title: Serum Alanine Aminotransferase and Hepatitis B DNA Flares in Pregnant and Postpartum Women with Chronic Hepatitis B.
abstract: Alterations in the immune system during pregnancy have been associated with reactivation of hepatitis B virus (HBV) in chronic hepatitis B (CHB) women. However, the effects of pregnancy on CHB remain not well understood. The goal of this study was to examine flares in HBV DNA and serum alanine aminotransferase (ALT) during pregnancy and postpartum in CHB women untreated prior to pregnancy.
  
  
  
  This was a multicenter retrospective study of 113 pregnancies in 101 CHB women who presented during pregnancy at two community gastroenterology clinics and two tertiary medical centers in the United States during 1997-2015. Outcomes analyzed included onset, severity, and resolution of flares in HBV and ALT that occurred prior to starting antiviral therapy, if antiviral therapy was subsequently initiated. Women who initiated antiviral therapy during pregnancy were not included in the analysis of postpartum flares.
  
  
  
  HBV DNA flares were observed in 9% (8/90) of women during pregnancy and 4% (2/48) of women during postpartum. Flares in ALT (99-2522 U/l) were observed in 6% (7/112) of women during pregnancy and 10% (5/51) of women within the first 3 months of delivery. Age, HBeAg positivity, baseline HBV DNA, baseline ALT, gravida, and parity were not found to be significant predictors of flare.
  
  
  
  Flares in HBV DNA and ALT can occur during late pregnancy and early postpartum in CHB women, and can be severe. Women with CHB should therefore be closely monitored during pregnancy and early postpartum.
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA.|University of California, Los Angeles School of Medicine, Los Angeles, California, USA.
authors.forename: Christine Y
authors.initials: CY
authors.lastname: Chang
authors.affiliation: Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Natali
authors.initials: N
authors.lastname: Aziz
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Mugilan
authors.initials: M
authors.lastname: Poongkunran
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Asad
authors.initials: A
authors.lastname: Javaid
authors.affiliation: San Jose Gastroenterology, San Jose, California, USA.
authors.forename: Huy N
authors.initials: HN
authors.lastname: Trinh
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Daryl
authors.initials: D
authors.lastname: Lau
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA.
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D000998:Antiviral Agents / Q000627:therapeutic use; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000188:drug therapy; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood* / Q000188:drug therapy; D011644:Puerperal Disorders / Q000097:blood* / Q000188:drug therapy; D012189:Retrospective Studies; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000410:Alanine Transaminase