Maternal Hepatitis B Infection and Pregnancy Outcomes in the United States: A Population-Based Cohort Study.
Maternal Hepatitis B Infection and Pregnancy Outcomes in the United States: A Population-Based Cohort Study.
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DOI：
10.1093/ofid/ofy134
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发表时间：
2018-06
影响因子：
4.2
通讯作者：
Heffron R
中科院分区：
文献类型：
--
作者：
Bajema KL;Stankiewicz Karita HC;Tenforde MW;Hawes SE;Heffron R
在高度流行的环境中，妊娠期乙型肝炎病毒（HBV）感染与孕产妇和婴儿不良结局的风险相关，但这种关联在美国尚未得到很好的表征。我们在华盛顿州进行了一项基于人群的回顾性队列研究，使用了1992-2014年的相关出生证明和出院记录。在患有乙型肝炎的孕妇（n = 4391）和乙型肝炎阴性组（n = 22410）中，我们使用多变量logistic回归比较了妊娠期糖尿病、先兆子痫、子痫、前置胎盘、早产、低出生体重、小胎龄和大胎龄的风险。感染乙型肝炎的孕妇更可能是亚洲人（61%对8%，P < 0.001）、外国出生（76%对23%，P < 0.001）和年龄较大（77%对64%≥26岁，P < 0.001）。他们较少超重或肥胖（33% vs 50%, P < 0.001）。感染乙肝病毒的妇女发生小于胎龄婴儿的风险较低（校正RR [aRR]， 0.79； 95%可信区间[CI]， 0.67-0.93）。其他不良结局的风险在乙型肝炎感染和阴性妇女之间没有显著差异（妊娠糖尿病：aRR， 1.11; 95% CI, 0.92-1.34；先兆子痫：aRR， 1.06; 95% CI, 0.82-1.35；子痫：aRR， 2.31; 95% CI, 0.90-5.91；前置胎盘：aRR， 1.16; 95% CI, 0.35-3.84；早产：aRR， 1.15; 95% CI, 0.98-1.34；低出生体重：aRR， 1.08; 95% CI, 0.90-1.29；胎龄大：aRR， 1.01; 95% CI, 0.82-1.24）。在美国的低负担环境中，乙型肝炎感染与不良妊娠结局无关。
Hepatitis B virus (HBV) infection in pregnancy has been associated with risk of adverse maternal and infant outcomes in highly endemic settings, but this association is not well characterized in the United States. We conducted a retrospective population-based cohort study in Washington State using linked birth certificate and hospital discharge records from 1992–2014. Among pregnant women with hepatitis B (n = 4391) and a hepatitis B–negative group (n = 22 410), we compared the risk of gestational diabetes, pre-eclampsia, eclampsia, placenta previa, preterm delivery, low birthweight, small for gestational age, and large for gestational age using multivariate logistic regression. Hepatitis B–infected pregnant women were more likely to be Asian (61% vs 8%, P < .001), foreign-born (76% vs 23%, P < .001), and older in age (77% vs 64% ≥26 years, P < .001). They were less commonly overweight or obese (33% vs 50%, P < .001). There was a lower risk of small for gestational age infants among HBV-infected women (adjusted RR [aRR], 0.79; 95% confidence interval [CI], 0.67–0.93). The risk of other adverse outcomes was not significantly different between hepatitis B–infected and –negative women (gestational diabetes: aRR, 1.11; 95% CI, 0.92–1.34; pre-eclampsia: aRR, 1.06; 95% CI, 0.82–1.35; eclampsia: aRR, 2.31; 95% CI, 0.90–5.91; placenta previa: aRR, 1.16; 95% CI, 0.35–3.84; preterm delivery: aRR, 1.15; 95% CI, 0.98–1.34; low birth weight: aRR, 1.08; 95% CI, 0.90–1.29; large for gestational age: aRR, 1.01; 95% CI, 0.82–1.24). In a low-burden setting in the United States, hepatitis B infection was not associated with adverse pregnancy outcomes.
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