Effect of immediate postpartum discontinuation of medication on ALT and viral load in pregnant women with HBV infection treated with antiviral therapy during pregnancy
Objective To explore the impact of stopping medication immediately after delivery on postpartum alanine aminotransferase(ALT)and hepatitis B virus(HBV)load in pregnant women with chronic HBV infection treated with antiviral therapy during pregnancy.Methods A total of 150 HBV-infected patients who underwent diagnosis and treatment in the Third Hospital of Wuhan from February 2017 to February 2022 were included in this study.Based on the time of discontinuation of antiviral treatment after delivery,the patients were divided into two groups:group A(n=75),who stopped the antiviral treatment 12 weeks after delivery,and group B(n=75),who stopped the antiviral treatment immediately after delivery.The changes in HBV DNA load before delivery and up to 16 weeks after delivery were recorded,and ALT levels were measured before delivery,during delivery,and at 6 months after delivery in both groups.The incidence of postpartum liver function abnormalities was compared between the two groups,and factors that might affect maternal liver function abnormalities were analyzed.Results There was no significant difference in HBV DNA levels between the two groups before delivery,during delivery,and 16 weeks postpartum(t=1.967,1.897,-0.985;all P＞0.05).However,the HBV DNA levels of Group B were significantly higher than those of Group A at 4 and 12 weeks postpartum(t=-41.994,-72.765;all P＜0.001).There was no significant difference in the levels of ALT before delivery,during delivery and peak ALT levels within 6 months postpartum between the two groups(t=0.928,0.866,-1.316;all P＞0.05).There was no significant difference in the incidence and degree of postpartum liver function abnormality between the two groups(Z/x2=0.176,0.348;all P＞0.05).The mother-to-child transmission rates were all 100％.Among the 28 postpartum women who had liver function abnormalities,122 other cases were included in the group with normal liver function;there was no significant difference between the two groups in terms of age,HBV family history,history of delivery,delivery mode,feeding method,discontinuation time,and premature delivery according to univariate analysis(all P＞0.05).Conclusion In HBV infected pregnant women who received antiviral treatment immediately after delivery,the effect of drug withdrawal on postpartum ALT was small,and the HBV DNA load at 4 weeks and 12 weeks postpartum was significantly affected,and the mother-to-child blocking rate was not affected.
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