Chronic hepatitis B infection and pregnancy

It is estimated that 350 to 400 million individuals worldwide are chronically infected with hepatitis B virus (HBV). In regions of high endemicity, many of these are females of reproductive age who are an important source for perinatal transmission. There are a number of issues specific to the women of childbearing age who have chronic HBV infection, including the safety of antiviral therapy during pregnancy and breast-feeding, the changes in the immune system during pregnancy and postpartum that may impact on the natural history of HBV, and the emerging role of antivirals to reduce perinatal transmission of HBV. For women in their reproductive years who require treatment, many of the available antivirals have not been studied in pregnant or breast-feeding women and their use requires the development of a carefully considered strategy, considering the impact of both the disease and treatment on the mother and fetus/infant. The purpose of this article is to (1) review data regarding the mechanisms and timing of perinatal HBV infection; (2) review data on interventions, particularly antiviral therapy, to reduce perinatal transmission beyond the protection afforded by hepatitis B immunoglobulin and vaccination; (3) summarize the immunological changes associated with pregnancy and the potential effect these may have on the natural history of HBV infection; and (4) summarize the information currently available for antiviral therapy available for HBV treatment, focusing specifically on safety data pertaining to reproduction, pregnancy, and breast-feeding. TARGET AUDIENCE: Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES: After completing this CME activity physicians should be better able to classify the interventions to reduce mother-to-child transmission of hepatitis B including antivirals, caesarean section, hepatitis B immunoglobulin and hepatitis B vaccine, assess the immunological changes associated with pregnancy and the potential effect this may have on the natural history of HBV infection and apply the information currently available for antiviral therapy licensed for HBV treatment, focusing specifically on safety data in pregnancy and during breastfeeding.     

Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers

OBJECTIVE: To measure the rate of hepatitis B (HBV) transmission from chronic HBV carriers to breast-fed infants after immunoprophylaxis. METHODS: Since 1992, information on women with HBV during pregnancy has been collected in a prospective longitudinal study. Those HBV carriers and their infants participating in a county HBV immunoprophylaxis program were identified. Infants were followed for up to 15 months and examined for hepatitis B infection by hepatitis B surface antigen (HBsAg). RESULTS: A total of 369 infants born to women with chronic HBV met the inclusion criteria and received hepatitis B immune globulin at birth and the full course of the hepatitis B vaccine series. We compared 101 breast-fed infants with 268 formula-fed infants. There was no significant difference between the two groups with respect to the number of women who were positive for hepatitis B e antigen (HBeAg) (22% versus 26%, P =.51). Three women in the breast-feeding group had liver transaminase abnormalities, compared with six women in the formula-feeding group (P =.29). Overall, there were nine cases of HBV infection transmission (2.4%). None of the 101 breast-fed infants and nine formula-fed infants (3%) were positive for HBsAg after the initial vaccination series (P =.063). The mean length of time for breast-feeding was 4.9 months (range 2 weeks to 1 year). CONCLUSION: With appropriate immunoprophylaxis, including hepatitis B immune globulin and hepatitis B vaccine, breast-feeding of infants of chronic HBV carriers poses no additional risk for the transmission of the hepatitis B virus.     

131例乙肝孕妇行介入性产前诊断的垂直传播风险分析

目的了解行介入性诊断的乙肝孕妇发生垂直传播的风险情况。方法回顾性分析2017年7月至2018年6月间来广东省妇幼保健院产前诊断科行介入性产前诊断、符合纳入标准的乙肝表面抗原(HBsAg)阳性孕妇及其所生婴儿的临床资料,总结不同穿刺类型、不同穿刺指征、是否合并乙肝e抗原(HBeAg)阳性等情况下的母婴垂直传播风险。结果本研究共纳入131例(含双胎5例)乙肝孕妇和136例所生婴儿,共3例(2.21%)在乙肝联合免疫后依然被检出感染乙肝;HBeAg阴性和HBeAg阳性孕妇所生婴儿发生感染的几率分别为1.09%(1/92)和5.71%(2/35);乙肝病毒DNA定量超过106IU/ml和107IU/ml的垂直传播率分别为4.35%(1/23)和5.00%(1/20);行羊膜腔穿刺术、脐静脉穿刺术和绒毛吸取术的乙肝孕妇发生垂直传播的几率分别为1.11%(1/90)、2.56%(1/39)和14.29%(1/7);因超声异常表现和其他非超声异常指征行介入性产前诊断孕妇发生垂直传播的风险分别为2.82%(2/71)和1.54%(1/65);10例孕妇孕期接受了抗病毒治疗,该10例所生婴儿均未发生感染。结论乙肝孕妇行介入性产前诊断有发生母婴垂直传播的风险,仍需大样本研究进一步探讨。     

乙型肝炎女性围产期管理

虽然乙型肝炎（乙肝）疫苗联合乙肝高效价免疫球蛋白的免疫可以有效地预防围产期和幼儿期乙肝感染,但我国每年约有（12~17）万儿童因免疫失败成为慢性乙肝病毒感染者。因此,对乙肝女性的孕前、孕期及产后进行规范化管理,从源头上阻断乙肝母婴传播,将宫内感染和新生儿感染风险降到最低是当务之急。文章结合我国及国外最新指南,对乙肝女性围产期的预防和管理进行总结和概述。     

Hepatitis B – Vertical transmission and the prevention of mother-to-child transmission

Hepatitis B virus (HBV) infection is the commonest cause of chronic hepatitis, with an estimated global prevalence of 3.5%, and which leads to significant morbidity and mortality. Mother-to-child transmission (MTCT) during pregnancy is the leading form of transmission in endemic populations, and its interruption is thus crucial as the initial step in the elimination of HBV infection, notwithstanding the availability of potent antiviral medications. The risk of MTCT is dramatically reduced by timely neonatal HBV vaccination and the administration of hepatitis B immunoglobulin after birth in high-risk infants. Maternal HBV DNA quantification during pregnancy allows the assessment of the risk of newborn immunoprophylaxis failure (IF). Maternal antiviral treatment in highly viremic women can reduce the risk of IF. However, the optimal HBV DNA cutoff level for the initiation of antiviral treatment remains to be determined.     

Risk of perinatal transmission of hepatitis B virus in Jordan

OBJECTIVES: To determine the risk of perinatal transmission of hepatitis B virus (HBV) in Jordan. METHODS: Plasma samples from 1000 pregnant Jordanian women were screened by ELISA for HBV markers (HBsAg, HBeAg, anti-HBe, anti-HBc and anti-HBs). RESULTS: HBsAg and HBeAg were detected in 4.3% and 0.1% of the pregnant women, respectively. The overall prevalence of antibodies was 6%, 11.1% and 7.5% for anti-HBe, anti-HBc and anti-HBs, respectively. Women were assigned to four groups according to the serological patterns of HBV markers: susceptible (85.9%), with acute infection (2.9%), with chronic infection (1.4%) and previously infected (9.8%). Most women were at the third trimester of pregnancy, therefore women with acute and chronic hepatitis at this gestational age were at risk of transmitting HBV infection to their newborns. Women who belonged to the low socio-economic class were at higher risk of HBV infection. CONCLUSIONS: Based on the results, we recommend screening women for HBV during pregnancy in order to identify HBV carriers. All newborns born to carriers should be vaccinated immediately after birth, both passively and actively. Also vaccination of HBV seronegative pregnant women is recommended.     

Hepatitis B and C in pregnancy

In general, pregnancy does not influence the course of hepatitis B (HBV) and C (HCV) infection. Most neonates born to mothers who suffer from acute viral hepatitis B and C are asymptomatic. Chronic hepatitis B and C infections can be transmitted to neonates. This route of transmission of HBV is a major contributing factor to the high carrier rate in endemic countries where 80–95% of infants born to HBsAg/HBeAg-positive (hepatitis B surface antigen and hepatitis B e antigen respectively) mothers are infected. Despite the availability of a immunoprophylactic vaccine, 10–15% of these infants are still infected. The possible reasons for vaccine failure include the ability of HBV antigens to induce immunotolerance and the existence of HBV variants. The factors contributing to vertical transmission of HBV and HCV are also discussed. These factors include viral load, virus variants and sensitivity of diagnostic tests. The rate of vertical transmission of HCV of less than 5% is lower compared to HBV in HCV-ribonucleic-acid-positive mothers. However, the risk of HCV transmission is increased to about 23% if the pregnant women are also human immunodeficiency virus (HIV) positive.     

妊娠合并乙型肝炎病毒感染围分娩期管理

对乙型肝炎(乙肝)病毒感染孕妇采取合理的围分娩期管理以阻断母婴垂直传播是降低我国慢性乙肝感染率的关键。新生儿出生后及时注射乙肝免疫球蛋白,并按照0、1、6方案接种乙肝疫苗,可有效阻断乙肝的围分娩期传播。孕妇在晚孕期进行抗病毒治疗可能通过降低母体病毒水平而减少围分娩期传播风险,但抗病毒药物对胎儿的安全性仍需进一步验证。     

乙型肝炎表面抗原阳性孕妇妊娠早期绒毛细胞乙型肝炎病毒感染状况的研究

目的观察早期妊娠(孕40～90d)HBsAg阳性孕妇绒毛细胞乙型肝炎病毒(HBV)感染状况。方法采用酶联免疫吸附(ELISA)法,复查血清HBsAg阳性的25例早期妊娠妇女血清HBsAg、乙型肝炎e抗原(HBeAg),对其绒毛细胞用免疫组化链霉亲和素-生物素过氧化物酶复合物(SABC)法和原位杂交法检测HBsAg、乙型肝炎核心抗原(HBcAg)和：HBVDNA,并通过透射电镜观察绒毛细胞超微结构变化。结果25例HBsAg阳性孕妇中,HBV感染率为32％(8／25);蜕膜细胞、滋养细胞和绒毛间质细胞均出现HBsAg或HBcAg的阳性染色,出现HBsAg或HBcAg阳性蜕膜细胞、滋养细胞和绒毛问质细胞的标本百分率分别为28％(7／25)、32％(8／25)和16％(4／25);滋养细胞间桥粒连接完整,并在滋养细胞的粗面内质网内可见HBsAg蛋白丝样结构和HBV样结构。结论HBV可感染早期妊娠绒毛细胞;HBV直接穿透滋养细胞问桥粒连接的可能性不大。     

Preventing Neonatal Hepatitis B Infection During the Perinatal Period

In the United States, hepatitis B virus (HBV) infection is a growing problem with serious long-term consequences. Because previous vaccination programs have been ineffective in lowering the incidence of HBV, the U.S. Centers for Disease Control now recommend a comprehensive plan to reduce transmission of the virus. This article explores the epidemiology of HBV infection, the use of hepatitis B immune globulin and hepatitis B vaccines, and current recommendations for eliminating transmission of HBV during the perinatal period.     

孕晚期注射乙肝免疫球蛋白阻断乙肝病毒宫内感染的Meta分析

目的:综合评价孕晚期注射乙肝免疫球蛋白阻断乙肝病毒宫内感染的效果和安全性。方法:应用Revman 4.2.10软件,对计算机检索后筛选出的5项随机对照研究采用固定模型进行分析。结果:孕晚期注射HB IG组宫内感染发生率显著低于对照组[RR=0.40,95%CI(0.30,0.54)]。结论:孕晚期注射乙肝免疫球蛋白可有效地阻断乙肝病毒宫内感染。     

乙型肝炎疫苗和乙肝免疫球蛋白阻断乙肝病毒母婴传播的效果

目的:调查实际应用中免疫预防阻断乙型肝炎病毒(HBV)母婴传播的效果,观察孕期注射乙肝免疫球蛋白(HBIG)能否减少HBV母婴感染。方法:对2006年1月至2010年12月在镇江市妇幼保健院分娩的224例乙肝表面抗原(HBsAg)阳性母亲以及250例儿童,结合住院病历,进行回顾性调查,记录母亲孕期HBIG使用情况、子女出生后HBIG和乙型肝炎疫苗接种资料,并采血检测HBV血清标志物及谷丙转氨酶(ALT)。其中69例儿童出生后免疫预防前采外周血检测HBV血清标志物。结果:250例HBsAg阳性孕妇的子女随访时年龄(3.3±1.6)岁,出生时检测HBV标志物的69例中,4例HB-sAg阳性,其中2例随访时HBsAg仍阳性,乙型肝炎e抗原(HBeAg)也阳性,说明慢性感染,另外2例HBsAg转阴;1例出生时HBsAg阴性,但随访时转为阳性。另1例出生时未检测,随访时HBsAg阳性。因此共4例(1.6%)慢性感染HBV,其母亲均为HBeAg阳性。4例感染儿童中,2例出生时未注射HBIG,且未正规接种疫苗。随访的224例母亲中,215例明确孕期使用HBIG的情况;76例子女的母亲孕期注射了HBIG,1例(1.3%)HBsAg阳性,142例子女的139例母亲孕期未使用HBIG,3例(2.1%)HBsAg阳性(P>0.05)。结论:HBsAg阳性孕妇的子女经正规免疫预防后,HBV母婴阻断效果良好,部分预防失败是由于未实施正规预防。新生儿出生时HBV血清标志物不能作为诊断是否感染HBV的指标。孕晚期使用HBIG对阻断母婴感染无效。     

Prevention of vertical hepatitis B transmission by hepatitis B immunoglobulin in the third trimester of pregnancy.

OBJECTIVE: To explore the possible efficacy of using hepatitis B immunoglobulin (HBIG) during the third trimester of pregnancy to prevent intrauterine transmission of hepatitis B virus (HBV). METHODS: Of 469 pregnant women testing positive for hepatitis B surface antigens (HBsAg), 126 had hepatitis B e antigen (HBeAg) and 343 did not. RESULTS: There were women who declined to be treated with HBIG in these 2 groups. Among infants born to HBeAg-positive mothers, the rates of those testing positive for HBsAg at birth and at the 6-month visit were significantly lower when the mothers had been treated with HBIG (P<0.05). Among infants born to HBeAg-negative mothers, however, no significant differences were found whether the mothers had been treated or not. Furthermore, all newborns received HBIG treatment and the first dose of a vaccination schedule within 12 h of birth. At the 6-month visit the protective anti-HBs rates were only 32.3% among infants whose mothers were HBeAg-positive and 56.2% among those whose mothers were HBeAg-negative when their mothers had not been treated with HBIG during pregnancy, whereas the corresponding rates were as high as 75.8% and 88.7% when the mothers had been treated. CONCLUSION: Maternal administration of HBIG is effective in preventing intrauterine fetal HBV infection in HBsAg-positive, HBeAg-positive pregnant women and in improving immune response to hepatitis B vaccine in infants born to HBV carriers.     

胎盘乙型肝炎病毒感染与宫内传播的关系

目的 探讨乙型肝炎病毒（ＨＢＶ）宫内传播的危险因素,并追踪ＨＢＶ经胎盘传播的途径和胎儿宫内感染的时间,方法 共收集了乙型肝炎表面抗原（ＨＢｓＡｇ）携带孕妇１３１例,其中孕早期人工流产胎盘２４例,孕中期引产胎盘和胎儿各６例,足月分娩胎盘和新生儿各１０１例。孕妇和新生儿血清ＨＢｓＡｇ和ＨＢＶ ＤＮＡ检测分别采用酶联免疫吸附试验和聚酶链反应法。     

Towards complete eradication of hepatitis B infection from perinatal transmission: review of the mechanisms of in utero infection and the use of antiviral treatment during pregnancy

Hepatitis B infection remains the most common form of chronic hepatitis. Mother to child transmission occurs despite immunoprophylaxis with vaccination and immunoglobulin. In utero infection is suggested to account for most of the cases with immunoprophylaxis failure. Infants who suffer from hepatitis B infection at birth have a higher risk of becoming chronic carriers and may develop liver cirrhosis or hepatocellular carcinoma in the future. Infected germ cells, transplacental infection, invasive prenatal diagnostic tests and various perinatal factors are possible factors leading to in utero infection and subsequent immunoprophylaxis failure. Hepatitis B e antigen positive status and high viral load increase the risk of immunoprophylaxis failure. Recent evidence shows promising results regarding the use of antiviral treatment in late gestation to suppress viral load, so as to decrease the risk of vertical transmission. This review discusses the possible mechanisms of in utero infection and the use of antiviral treatment during pregnancy.     

Risk of hepatitis B transmission after amniocentesis in chronic hepatitis B carriers

OBJECTIVE: To measure the risk of perinatal transmission of HBV in chronic carriers who undergo amniocentesis. METHODS: This was a prospective, longitudinal study from 1990 to 1995 of women who were HBV carriers and underwent amniocentesis. The infants of these women were followed from birth to one year of age. Maternal data examined included HBV antigen and antibody status, liver function tests (LFTs) and the amniocentesis report. RESULTS: Twenty-eight women were identified. Two of 28 neonates were stillborn unrelated to hepatitis. Five infants were lost to follow-up leaving 21 mother-child pairs to evaluate. All 21 women were chronic HBV carriers at the time of amniocentesis for delivery. No mother had abnormal LFTs, and only one of 21 women was positive for hepatitis B e antigen (HBeAg). Thirteen amniocenteses were for advanced maternal age, and four were for abnormal maternal serum alphafetoprotein (MSAFP) screening. None of the amniocenteses were recorded as bloody, and the placenta was anterior in 6 of 21 procedures. None of the 21 infants (95% CI: 0-16.8%) were positive for HbsAg during the first month of life or at 12 months of age. All infants received HBV vaccine and HBIG immunoprophylaxis. CONCLUSION: The risk of transmission of HBV to the fetus after amniocentesis in women who are HBV carriers is low. Immunoprophylaxis in these infants was successful.     

Hepatitis B – chronic carrier status and pregnancy outcomes: An obstetric perspective

Antenatal screening for hepatitis B surface antigen (HBsAg) only identifies women with hepatitis B virus (HBV) infection for neonatal immunoprophylaxis. It does not reflect the phase of chronic infection, viral genotype and activity, hepatic inflammation, or other co-existing liver disorders. Coinfection with other viruses and micro-organisms may also be present. These factors in various combinations can impact pregnancy outcomes, and they are probably responsible for the conflicting literature on this issue. Pregnancy complications may interact with maternal HBV infection and hepatitis flares, leading to serious and lethal complications. Hepatitis flares are common especially postpartum, and they are unpredictable and unpreventable with antiviral treatment. Evidence on the association between HBsAg seropositivity with gestational diabetes mellitus, preterm birth, increased foetal growth, and reduced pregnancy hypertensive disorders is stronger than other adverse pregnancy outcomes. Baseline assessment of liver function, and viral markers and activity, can delineate the truly high-risk pregnancies for close monitoring.     

ACOG Committee Opinion No. 489: Hepatitis B, hepatitis C, and human immunodeficiency virus infections in obstetrician-gynecologists

In the health care setting, bloodborne pathogens such as the hepatitis B virus (HBV), hepatitis C virus, and human immunodeficiency virus (HIV) may be transmitted from infected patients to health care workers as well as from infected health care workers to patients. To reduce the risk of transmission, all practicing obstetrician-gynecologists should receive the HBV vaccine. Obstetrician-gynecologists infected with HBV, hepatitis C virus, or HIV are advised to follow the updated Society for Healthcare Epidemiology of America's recommendations, regarding infection-control measures, supervision, and periodic testing. These recommendations provide a framework within which to consider such cases; however, each case should be independently considered in context by the expert review panel.     

常规免疫预防阻断乙型肝炎病毒母婴感染的效果

目的 评价免疫预防措施在实际应用中阻断乙型肝炎病毒(hepatitis B virus,HBV)母婴感染的效果,阐明孕妇孕晚期使用乙肝免疫球蛋白(hepatitis B immunoglobulin,HBIG)能否减少HBV母婴感染.方法 将2002年7月至2004年8月江苏省14个县市的419例乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)阳性孕妇所分娩子女作为研究组,同地区同期的453例 HBsAg-孕妇分娩的子女作为对照组,于2009年10月至2010年3月期间对2组研究对象进行随访,调查母亲孕期HBIG使用情况以及子女出生后HBIG和乙型肝炎疫苗接种情况,检测儿童HBV血清标志物.率的比较采用χ2分析或者Fisher精确概率法,均数的比较采用t检验.结果研究组实际随访298例(71.12%),其中11例(3.69%) HBsAg+;而随访的328例(72.41%)对照组中,HBsAg阳性率为0.00 (χ2=12.32,P<0.01).共11例儿童HBsAg+,其母亲均为HBsAg和HBeAg同时阳性,除1例具体情况不详外,9例儿童在出生时明确没有使用HBIG或延迟接种疫苗,仅1例同时规范使用了HBIG和乙型肝炎疫苗.2组儿童抗-HBs阳性率分别为69.46%和69.21% (χ2=0.01,P=0.95).孕晚期注射HBIG的92例孕妇中,2例(2.17%)儿童HBsAg+;未使用HBIG的197例孕妇中,9例(4.57%)儿童HBsAg+ (χ2=0.98,P=0.51).结论 江苏省常规免疫预防措施在阻断母婴HBV感染方面取得了良好的效果,但对HBV携带孕妇(特别是HBeAg+者)的新生儿仍需强调及时注射HBIG.孕妇孕晚期使用HBIG不能减少母婴HBV感染.

Abstract：

Objective To assess the protective effect of vaccination in routine application on hepatitis B virus (HBV) exposed infants and to clarify whether hepatitis B immunoglobulin (HBIG) administration of pregnant women may reduce the risk of maternal-fetal transmission of HBV. Methods Serum samples of 6398 pregnant women at gestation of 15-20 weeks from 6 urban and 8 rural areas across Jiangsu province were previously tested for serologic markers of HBV by ELISA from July 2002 to August 2004. In this study, infants born to 419 HBV carrier mothers were taken as the study group, while infants born to 453 non-carrier mothers were taken as the control group by stratified random sampling. They were followed-up and screened for HBV markers during October 2009 to March 2010. Information including HBIG administration during pregnancy, HBV vaccination and HBIG administration of the infants were collected. χ2 test or Fisher′s exact method were used to compare the rates and the comparison of the means was by t test. Results The follow-up rates of the study group and control group were 71.12% (298/419) and 72.41% (328/453), respectively. Of the 298 infants born to HBV carrier mothers, 11 (3.7%) were positive for HBsAg, while none of the 328 infants born to non-carrier mothers was HBsAg positive (χ2=12.32, P<0.01). All of the 11 children were born to mothers with both HBsAg and HBeAg positive, and nine of the 11 children were not injected HBIG or not immunized with hepatitis B vaccine within 24 hours after birth, with only one received regular vaccination and detailed information was unknown in one case. The positive rates of anti-HBs in the study group and the control group were 69.46% and 69.21% respectively (χ2=0.01, P=0.95). HBsAg positive rate of the children born to pregnant women treated with HBIG during late pregnancy (n=92) was 2.17% (n=2), whereas that in the children born to women not treated with HBIG (n=197) was 4.57% (χ2=0.98, P=0.51). Conclusions The protective effect of immunoprophylaxis in routine application against perinatal HBV infection in Jiangsu province is good. Efforts are required to emphasize the importance of HBIG administration in infants born to HBV carrier mothers, especially in HBeAg positive mothers within 24 hours after delivery. Treatment of HBsAg positive pregnant women with HBIG in third trimester would not decrease the risk of maternal-fetal transmission of HBV.     

Relationship between viral load and pregnancy outcomes among hepatitis B carriers

ObjectivePregnant hepatitis B carriers may have a higher risk of adverse pregnancy outcomes. Current evidences are conflicting regarding the relationship between hepatitis B virus (HBV) and various pregnancy complications, owing to the inclusion of women with different viral activity. This study is to evaluate the relationship between hepatitis B e antigen (HBeAg) status/HBV DNA level and pregnancy outcomes among pregnant hepatitis B carriers in Hong Kong.Materials and methodsThis was a retrospective analysis of a prospective multicenter observational study carried out in Hong Kong between 2014 and 2016. Pregnant HBV carriers were recruited. HBeAg was tested. HBV DNA level was quantified at 28–30 weeks of gestation. The rates of gestational diabetes mellitus (GDM), gestational hypertension, pre-eclampsia, preterm prelabour rupture of membranes (PPROM), preterm birth, low birth weight (LBW), macrosomia and mode of delivery were recorded.Results679 pregnancies were analyzed. 23.3% of women were seropositive for HBeAg. The mean viral load (SD) at 28–30 weeks of gestation was 3.6 (2.5) log₁₀IU/ml. No statistically significant differences were found in the rates of GDM, gestational hypertension, pre-eclampsia, PPROM, preterm birth, LBW, macrosomia and mode of delivery among women with different viral load levels (≤2 log₁₀IU/ml, 2.01–6 log₁₀IU/ml and >6 log₁₀IU/ml). Positive maternal HBeAg status was not associated with pregnancy complications compared to seronegative women.ConclusionSeropositive HBeAg status or a higher level of HBV DNA during pregnancy did not pose a significant negative impact to the pregnancy outcomes.