Prevalence and outcomes of hepatic flare in hepatitis B carriers during pregnancy

Introduction: The aim of this study was to examine the prevalence and severity of hepatic flare among pregnant women with chronic hepatitis B (CHB) and to assess pregnancy and neonatal outcomes. Methods: Records of all hepatitis B surface antigen-positive pregnant women who had their first antenatal visit between January 2017 and December 2018 and had a live birth in the Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong were retrospectively reviewed. Hepatic flare was defined as an alanine aminotransferase (ALT) ≥2 times the upper limit of normal, which is 19 U/L for females. Pregnancy and neonatal outcomes between those with and without hepatic flare were compared. Results: 6.3% of pregnant women with CHB had hepatic flare, with ALT level ranging from 39 to 179 IU/L. None of the women had hyperbilirubinemia or liver failure. In those with hepatic flare, the median hepatitis B virus DNA level was 5.77 log10 IU/mL. The rate of postpartum haemorrhage was higher in those with hepatic flare (19.4% vs 10.8%, p=0.024). Conclusion: 6.3% of pregnant women with CHB had hepatic flare. The rate of postpartum haemorrhage was higher in those with hepatic flare. Monitoring of liver function is recommended in pregnant women with CHB and hepatic flare.