Just Accepted by The Journal of Maternal-Fetal & Neonatal Medicine Minimal adverse influence of maternal hepatitis B carrier status on perinatal outcomes and child's growth Jie Chen, Shu Zhang, Yi-Hua Zhou, Biyun Xu, and Yali Hu doi: 10.3109/14767058.2014.981805 Abstract

J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by Ondokuz Mayis Univ. on 11/05/14 For personal use only.

Objective: To clarify whether maternal HBsAg positivity may add risk for adverse neonatal outcomes and even affect child’s growth. Methods: The perinatal data and neonatal outcomes in 380 HBsAg-positive and 428 HBsAg-negative women delivered during 2002–2004 were investigated. Furthermore, 271 (71.3%) children of HBsAg-positive and 297 (69.4%) of HBsAg-negative mothers were followed at ages of 5–7 years. Child’s growth including weight, height, and health conditions were evaluated. Results: The prevalence of preterm birth was relatively higher in HBsAgpositive group (2.9% vs. 1.4%), but it failed to reach statistical significance (p = 0.140). There was no difference in other neonatal outcomes including stillbirth (0.5% vs. 0.2%), neonatal death (0.5% vs. 0.5%) and congenital malformation (0.8% vs. 1.4%). Logistic regression analyses demonstrated maternal HBsAg positivity had no adverse influence on neonatal outcomes. Abnormal health conditions, other than adverse neonatal outcomes, was identified in one child (0.3%) of HBsAg-positive mother and four children (0.9%) of HBsAg-negative mothers at follow-up (p = 0.444). No maternal death occurred in HBsAg-positive or -negative mothers. Conclusions: Maternal HBsAg carrier status does not add risk for adverse neonatal outcomes or child’s growth; therefore, heightening surveillance for adverse neonatal complications in HBV-infected pregnant women may be unnecessary.

© 2014 Informa UK Ltd. This provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. DISCLAIMER: The ideas and opinions expressed in the journal’s Just Accepted articles do not necessarily reflect those of Informa Healthcare (the Publisher), the Editors or the journal. The Publisher does not assume any responsibility for any injury and/or damage to persons or property arising from or related to any use of the material contained in these articles. The reader is advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each drug to be administered to verify the dosages, the method and duration of administration, and contraindications. It is the responsibility of the treating physician or other health care professional, relying on his or her independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient. Just Accepted articles have undergone full scientific review but none of the additional editorial preparation, such as copyediting, typesetting, and proofreading, as have articles published in the traditional manner. There may, therefore, be errors in Just Accepted articles that will be corrected in the final print and final online version of the article. Any use of the Just Accepted articles is subject to the express understanding that the papers have not yet gone through the full quality control process prior to publication.

Minimal adverse influence of maternal hepatitis B carrier status on perinatal outcomes and child's growth

J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by Ondokuz Mayis Univ. on 11/05/14 For personal use only.

Jie Chen1, Shu Zhang1, Yi-Hua Zhou2,3, Biyun Xu4, and Yali Hu1,3*

1

Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing Medical

University, Nanjing, China, 2Departments of Experimental Medicine and Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China, 3Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China, 4

Department of Biostatistics, Nanjing Drum Tower Hospital, Nanjing University Medical School,

Nanjing, China

Address for correspondence: Yali Hu, Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, 321 Zhongshan Road, Nanjing 210008, China. Tel.: +86-25-8330-4616 Ext. 66808. Fax: +86-25-8310-5998. E-mail: [email protected]

Short title: Maternal HBV infection and child’s healthy outcome

Keywords: Hepatitis B virus, pregnancy, neonatal outcome, child’s growth

1

Abstract Objective: To clarify whether maternal HBsAg positivity may add risk for adverse neonatal outcomes and even affect child’s growth. Methods: The perinatal data and neonatal outcomes in 380 HBsAg-positive and 428 HBsAg-

J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by Ondokuz Mayis Univ. on 11/05/14 For personal use only.

negative women delivered during 2002–2004 were investigated. Furthermore, 271 (71.3%) children of HBsAg-positive and 297 (69.4%) of HBsAg-negative mothers were followed at ages of 5–7 years. Child’s growth including weight, height, and health conditions were evaluated. Results: The prevalence of preterm birth was relatively higher in HBsAg-positive group (2.9% vs. 1.4%), but it failed to reach statistical significance (p = 0.140). There was no difference in other neonatal outcomes including stillbirth (0.5% vs. 0.2%), neonatal death (0.5% vs. 0.5%) and congenital malformation (0.8% vs. 1.4%). Logistic regression analyses demonstrated maternal HBsAg positivity had no adverse influence on neonatal outcomes. Abnormal health conditions, other than adverse neonatal outcomes, was identified in one child (0.3%) of HBsAg-positive mother and four children (0.9%) of HBsAg-negative mothers at follow-up (p = 0.444). No maternal death occurred in HBsAg-positive or -negative mothers. Conclusions: Maternal HBsAg carrier status does not add risk for adverse neonatal outcomes or child’s growth; therefore, heightening surveillance for adverse neonatal complications in HBVinfected pregnant women may be unnecessary.

2

Introduction Chronic hepatitis B virus (HBV) infection continues to be a major public health problem worldwide. The global seroprevalence of hepatitis B surface antigen (HBsAg) in childbearing women is still as high as 1.2–8.7% [1], although routine maternal HBsAg screening during

J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by Ondokuz Mayis Univ. on 11/05/14 For personal use only.

pregnancy and immunoprophylaxis with hepatitis B immune globulin (HBIG) and/or hepatitis B vaccine in infants are effective in preventing mother-to-child transmission of HBV [2]. Although several published studies focused on the impact of maternal HBsAg carrier status on pregnancy outcomes, data are still conflicting [3–11]. Some studies indicted maternal HBsAg positivity is associated with higher neonatal morbidity and mortality, such as preterm birth, stillbirth, low birth weight or macrosomia, and congenital malformations [3–5]; however, these studies partially or not adjusted at all for potential confounding factors such as socioeconomic status and maternal co-infection with hepatitis C [3,4], and potential bias on study subjects’ selection may be found [5]. Other investigations suggested maternal HBsAg positivity is not associated with adverse neonatal outcomes [6–10]. Nevertheless, most studies were conducted in low HBV-endemic areas (HBsAg prevalence 0.1–0.5%), and pregnant women enrolled were mainly black or white people [6,7]. Additionally, the effect produced by confounding variables was not prevented [8,9]. In this study, we compared neonatal outcomes between HBsAg-positive and HBsAg-negative pregnant women, to clarify whether maternal HBsAg positivity may add risk for adverse neonatal outcomes. Since the study enrolled pregnant women (mainly Han ethnicity) across Jiangsu Province, China (HBsAg prevalence 6.7%) [12], one of high endemic areas, and adjusted for

3

potential confounding factors, it would contribute to fulfilling the current gaps in knowledge of the impact of maternal HBsAg positivity on neonatal outcomes. Furthermore, since previous studies suggested maternal HBV infection was associated with adverse neonatal outcomes [3–5], in this study, we attempted to see whether it is also the same in

J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by Ondokuz Mayis Univ. on 11/05/14 For personal use only.

Chinese and clarify whether the influence is long-term, which has not been investigated. Thus, we further followed up the children above at 5–7-year-old, and compared children’s growth, including height, weight and health conditions.

Methods Study subjects During 2002–2004, in a study on the provincial prevalence of birth defects conducted in Jiangsu, China, 6 cities (urban) and 8 counties (rural areas) were selected as surveillance spots by stratified cluster sampling. All pregnant women at first trimester were enrolled and serum samples from 19 904 women at 15–20 weeks of gestation were collected and kept at –30°C [13]. The women selected above represented the pregnant women population in Jiangsu and all delivered their infants in hospitals. The data of antenatal examination and neonatal outcomes were recorded in a computerized database. Recently, we retrospectively tested HBV serologic markers in the 6398 sera, which had been randomly selected from above subjects, and found that 419 (6.55%) were defined to be chronically infected with HBV [12]. In this study, the 419 women and their 422 infants were recruited. Meanwhile, a similar number of HBsAg-negative pregnant women in each area were

4

selected as controls using stratified random sampling. Finally, 453 HBsAg-negative women and their 457 infants were enrolled. During 2009-2010, we invited above mothers and their children to participate in the follow-up study about the prevention of perinatal HBV transmission as well as the effect of maternal HBsAg positivity on the child’s growth [14].

J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by Ondokuz Mayis Univ. on 11/05/14 For personal use only.

This study was approved by the institutional review boards of Nanjing Drum Tower Hospital (ECXK200709) and Jiangsu Family Planning Institute (EC2008501). Since the pregnant women gave the written informed consent in the birth defect study [13], relevant data of the women and their neonates were used in this study via an exemption. In the follow-up study, all the women provided their written informed consent; mothers/fathers or guardians on the behalf of their children signed the written informed consent.

Data collection The obstetrical and perinatal information was recorded in the computer database [13]. Characteristics of each pregnant woman, including maternal age, height, weight, educational level and family income, gravidity and parity, and history of abnormal pregnancies, were retrieved. Perinatal information, including gestational age, delivery mode, birth weight and height, and neonatal complications such as preterm birth (

Minimal adverse influence of maternal hepatitis B carrier status on perinatal outcomes and child's growth.

To clarify whether maternal HBsAg positivity may add risk for adverse neonatal outcomes and even affect child's growth...
1MB Sizes 0 Downloads 4 Views