Abstract
To date, the problem of HBV-infection in pregnant women remains relevant and one of the most important for medical science and health care, as it can be considered as a maternal-fetal infection.
The aim of the research is to investigate the course of HBV-infection in pregnant women, depending on the duration of the disease, the degree of viremia and the activity of hepatitis, taking into account gestational periods.
Materials and methods. The course of pregnancy in 142 women aged 18-35 years with HBV-infection was monitored. Serum markers and viral load (VL) of hepatitis B (HB) were determined, as well as the levels of ALT, AST, thymol test, serum bilirubin levels during each trimester of pregnancy.
Results. In pregnant women with HBV-infection, HBsAg-carriage was most often diagnosed, and the replication stages were less frequent (96 and 46, respectively).
Clinical picture of the immune-active phase of chronic HBV-infection was oligosymptomatic without violation of pigment metabolism and manifestations of mesenchymal-inflammatory reaction. The minimal degree of cytolysis prevailed, which did not depend on the degree of the viremia. In women with immune-tolerant phase of cytolysis during pregnancy was not observed.
In pregnant women with replication stage of HBV-infection and low degree of viremia, the VL increased at 1-2 log compared to the second and third trimesters, and in women with high viremia – at 2-3 log.
In most women-carriers of HBsAg moderate degree of viremia predominated, and in the rest – it was not determined. During the entire pregnancy, the immune-tolerant phase of chronic HBV-infection was latent and did not transform into the immune-active phase.
Conclusion. Thus, the diagnosis of chronic HBV-infection was verified before pregnancy in 2.8 %, and during pregnancy – in 97.2 % of women. Carriage of HBsAg prevailed in them (67.6 %), and replicative forms were registered in 32.4 % of patients. The peculiarity of replicative forms is subclinical (65.3 %) and asymptomatic (34.7 %) clinical course with low VL (˂ 105 copies/mL), which in most cases (91.3 %) increases before delivery at 1-2 log and is accompanied by low activity of hepatitis, without violation of pigment metabolism.
References
Randiuk YuO. Peculiarities of the course of HBV-infection in pregnant women and prognosis of the possible complications: Extended abstract of PhD thesis. Institute of Epidemiology and Infectious Diseases named after L. V. Gromashevsky. AMN of Ukraine. 2006; 22.
Hural AL, Shahinian VR, Serheieva TA, Kruhlov IuV, Maksymenok OV, Manko VH.. The role of a specific laboratory examination in the prevention of perinatal transmission of hepatitis B and C virus. Laboratorna diahnostyka. 2007; 3 (41): 3-10.
Kuzmin VN. Specificity of the therapy of viral hepatitis B in pregnant women. Zdorovye zhenshchiny. 2009; 10 (46): 114-116.
Maevskaya MV. Hepatitis B and reproductive health. Rossiyskiy zhurnal Gastroenterologii, Gepatologii, Koloproktologii. 2009; (5): 4-9.
Pereverten LYu, Matiushkina LS, Rachkova EV. Clinical and laboratory characteristics of chronic viral hepatitis in pregnant women. Sovremennye naukoemkiye tekhnologii. 2014; 12(1): 66-70.
Chuikova KI, Kovaleva TA, Evtushenko ID. Chronic viral hepatitis B and C during pregnancy (the strategy to minimize the risk of the infection vertical transmission). Lechashchiy vrach. 2009; (11): 68-71.
Navabakhsh B, Mehrabi N, Estakhri A, Mohamadnejad M, Poustchi H. Hepatitis B Virus Infection during Pregnancy: Transmission and Prevention. Middle East Journal of Digestive Diseases. 2001; 3 (2): 92-102.
Jonas MM. Hepatitis B and pregnancy: an underestimated issue. Liver International. 2009; 29 (1): 133-139. DOI: https://doi.org/10.1111/j.1478-3231.2008.01933.x [PMid:19207977]
Han J-R, Xu C-L, Zhao W, Yang Y-F. Management of chronic hepatitis B in pregnancy. World Journal Gastroenterology. 2012; 18 (33): 4517-4521. DOI: https://doi.org/10.3748/wjg.v18.i33.4517 [PMid:22969224 PMCid:PMC3435776]
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