title: Clinical and virological predictors of hepatic flares in pregnant women with chronic hepatitis B.
abstract: BACKGROUND
  Unique immunological changes occur during pregnancy; the impact of which, on virological and biochemical markers of hepatitis B infection is not well established. Rapid changes in the immunological profile post partum and consequent rebound of the inflammatory response may result in hepatic flares.
  
  
  METHODS
  Women with chronic hepatitis B were recruited during pregnancy into this observational study. Demographic and clinical data were collected together with virological and biochemical parameters at two time points during pregnancy (early and late) and two time points post partum (between 6 weeks and 12 weeks and at 12 months). Outcomes analysed included changes in HBV DNA, hepatitis B e antigen (HBeAg) status and flares of hepatitis.
  
  
  RESULTS
  One hundred and twenty-six women were recruited. Twenty-seven women out of 108 with postpartum bloods (25%) met our definition of a postpartum flare (ALT range 38-1654). Using univariate analysis HBeAg status, younger age, gravida and parity were associated with a flare. On multivariate analysis HBeAg positivity at baseline fell just outside of statistical significance in predicting a postpartum flare (p=0.051).
  
  
  CONCLUSIONS
  25% of women with chronic hepatitis B will demonstrate increased liver inflammation in the postpartum period. This is usually asymptomatic and resolves spontaneously. This is more likely if the woman is HBeAg-positive at baseline (2.56 times the risk), although flares also commonly occur in HBeAg-negative women.
authors.affiliation: Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Victoria, Australia Department of Infectious Diseases, the Royal Women's Hospital, Melbourne, Victoria, Australia Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Giles
authors.affiliation: Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia Department of Medicine, St. Vincents Hospital, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Kumar
authors.initials: K
authors.lastname: Visvanathan
authors.affiliation: Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Victoria, Australia Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Lewin
authors.affiliation: Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
authors.forename: Scott
authors.initials: S
authors.lastname: Bowden
authors.affiliation: Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Locarnini
authors.affiliation: Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Spelman
authors.affiliation: Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Victoria, Australia Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
authors.forename: Joe
authors.initials: J
authors.lastname: Sasadeusz
mesh_terms: D000328:Adult; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000821:virology*; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood* / Q000821:virology*; D011379:Prognosis; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000097:blood* / Q000821:virology*; D000067251:Symptom Flare Up
keywords: CHRONIC VIRAL HEPATITIS; HEPATITIS B; INFLAMMATION; LIVER DISEASE IN PREGNANCY