Association of gestational hepatitis B virus infection and antiviral therapy with pregnancy outcomes: A retrospective study

Abstract Objective To explore the relationships between gestational hepatitis B virus (HBV) infection, antiviral therapy, and pregnancy outcomes. Methods We retrospectively selected hepatitis B surface antigen (HBsAg)‐positive pregnant women hospitalized for delivery at Fujian Medical University Affiliated Hospital from October 1, 2016 to October 1, 2020. The control group included randomly selected healthy pregnant women hospitalized for delivery during the same time. Results Overall, 1115 participants were enrolled and grouped into control ( n = 380) and HBsAg‐positive groups ( n = 735), which were further divided into groups I ( n = 407; low viral load), II ( n = 207; high viral load without antiviral therapy), and III ( n = 121; high viral load with antiviral therapy). Pregnant women with HBV were positively correlated with the incidence of intrahepatic cholestasis of pregnancy (ICP) (adjusted odds ratio [aOR] 5.1, 95% confidence interval [CI] 2.62–9.92, P < 0.001), neonatal jaundice (aOR 10.56, 95% CI 4.49–24.83, P < 0.001), and neonatal asphyxia (aOR 5.03, 95% CI 1.46–17.27, P = 0.01). Aspartate aminotransferase (AST) greater than the upper limit of normal (ULN) was an independent risk factor for increased ICP incidence (aOR 3.49, 95% CI 1.26–9.67, P = 0.019). Antiviral therapy considerably reduced HBV DNA and improved liver function. High viral load and antiviral therapy did not correlate significantly with adverse pregnancy outcomes ( P < 0.05). Conclusion Pregnant women with HBV have significantly elevated incidence of ICP, neonatal jaundice, and neonatal asphyxia not significantly correlated with viral load. AST greater than ULN independently increases the risk of ICP. Antiviral therapy effectively reduces viral replication and improves liver function without increasing the risk of adverse outcomes.