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      Effects of maternal hepatitis B surface antigen positive status on the pregnancy outcomes: A retrospective study in Xiamen, China, 2011-2018

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          Abstract

          Objective

          Hepatitis B virus infection is a major social and economic burden in developing countries, especially in China. We aimed to evaluate the effects of hepatitis B surface antigen (HBsAg) positive status on the pregnancy outcomes in the Chinese population.

          Methods

          This retrospective cohort study was performed using data from the Medical Birth Registry of Xiamen, China, from January 2011 to March 2018. Multivariate logistic regression analysis was used to assess the association between the HBsAg status and pregnancy outcomes.

          Results

          This study included 3,789 HBsAg-positive women and 29, 648 non-exposed women. The HBsAg-positive pregnant women were slightly older in age (29.3±4.3 vs. 28.9±4.4, P< 0.001). Additionally, pregnant women with a positive HBsAg status had higher odds of gestational diabetes mellitus (GDM) (adjusted odds ratio [aOR], 1.13; 95% confidence interval [CI], 1.03–1.23), and cesarean delivery (aOR, 1.12; 95%CI, 1.03–1.21). The risk of infants being large or small-for-gestational age, having low-birth weight, and of macrosomia, preterm birth, and stillbirth did not differ significantly between the HBsAg-positive and–negative women.

          Conclusion

          In Xiamen, China, the slightly higher risk of GDM and cesarean section in women positive for HBsAg should not be neglected. Further studies should be conducted to evaluate the effects of HBsAg positivity on the pregnancy outcomes in different ethnic populations.

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          Most cited references21

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          Birth weight and adult hypertension, diabetes mellitus, and obesity in US men.

          Low birth weight has been associated with several chronic diseases in adults, including hypertension, diabetes mellitus, and obesity. Further study of these diseases in a large cohort with information on a wide variety of risk factors is essential to determine more precisely the risks associated with birth weight. We examined the relation between birth weight and cumulative incidence of adult hypertension, incidence of non-insulin-dependent diabetes mellitus, and prevalence of obesity in a cohort of 22,846 US men (Health Professionals Follow-up Study). Birth weights, medical histories, family histories, and other factors were collected by biennial mailed questionnaires. Logistic regression was used to examine the association between birth weight and these chronic adult diseases. Low birth weight was associated with an increased risk of hypertension and diabetes; high birth weight was associated with an increased risk of obesity. Compared with men in the referent birth weight category (7.0 to 8.4 lb), men who weighed or = 10.0 lb was 2.08 (95% CI, 1.73 to 2.50). These findings support the hypothesis that early life exposures, for which birth weight is a marker, are associated with several chronic diseases in adulthood.
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            Pregnancy outcomes associated with viral hepatitis.

            The aim of this study was to examine the contribution of hepatitis B virus (HBV) and hepatitis C virus (HCV) to pregnancy-related complications including gestational diabetes mellitus (GDM), preterm birth (PTB), intrauterine growth restriction (IUGR), pre-eclampsia, antepartum haemorrhage and cholestasis. The Nationwide Inpatient Sample was queried for all pregnancy-related discharges, pregnancy complications and viral hepatitis from 1995 to 2005. Logistic regression was used to examine the association between HBV, HCV, HBV + HCV and pregnancy-related complications including GDM, PTB, IUGR, pre-eclampsia, antepartum haemorrhage, cholestasis and caesarean delivery. Model covariates included maternal age, race, insurance status, substance use and medical complications including liver complication, hypertension, HIV, anaemia, thrombocytopenia and sexually transmitted infections. Of 297 664 pregnant women data available for analysis, 1446 had a coded diagnosis of HBV, HCV or both. High-risk behaviours, such as smoking, alcohol and substance use were higher in women with either HBV or HCV. Women with HBV had an increased risk for PTB (aOR 1.65, CI [1.3, 2.0]) but a decreased risk for caesarean delivery (aOR 0.686, CI [0.53, 0.88]). Individuals with HCV had an increased risk for GDM (aOR 1.6, CI [1.0, 2.6]). Individuals with both HBV and HCV co-infection had an increased risk for antepartum haemorrhage (aOR 2.82, CI [1.1, 7.2]). There was no association of viral hepatitis with IUGR or pre-eclampsia. Women with hepatitis have an increased risk for complications during pregnancy. Research to determine the efficacy and cost-effectiveness of counselling patients about potential risks for adverse outcomes is warranted. © 2011 Blackwell Publishing Ltd.
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              Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes.

              To examine the association between maternal hepatitis B and C mono- and co-infections with singleton pregnancy outcomes in the state of Florida. We analysed all Florida births from 1998 to 2007 using birth certificate records linked to hospital discharge data. The main outcomes of interest were selected pregnancy outcomes including preterm birth, low birth weight (LBW), small for gestational age (SGA), fetal distress, neonatal jaundice and congenital anomaly. The study sample consisted of 1,670,369 records. Human immunodeficiency virus co-infection and all forms of substance abuse were more frequent in mothers with hepatitis B and C infection. After using multivariable modelling to adjust for important socio-demographical variables and obstetric complications, women with hepatitis C infection were more likely to have infants born preterm [odds ratio (OR), 1.40; 95% confidence intervals (CI), 1.15-1.72], with LBW (OR, 1.39; 95% CI, 1.11-1.74) and congenital anomaly (OR, 1.55; 95% CI, 1.14-2.11). In addition, women with hepatitis B infection were less likely to have infants born SGA (OR, 0.79; 95% CI, 0.66-0.95). Our findings provide further understanding of the association between maternal hepatitis B or C carrier status and perinatal outcomes. Infants born to women with hepatitis C infection appear to be at risk for poor birth outcomes, including preterm birth, LBW and congenital anomaly. © 2011 John Wiley & Sons A/S.
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                Author and article information

                Contributors
                Role: Writing – original draftRole: Writing – review & editing
                Role: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysis
                Role: Data curationRole: Methodology
                Role: Data curationRole: Methodology
                Role: Data curationRole: Formal analysisRole: Methodology
                Role: InvestigationRole: ResourcesRole: Software
                Role: ConceptualizationRole: ResourcesRole: Software
                Role: SupervisionRole: Visualization
                Role: ConceptualizationRole: Project administration
                Role: ConceptualizationRole: Project administrationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                10 March 2020
                2020
                : 15
                : 3
                : e0229732
                Affiliations
                [1 ] Xiamen Diabetes Institute, Xiamen, China
                [2 ] Xiamen University Medical College, Xiamen, China
                [3 ] Department of Endocrinology and Diabetes, the First Affiliated Hospital of Xiamen University, Xiamen, China
                University of Mississippi Medical Center, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-7966-2100
                Article
                PONE-D-19-28885
                10.1371/journal.pone.0229732
                7064202
                32155166
                48311a8a-bb6d-4cc9-bb7b-cb441d08b744
                © 2020 Zhao et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 30 October 2019
                : 12 February 2020
                Page count
                Figures: 0, Tables: 4, Pages: 9
                Funding
                the authors received no specific funding for this work
                Categories
                Research Article
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Preterm Birth
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Preterm Birth
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Pregnancy Complications
                Preterm Birth
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Pregnancy Complications
                Preterm Birth
                Medicine and Health Sciences
                Gastroenterology and Hepatology
                Liver Diseases
                Liver Disease and Pregnancy
                Biology and life sciences
                Microbiology
                Medical microbiology
                Microbial pathogens
                Viral pathogens
                Hepatitis viruses
                Hepatitis B virus
                Medicine and health sciences
                Pathology and laboratory medicine
                Pathogens
                Microbial pathogens
                Viral pathogens
                Hepatitis viruses
                Hepatitis B virus
                Biology and life sciences
                Organisms
                Viruses
                Viral pathogens
                Hepatitis viruses
                Hepatitis B virus
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Gestational Diabetes
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Gestational Diabetes
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Obstetric Procedures
                Cesarean Section
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Birth Weight
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Birth Weight
                Custom metadata
                There are ethical and legal restrictions on sharing our data set according to Chinese law. Study data contain sensitive patient information. Data cannot be shared publicly because all data are research data and belongs to Xiamen Diabetes Institute. Data can be available upon request on ethical and legal restrictions from Xiamen Diabetes Institute. Institutional data access contact: Xin Zeng, Xiamen Diabetes Institute, Xiamen, China, at cynthia.zeng@ 123456aliyun.com for researchers who meet the criteria for access to confidential data.

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