HBV and HCV associated with increased obstetric complications

Results from a seven-year nationwide inpatient sample study demonstrate that hepatitis B virus and hepatitis C virus are each associated with pregnancy complications.

Previous data conflict regarding the association of chronic HBV and HCV with adverse pregnancy outcomes, according to investigator Bing Chen, MD, who presented the findings at the American Association for the Study of Liver Diseases (AASLD) 2021 Liver Meeting. To shed light on the issue, a team led by Dr. Chen, who at the time of the study was a resident at Mount Sinai Morningside-West and is now a clinical assistant professor at NYU Grossman School of Medicine, both in New York City, evaluated trends in diagnosis of HBV and HCV in pregnant women and the prevalence of associated adverse pregnancy outcomes.

In their retrospective review, which was designated an AASLD Presidential Poster of Distinction, the investigators identified all patients who were pregnant and had a diagnosis of HBV and HCV in the National Inpatient Sample database from 2012 to 2018 (abstract 891). They excluded patients with acute liver disease. The investigators performed a longitudinal analysis to assess trends in pregnancy-related complications including rates of cesarean delivery, preeclampsia/eclampsia, preterm labor and gestational diabetes, as well as all-cause in-hospital mortality, length of stay and total cost of the hospital stay.

A total of 28.68 million pregnancy-related admissions met the eligibility criteria, including 52,445 with HBV and 133,680 with HCV. Over the seven-year period, the prevalence of HBV increased from 0.15% to 0.21% (P<0.001), and the prevalence of HCV increased from 0.32% to 0.58% (P<0.001). Pregnant patients with HBV were more likely to be Asian or Pacific Islander than pregnant patients without hepatitis (50.99% vs. 5.66%; P<0.001); pregnant patients with HCV were more likely to be white than pregnant patients without HCV (81.90% vs. 52.28%; P<0.001). In addition, those with HBV had a significantly higher rate of gestational diabetes (12.78% vs. 6.94%; P<0.001). Patients with HCV had significantly higher rates of preterm labor (9.68% vs. 6.27%; P<0.001) and all-cause mortality (0.05% vs. 0.01%; P<0.001), as well as a longer hospital length of stay (3.4 vs. 2.7 days; P<0.001) (Table).

Findings Should Inform Counseling

The researchers said these findings should inform counseling of women who are found to have HBV or HCV during pregnancy about the risk for adverse pregnancy outcomes.

Carla Brady, MD, an associate professor of medicine in the Department of Gastroenterology at Duke University School of Medicine, in Durham, N.C., who was not involved with the study, told Gastroenterology & Endoscopy News that the study offers updated data on health outcomes in pregnant women with HBV and HCV and provides data that can be helpful in counseling pregnant women about expected obstetric outcomes during their pregnancy. Although the differences in obstetric outcomes “were calculated as significant, such differences were relatively small,” Dr. Brady said, noting that “more research is needed to understand why these differences are observed and whether they exist across the broader population of women of childbearing age and pregnant women who are not hospitalized.”

Dr. Brady said, “The strongest message to clinicians is the need to ensure that women [of childbearing age] and pregnant women with hepatitis B and hepatitis C should be counseled on health outcomes in the setting of pregnancy in the context of their liver disease. Clinicians need to ensure that the care of pregnant women with hepatitis B and hepatitis C involves a multidisciplinary team of healthcare providers.”

By Kate O’Rourke