Postpartum hepatitis flares in mothers with chronic hepatitis B infection  

作　　者：Shi OuYang Yawen Geng Gongqin Qiu Yueying Deng Haitao Deng Calvin Q.Pan 

机构地区：[1]Department of Infectious Diseases,Key Laboratory of Biological Targeting Diagnosis,Therapy,and Rehabilitation of Guangdong Higher Education Institutes,The Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong,P.R.China [2]School of Public Health,North China University of Science and Technology,Tangshan,Hebie,P.R.China [3]Division of Gastroenterology and Hepatology,Department of Medicine,NYU Langone Health,New York University Grossman School of Medicine,New York,NY,USA

出　　处：《Gastroenterology Report》2024年第1期719-730,共12页胃肠病学报道(英文)

基　　金：supported by the“Belt and Road”Innovative Talent Exchange Project for Foreign Experts,sponsored by the Ministry of Science and Technology,China(G2022030048L);science and technology innovation strategy special fund project of Guangdong Province(pdjh2023b0433);undergraduate capacity enhancement innovation project of Guangzhou Province(2022JXA003).

摘　　要：Postpartum elevation of alanine aminotransferase(ALT)in mothers with chronic hepatitis B(CHB)presents a significant clinical challenge.However,the existing literature demonstrates inconsistencies regarding its incidence and predictors in mothers infected with the hepatitis B virus(HBV).Recent advancements in antiviral prophylaxis against mother-to-child transmission of HBV and postpartum cessation of antiviral therapy further complicate this issue.Our literature review,spanning PubMed,and two Chinese-language databases(CNKI and Wanfang)from 1 January 2000 to 31 December 2023 aimed to consolidate and analyse available data on the frequency and severity of postpartum ALT flares,identify risk factors,and propose a management algorithm.Data from 23 eligible studies involving 8,077 pregnant women revealed an overall incidence of postpartum ALT elevation:25.7%for mild cases,4.4%for moderate cases,and 1.7%for severe cases.In the subgroup of mothers who were HBeAg-positive and on antiviral prophylaxis for preventing mother-to-child transmission,postpartum intermediate and severe ALT elevations were reported with pooled rates of 5.9%and 0.8%,respectively.Importantly,none resulted in mortality or necessitated liver transplantation.Identified risk factors for postpartum ALT flares in mothers with CHB included HBV DNA levels,ALT levels during pregnancy,postpartum cessation of antiviral treatment,and HBeAg status.By leveraging this evidence and recent data on predictors of intermediate or severe postpartum ALT flares,we propose a risk-stratified algorithm for managing postpartum ALT elevation and selecting therapy in mothers with CHB,tailoring different approaches for treatment-naive vs treatment-experienced populations.These recommendations aim to provide guidance for clinical decision-making and enhance patient outcomes.

关 键 词：HBV hepatitis flares ALT elevation liver inflammation disease activation 

分 类 号：R51[医药卫生—内科学]