;P<0.05)the difference was statistically significant.The preterm birth rate of the antiviral group was significantly lower than that of the non-antiviral group(6.7%vs.18.8%;P<0.05)the difference was statistically significant.The mean weeks of gestation,the rate of transaminase recurrence,the rate of virus dropping to the detection line and the rate of virus dropping more than 21og in the antiviral group were significantly higher than those in the non-antiviral group(38.58 1.75vs.37.7 2.08).98.6%vs.38.4%;63.5%vs.3.6%;98.6%vs.9.4%;P<0.05)the difference was statistically significant.The rates of premature rupture of membranes(12.1%vs.11.5%),oligohydramnios(10.8%vs.10.1%),fetal distress(13.5%vs.10.3%),neonatal asphyxia(9.4%vs.9.4%),low birth weight(2.7%vs.9.4%),macrosomia(1.35%vs.3.1%),hepatic failure(0%vs.2.9%),GDM(13.5%vs.15.2%),and poor diet(0%)There was no significant difference in the incidence of hepatitis b at birth(0%vs.0.7%),pregnancy hypertension(2.7%vs.2.8%),hepatitis b infection rate at birth(0%vs.0.7%),hepatitis b infection rate at 6 months(0%vs.0.7%),and hepatitis b infection rate at 12 months(0%vs.0.7%).1.3 Pearson correlation analysis of abnormal TBA during pregnancy and pregnancy outcome:abnormal TBA during pregnancy is significantly positively correlated with fetal distress and neonatal asphyxia,and significantly negatively correlated with the gestational age(P<0.05).There was no significant correlation with premature rupture of membranes,oligohydramnios,infection rate of HBV in children at birth and infection rate of HBV in children at 12 months of age(P>0.05).1.4 Pearson correlation analysis between antiviral therapy and pregnancy outcome in patients with TBA abnormality during pregnancy:there was a significant positive correlation between antiviral therapy and the gestational age of pregnancy in patients with TBA abnormality during pregnancy(P<0.05).There was no significant correlation with premature rupture of membranes,oligohydramnios,fetal distress and neonatal asphyxia(P>0.05).2.When transaminase is normal:2.1 There was no significant difference in the mean age(age)%mean viral load(log)、HBeAg positive rate(28.8±4.4vs.28.1±3.4、7.5±0.50vs.7.4± 0.46±100%(122/122)vs.100%(236/236)),and P>0.05.2.2 compared with the non-antiviral group(group D),there was no significant difference in the abnormal rate of TBA during pregnancy,delivery and postpartum between the antiviral group and the non-antiviral group(17.2%vs.26.2%,14.7%vs.22.5%,3.2%vs.7.6%),P>0.05.Premature rupture rate(13.9%vs.16.1%),oligohydramnios rate(8.1%vs.7.6%),fetal distress rate(12.2%vs.17.3%),neonatal asphyxia rate(6.5%vs.6.77%),mean gestational age(38.8 1.27vs.38.8 1.12),preterm birth rate(3.2%vs.2.5%),low birth weight(1.6%vs.0.8%),macrosomia rate(4.0%vs.8.89%),GDM rate(12.3%vs.6.77%).There was no significant difference in blood glucose control rate(0.8%vs.0.8%),gestational hypertension rate(3.3%vs.2.5%),P>0.05.The virus detection rate in the antiviral group was lower than that in the non-antiviral group(15.5%vs.0%).100%vs 2.5%),P<0.05,the difference was statistically significant.The infection rate of hepatitis b at birth,6 months and 12 months in the antiviral group was significantly lower than that in the non-antiviral group(0%vs.8.89%,0%vs.4.23%,0%vs.4.23%),P<0.05,and the difference was statistically significant.(all hbv-infected patients at 6 and 12 months old were within the range of patients with positive hepatitis b infection at birth,and there were no new cases.)2.3 Pearson correlation analysis of abnormal TBA in pregnancy and pregnancy outcome:when liver function was normal,abnormal TBA in pregnancy was significantly negatively correlated with gestational age(P<0.05),which was statistically significant.There was no significant correlation between TBA abnormality in pregnancy and premature rupture of membranes,oligohydramnios,fetal distress,neonatal asphyxia,infection rate of hepatitis b in children at birth and infection rate of hepatitis b in children at 12 months of age(P>0.05).2.4 Pearson correlation analysis of the pregnancy outcome between antiviral treatment and TBA abnormality in pregnancy:there was no significant correlation between antiviral treatment and premature rupture of membranes,oligohydramnios,fetal distress,neonatal asphyxia,and gestational age of delivery in TBA abnormality in pregnancy(P>0.05).Conclusion:1.Abnormal transaminase:(1)antiviral treatment in the middle and late pregnancy can improve pregnancy outcome,restore liver function,improve TBA recurrence rate and transaminase recurrence rate,reduce preterm delivery rate,and extend the pregnancy.(2)antiviral treatment in the middle and late pregnancy did not increase the incidence of fetal distress,neonatal asphyxia,oligohydramnios and premature rupture of membranes,macrosomia,low-weight infants,GDM,gestational hypertension and poor dietary control of blood glucose.(3)abnormal TBA during pregnancy can lead to increased fetal distress rate,neonatal asphyxia rate and early gestational age.There was no significant correlation between TBA abnormality in pregnancy and premature rupture of membranes,oligohydramnios,and mother-to-child transmission of HBV.Antiviral therapy can prolong the gestational weeks of childbirth in TBA abnormal population,but has no significant effect on premature rupture of membranes,oligohydramnios,fetal distress rate and neonatal asphyxia rate.(4)when liver function is abnormal,oral nucleotide antiviral drugs in the middle and late pregnancy can significantly reduce HBV DNA load,but do not significantly affect the mother-to-child transmission rate.2.Transaminase is normal:(1)antiviral treatment in the middle and late pregnancy did not increase TBA recurrence rate,neonatal low body weight rate,macrosomia rate,premature rupture rate of membranes,fetal distress rate,premature delivery rate,neonatal asphyxia rate,oligohydramnios rate,GDM incidence rate,gestational hypertension disease rate,and poor dietary control of blood glucose rate.(2)abnormal TBA during pregnancy can lead to early pregnancy.TBA abnormality had no significant correlation with premature rupture of membranes,oligohydramnios,fetal distress,neonatal asphyxia,and mother-to-child transmission of HBV.Antiviral therapy could not prolong the gestational weeks of childbirth in the population with abnormal TBA,and had no significant effect on premature rupture of membranes,oligohydramnios,fetal distress and neonatal asphyxia.(3)in pregnant women with high HBV load in the immune tolerance stage,antiviral therapy in the middle and late pregnancy can significantly reduce the level of hbv-dna in the mother’s peripheral blood,and reduce the risk of mother-to-child transmission of HBV.