Maternal Hepatitis B Infection Burden, Comorbidity and Pregnancy Outcome in a Low-Income Population on the Myanmar-Thailand Border: A Retrospective Cohort Study
Bierhoff, Marieke; Angkurawaranon, Chaisiri; Myat Min, Aung; Gilder, Mary Ellen; Win Tun, Nay; Keereevijitt, Arunrot; Kyi Win, Aye; Win, Elsi; Carrara, Verena Ilona; Brummaier, Tobias; Chu, Cindy S; Thielemans, Laurence; Sriprawat, Kanlaya; Hanboonkunupakarn, Borimas; Rijken, Marcus; Nosten, François; van Vugt, Michele; McGready, Rose
(2019) Early Pregnancy [E], volume 2019
(Article)
Abstract
Objectives: Hepatitis B virus (HBV) was believed to have minimal impact on pregnancy outcomes apart from the risk of perinatal transmission. In more recent years, there have been reports of adverse associations, most consistently preterm birth (PTB), but this is in the context of high rates of caesarean section. The
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aim of this study was to explore the association of HBV on pregnancy outcomes in marginalized, low-income populations on the Myanmar-Thailand border. Methods: HBsAg positive (+) point of care rapid detection tests results were confirmed by immunoassays. Women with a confirmed HBsAg status, HIV- and syphilis-negative at first antenatal care screening, singleton fetus and known pregnancy outcome (Aug-2012 to Dec-2016) were included. Logistic regression analysis was used to evaluate associations between HBV group (controls HBsAg negative, HBsAg+/HBeAg-, or HBsAg+/HBeAg+) and pregnancy outcome and comorbidity. Results: Most women were tested, 15,046/15,114 (99.6%) for HBV. The inclusion criteria were not met for 4,089/15,046 (27.2%) women due mainly to unavailability of pregnancy outcome and nonconfirmation of HBsAg+. In evaluable women 687/11,025 (6.2%) were HBsAg+, with 476/11,025 (4.3%) HBsAg+/HBeAg- and 211/11,025 (1.9%) were HBsAg+/HBeAg+. The caesarean section rate was low at 522/8,963 (5.8%). No significant associations were observed between pregnancy comorbidities or adverse pregnancy outcomes and HBV status. Conclusions: The results highlight the disease burden of HBV in women on the Myanmar-Thailand border and support original reports of a lack of significant associations with HBsAg+ irrespective of HBeAg status, for comorbidity, and pregnancy outcomes in deliveries supervised by skilled birth attendants.
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Keywords: Obstetrics and Gynaecology, Journal Article
ISSN: 1537-6583
Publisher: Society for the Investigation of Early Pregnancy
Note: Funding Information: T his study was funded as part of the Wellcome-Trust Major Overseas Program in Southeast Asia (grant number: 106698/ Z/14/Z). Without the pregnant women, and cooperation between the departments at SMRU, this work would not have been possible. Special thanks are due to the counselors at antenatal care who are skilled in multiple languages and proactive in encouraging pregnant women to uptake testing and for posttest counseling. Thanks to the cleaners, logistic staff, drivers, nurses, health assistants, doctors, medics, midwives, nurses, and IT team for providing round the clock care for 365 days per year at each of the SMRU clinics. Thanks are due to Luuk Gras for his statistical advice and to Judith Recht for revision of the manuscript. Publisher Copyright: © 2019 Marieke Bierhoff et al. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
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