Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth: a population-based cohort study
Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth: a population-based cohort study
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DOI：
10.1016/s2214-109x(17)30142-0
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发表时间：
2017-06-01
影响因子：
34.3
通讯作者：
Zhang, Yiping
中科院分区：
文献类型：
--
作者：
Liu, Jue;Zhang, Shikun;Zhang, Yiping
背景：早产是5岁以下儿童死亡的主要原因。发达国家的大型队列研究表明，产妇乙型肝炎病毒感染与早产有关，但中国和其他发展中国家的可靠证据很少，这些国家的乙型肝炎病毒患病率为中等或高。因此，我们设计了这项研究，以调查孕前乙型肝炎病毒感染与早产和早产风险之间的关系。方法2010年1月1日至2012年12月31日，我们对参加国家免费孕前健康检查项目的中国220个县的489 965名21-49岁的农村单胎妇女进行了基于人群的队列研究。根据孕前乙肝病毒感染情况，将参与者分为三组：未感染乙肝病毒的妇女（对照组），HBsAg阳性和HBeAg阴性的妇女（暴露组1），HBsAg和HBeAg均阳性的妇女（暴露组2）。主要结局是早产（妊娠少于37周）。我们使用对数二项回归来估计妊娠前感染乙型肝炎病毒的妇女早产的调整风险比（aRR）和早期早产的风险（妊娠少于34周）。489 965名妇女符合纳入标准并纳入本研究；其中20827人（4.3%）感染乙型肝炎病毒。与未感染乙型肝炎病毒的妇女相比，HBsAg阳性和HBeAg阴性的妇女早产风险高26% (aRR 1.26, 95% CI 1.18-1.34)， HBsAg和HBeAg均阳性的妇女早产风险高20% （aRR 1.20, 1.08-1.32）。与未感染乙型肝炎病毒的妇女相比，HBsAg阳性和HBeAg阴性的妇女早期早产的风险高出18%（妊娠少于34周；aRR为1.18,1.04-1.34），HBsAg和HBeAg均阳性的妇女早期早产的风险高出34% （aRR为1.34,1.10-1.61）。孕妇孕前乙型肝炎病毒感染与早产和早产风险升高独立相关。根据基线特征，这些关联在参与者亚组中相似。除母婴传播外，感染乙型肝炎病毒的妇女发生早产的风险也不容忽视。侧重于怀孕前早期发现乙型肝炎病毒感染并为怀孕前和怀孕期间感染乙型肝炎病毒的妇女提供适当医疗干预的综合方案将有助于改善孕产妇和新生儿结局并降低儿童死亡率。
Background Preterm birth is the leading cause of child death in children younger than 5 years. Large cohort studies in developed countries have shown that maternal hepatitis B virus infection is associated with preterm birth, but there is little reliable evidence from China and other developing countries, where hepatitis B virus prevalence is intermediate or high. Hence, we designed this study to investigate the association between pre-pregnancy hepatitis B virus infection and risk of preterm and early preterm birth.Methods Between Jan 1, 2010, and Dec 31, 2012, we did a population-based cohort study using data from 489 965 rural women aged 21-49 years who had singleton livebirths from 220 counties of China who participated in the National Free Preconception Health Examination Project. Participants were divided into three groups according to their prepregnancy status of hepatitis B virus infection: women uninfected with hepatitis B virus (control group), women who were HBsAg positive and HBeAg negative (exposure group 1), and women who were both HBsAg and HBeAg positive (exposure group 2). The primary outcome was preterm birth (gestation at less than 37 weeks). We used log-binomial regression to estimate adjusted risk ratios (aRR) of preterm birth for women with pre-pregnancy hepatitis B virus infection, and risk of early preterm birth (gestation less than 34 weeks).Findings 489 965 women met inclusion criteria and were included in this study; of these, 20 827 (4.3%) were infected with hepatitis B virus. Compared with women who were not infected with hepatitis B virus, women who were HBsAg positive and HBeAg negative had a 26% higher risk of preterm birth (aRR 1.26, 95% CI 1.18-1.34) and women who were both HBsAg and HBeAg positive had a 20% higher risk of preterm birth (aRR 1.20, 1.08-1.32). Compared with women who were not infected with hepatitis B virus, women who were HBsAg positive and HBeAg negative manifested an 18% higher risk of early preterm birth (gestation less than 34 weeks; aRR 1.18, 1.04-1.34) and women who were both HBsAg and HBeAg positive had a 34% higher risk of early preterm birth (aRR 1.34, 1.10-1.61). Maternal pre-pregnancy hepatitis B virus infection was independently associated with higher risk of preterm birth and early preterm birth. These associations were similar in subgroups of participants as defined by baseline characteristics.Interpretation Besides mother-to-child transmission, the risk of preterm birth in women infected with hepatitis B virus should not be neglected. Comprehensive programmes that focus on early detection of hepatitis B virus infection before pregnancy and provide appropriate medical intervention for women infected with hepatitis B virus before and during pregnancy would be helpful in improving maternal and neonatal outcomes and reducing child mortality.