Hepatitis
B Exacerbation May Occur in Women after Giving Birth
During
pregnancy, several alterations in immune function allow mothers to tolerate the
genetically different fetus. These changes can potentially influence the status
of various diseases.
As reported in the January 2008 Journal of Viral
Hepatitis, researchers in the Netherlands investigated the evolution of liver
disease during and after pregnancy in women with chronic
hepatitis B patients. Findings
•
Between
1998 and 2006 at their clinic, 31 chronic hepatitis B surface antigen (HBsAg)
positive women had 38 pregnancies.
•
24
women (63%) were hepatitis B "e" antigen (HBeAg) positive and the rest
(37%) were HBeAg negative.
•
In 13 pregnancies (34%), the
women started taking lamivudine (Epivir-HBV)
during the last trimester to lower HBV DNA levels and reduce the risk of vertical
transmission to their infants.
•
In
17 of 38 pregnancies (45%), a significant increase in liver disease activity was
observed after delivery, defined as a 3-fold increase in alanine aminotransferase
(ALT) within 6 months after giving birth.
•
Among
women treated with lamivudine during the last trimester, 8 of 13 women (62%) still
experienced such exacerbations.
•
The
median maximal ALT elevation in these exacerbations was 4.0 times the upper limited
of normal (ULN); none led to decompensated liver disease.
•
It
was not possible to predict during pregnancy which women would experience liver
disease exacerbations on the basis of HBV DNA level, ALT level, HBeAg status,
or any other characteristic.
Conclusion
In
conclusion, the authors wrote, "a significant increase in liver inflammation
occurs often after pregnancy."
"This may be due to a reactivation
of the immune system after delivery," they suggested. "Based on our
data, we recommend monitoring closely and if necessary treating women with chronic
HBV shortly after delivery."
01/25/08
Reference MJ
Ter Borg, WF Leemans, RA de Man, and others. Exacerbation of chronic hepatitis
B infection after delivery. Journal of Viral Hepatitis 15(1): 37-41. January
2008.
