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Open Access 01-07-2017 | PERINATAL EPIDEMIOLOGY

Pregnancy outcome in more than 5000 births to women with viral hepatitis: a population-based cohort study in Sweden

Authors: Knut Stokkeland, Jonas Filip Ludvigsson, Rolf Hultcrantz, Anders Ekbom, Jonas Höijer, Matteo Bottai, Olof Stephansson

Published in: European Journal of Epidemiology | Issue 7/2017

Abstract

Previous studies have shown inconsistent results with respect to hepatitis B (HBV), hepatitis C (HCV) and pregnancy outcome. The aim of this study was to investigate pregnancy outcome in women with HBV or HCV. In a nationwide cohort of births between 2001 and 2011 we investigated the risks of adverse pregnancy outcomes in 2990 births to women with HBV and 2056 births to women with HCV using data from Swedish healthcare registries. Births to women without HBV (n = 1090 979), and births without HCV (n = 1091 913) served as population controls. Crude and adjusted relative risks (aRR) were calculated using Poisson regression analysis. Women with HCV were more likely to smoke (46.7 vs. 8.0%) and to have alcohol dependence (18.9 vs. 1.3%) compared with population controls. Most women with HBV were born in non-Nordic countries (91.9%). Maternal HCV was associated with a decreased risk of preeclampsia (aRR: 0.39, 95% CI: 0.24–0.64), but an increased risk of preterm birth (aRR: 1.32, 95% CI: 1.08–1.60) and late neonatal death (7–27 days: aRR: 3.79, 95% CI: 1.07–13.39) Preterm birth were also more common in mothers with HBV, aRR: 1.21 (95% CI: 1.02–1.45). Both HBV and HCV are risk factors for preterm birth, while HCV seems to be associated with a decreased risk for preeclampsia. Future studies should corroborate these findings.

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http://www.who.int/mediacentre/factsheets/fs164/en/. 2017. Accessed 9 Jan 2017.

http://www.who.int/mediacentre/factsheets/fs204/en/. WHO. 2017. Accessed 9 Jan 2017.

https://www.folkhalsomyndigheten.se/folkhalsorapportering-statistik/statistikdatabaser-och-visualisering/sjukdomsstatistik/hepatit-c/. The Public Health Agency of Sweden. 2017. Accessed 9 Jan 2017.

https://www.folkhalsomyndigheten.se/folkhalsorapportering-statistik/statistikdatabaser-och-visualisering/sjukdomsstatistik/hepatit-b/. The Public Health Agency of Sweden. 2017. Accessed 9 Jan 2017.

Tang CM, Yau TO, Yu J. Management of chronic hepatitis B infection: current treatment guidelines, challenges, and new developments. World J Gastroenterol WJG. 2014;20(20):6262–78. doi:10.3748/wjg.v20.i20.6262.CrossRefPubMed

Reddick KL, Jhaveri R, Gandhi M, James AH, Swamy GK. Pregnancy outcomes associated with viral hepatitis. J Viral Hepat. 2011;18(7):e394–8. doi:10.1111/j.1365-2893.2011.01436.x.CrossRefPubMed

Safir A, Levy A, Sikuler E, Sheiner E. Maternal hepatitis B virus or hepatitis C virus carrier status as an independent risk factor for adverse perinatal outcome. Liver Int Off J Int Assoc Study Liver. 2010;30(5):765–70. doi:10.1111/j.1478-3231.2010.02218.x.CrossRef

Tse KY, Ho LF, Lao T. The impact of maternal HBsAg carrier status on pregnancy outcomes: a case–control study. J Hepatol. 2005;43(5):771–5. doi:10.1016/j.jhep.2005.05.023.CrossRefPubMed

Lao TT, Sahota DS, Cheng YK, Law LW, Leung TY. Maternal hepatitis B surface antigen status and incidence of pre-eclampsia. J Viral Hepat. 2013;20(5):343–9. doi:10.1111/jvh.12037.CrossRefPubMed

10.

Wong S, Chan LY, Yu V, Ho L. Hepatitis B carrier and perinatal outcome in singleton pregnancy. Am J Perinatol. 1999;16(9):485–8.CrossRefPubMed

11.

Lobstein S, Faber R, Tillmann HL. Prevalence of hepatitis B among pregnant women and its impact on pregnancy and newborn complications at a tertiary hospital in the eastern part of Germany. Digestion. 2011;83(1–2):76–82. doi:10.1159/000320455.CrossRefPubMed

12.

Sirilert S, Traisrisilp K, Sirivatanapa P, Tongsong T. Pregnancy outcomes among chronic carriers of hepatitis B virus. Int J Gynaecol Obstet Off Organ of the Int Fed Gynaecol Obstet. 2014;126(2):106–10. doi:10.1016/j.ijgo.2014.02.019.CrossRef

13.

To WW, Cheung W, Mok KM. Hepatitis B surface antigen carrier status and its correlation to gestational hypertension. Aust N Z J Obstet Gynaecol. 2003;43(2):119–22.CrossRefPubMed

14.

Connell LE, Salihu HM, Salemi JL, August EM, Weldeselasse H, Mbah AK. Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes. Liver Int Off J Int Assoc Study Liver. 2011;31(8):1163–70. doi:10.1111/j.1478-3231.2011.02556.x.CrossRef

15.

Pergam SA, Wang CC, Gardella CM, Sandison TG, Phipps WT, Hawes SE. Pregnancy complications associated with hepatitis C: data from a 2003–2005 Washington state birth cohort. Am J Obstet Gynecol. 2008;199:38.e1–9. doi:10.1016/j.ajog.2008.03.052.CrossRef

16.

Cnattingius S, Ericson A, Gunnarskog J, Kallen B. A quality study of a medical birth registry. Scand J Soc Med. 1990;18(2):143–8.CrossRefPubMed

17.

Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A. The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol. 2009;24(11):659–67. doi:10.1007/s10654-009-9350-y.CrossRefPubMedPubMedCentral

18.

Ludvigsson JF, Andersson E, Ekbom A, et al. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450. doi:10.1186/1471-2458-11-450.CrossRefPubMedPubMedCentral

19.

Marsal K, Persson PH, Larsen T, Lilja H, Selbing A, Sultan B. Intrauterine growth curves based on ultrasonically estimated foetal weights. Acta paediatrica (Oslo, Norway: 1992). 1996;85(7):843-8.

20.

Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6. doi:10.1093/aje/kwh090.CrossRefPubMed

21.

Floreani A, Paternoster D, Zappala F, et al. Hepatitis C virus infection in pregnancy. Br J Obstet Gynaecol. 1996;103(4):325–9.CrossRefPubMed

22.

Jabeen T, Cannon B, Hogan J, et al. Pregnancy and pregnancy outcome in hepatitis C type 1b. QJM Monthly J Assoc Phys. 2000;93(9):597–601.

23.

Hillemanns P, Langenegger P, Langer BC, Knitza R, Hasbargen U, Hepp H. Prevalence and follow-up of hepatitis C virus infection in pregnancy. Z Geburtshilfe Neonatol. 1998;202(3):127–30.PubMed

24.

Roberts CL, Ford JB, Algert CS, Antonsen S, Chalmers J, Cnattingius S, Gokhale M, Kotelchuck M, Melve KK, Langridge A, Morris C, Morris JM, Nassar N, Norman JE, Norrie J, Sørensen HT, Walker R, Weir CJ. Population-based trends in pregnancy hypertension and pre-eclampsia: an international comparative study. BMJ Open. 2011;. doi:10.1136/bmjopen-2011-000101.

25.

Levine RJ, Maynard SE, Qian C, et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004;350(7):672–83. doi:10.1056/NEJMoa031884.CrossRefPubMed

26.

Hirokoshi K, Maeshima Y, Kobayashi K, et al. Increase of serum angiopoietin-2 during pregnancy is suppressed in women with preeclampsia. Am J Hypertens. 2005;18(9 Pt 1):1181–8. doi:10.1016/j.amjhyper.2005.03.745.CrossRefPubMed

27.

Talaat RM. Soluble angiogenesis factors in sera of Egyptian patients with hepatitis C virus infection: correlation with disease severity. Viral Immunol. 2010;23(2):151–7. doi:10.1089/vim.2009.0089.CrossRefPubMed

28.

Rodriguez-Munoz Y, Martin-Vilchez S, Lopez-Rodriguez R, et al. Preliminary evidence of sustained expression of angiopoietin-2 during monocyte differentiation in chronic hepatitis C. Liver Int Off J Int Assoc Study Liver. 2013;33(6):864–70. doi:10.1111/liv.12125.

29.

Hillemanns P, Dannecker C, Kimmig R, Hasbargen U. Obstetric risks and vertical transmission of hepatitis C virus infection in pregnancy. Acta Obstet Gynecol Scand. 2000;79(7):543–7.CrossRefPubMed

30.

Dunkelberg JC, Berkley EM, Thiel KW, Leslie KK. Hepatitis B and C in pregnancy: a review and recommendations for care. J Perinatol. 2014;34(12):882–91. doi:10.1038/jp.2014.167.CrossRefPubMedPubMedCentral

31.

Lee SM, Park JS, Norwitz ER, et al. Mid-trimester amniotic fluid pro-inflammatory biomarkers predict the risk of spontaneous preterm delivery in twins: a retrospective cohort study. J Perinatol. 2015;. doi:10.1038/jp.2015.29.

32.

Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371(9606):75–84. doi:10.1016/s0140-6736(08)60074-4.CrossRefPubMed

33.

Huang QT, Huang Q, Zhong M, et al. Chronic hepatitis C virus infection is associated with increased risk of preterm birth: a meta-analysis of observational studies. J Viral Hepat. 2015;22(12):1033–42. doi:10.1111/jvh.12430.CrossRefPubMed

34.

Stephansson O, Larsson H, Pedersen L, et al. Congenital abnormalities and other birth outcomes in children born to women with ulcerative colitis in Denmark and Sweden. Inflamm Bowel Dis. 2011;17(3):795–801. doi:10.1002/ibd.21369.CrossRefPubMed

35.

Stephansson O, Larsson H, Pedersen L, et al. Crohn’s disease is a risk factor for preterm birth. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2010;8(6):509–15. doi:10.1016/j.cgh.2010.02.014.

36.

Stokkeland K, Ebrahim F, Hultcrantz R, Ekbom A, Stephansson O. Mothers with alcoholic liver disease and the risk for preterm and small-for-gestational-age birth. Alcohol Alcoholism. 2013;48(2):166–71. doi:10.1093/alcalc/ags122.CrossRefPubMed

37.

Carlens C, Jacobsson L, Brandt L, Cnattingius S, Stephansson O, Askling J. Perinatal characteristics, early life infections and later risk of rheumatoid arthritis and juvenile idiopathic arthritis. Ann Rheum Dis. 2009;68(7):1159–64. doi:10.1136/ard.2008.089342.CrossRefPubMed

38.

Hagstrom H, Hoijer J, Ludvigsson JF, et al. Adverse outcomes of pregnancy in women with non-alcoholic fatty liver disease. Liver Int Off J Int Assoc Study Liver. 2015;. doi:10.1111/liv.12902.

39.

Stokkeland K, Ludvigsson JF, Hultcrantz R, et al. Increased risk of preterm birth in women with autoimmune hepatitis—a nationwide cohort study. Liver Int Off J Int Assoc Study Liver. 2015;. doi:10.1111/liv.12901.

40.

Aliyu MH, Lynch O, Belogolovkin V, Zoorob R, Salihu HM. Maternal alcohol use and medically indicated vs. spontaneous preterm birth outcomes: a population-based study. Eur J Pub Health. 2010;20(5):582–7. doi:10.1093/eurpub/ckq036.CrossRef

41.

Odendaal HJ, Steyn DW, Elliott A, Burd L. Combined effects of cigarette smoking and alcohol consumption on perinatal outcome. Gynecol Obstet Invest. 2009;67(1):1–8. doi:10.1159/000150597.CrossRefPubMed

42.

O’Leary CM, Nassar N, Kurinczuk JJ, Bower C. The effect of maternal alcohol consumption on fetal growth and preterm birth. BJOG Int J Obstet Gynaecol. 2009;116(3):390–400. doi:10.1111/j.1471-0528.2008.02058.x.CrossRef

43.

Mullally A, Cleary BJ, Barry J, Fahey TP, Murphy DJ. Prevalence, predictors and perinatal outcomes of peri-conceptional alcohol exposure–retrospective cohort study in an urban obstetric population in Ireland. BMC Pregnancy Childbirth. 2011;11:27. doi:10.1186/1471-2393-11-27.CrossRefPubMedPubMedCentral

44.

Albertsen K, Andersen AM, Olsen J, Gronbaek M. Alcohol consumption during pregnancy and the risk of preterm delivery. Am J Epidemiol. 2004;159(2):155–61.CrossRefPubMed

45.

Mei-Dan E, Walfisch A, Weisz B, Hallak M, Brown R, Shrim A. The unborn smoker: association between smoking during pregnancy and adverse perinatal outcomes. J Perinat Med. 2014;. doi:10.1515/jpm-2014-0299.

46.

Wei J, Liu CX, Gong TT, Wu QJ, Wu L. Cigarette smoking during pregnancy and preeclampsia risk: a systematic review and meta-analysis of prospective studies. Oncotarget. 2015;6(41):43667–78. doi:10.18632/oncotarget.6190.CrossRefPubMedPubMedCentral

Title: Pregnancy outcome in more than 5000 births to women with viral hepatitis: a population-based cohort study in Sweden
Authors: Knut Stokkeland
Jonas Filip Ludvigsson
Rolf Hultcrantz
Anders Ekbom
Jonas Höijer
Matteo Bottai
Olof Stephansson
Publication date: 01-07-2017
Publisher: Springer Netherlands
Published in: European Journal of Epidemiology / Issue 7/2017
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI: https://doi.org/10.1007/s10654-017-0261-z

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Springer Medicine

Pregnancy outcome in more than 5000 births to women with viral hepatitis: a population-based cohort study in Sweden

Abstract

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Springer Medicine

Abstract

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