"Clinical features and management strategies of re-pregnant women with chronic hepatitis B virus infection after implementation of ""two-child policy""" / 中华临床感染病杂志

ABSTRACT

Objective To investigate the clinical features and management strategies of re-pregnant women with chronic hepatitis B virus infection after implementation of two-child policy.Methods A total of 173 women with chronic hepatitis B virus infection in a subsequent pregnancy were enrolled from Hangzhou Xixi Hospital, among whom 91 cases were before implementation of the policy (from January to August 2015, control group), and 82 cases were after policy implementation (from March to December 2016, study group).The clinical data including basic information, pregnancy complications, postpartum complications, delivery mode and perinatal complications were retrospectively analyzed,t test or χ2 test was used for comparison between the two groups.Results There were significant differences in proportion of age>35 years (31.71% vs.16.48%,χ2=5.528), frequency of abortion(3.2±0.3 vs.1.3±0.4,t=5.723), fertility interval with first pregancy[(57.8±21.4)months vs.(40.4±16.6)months,t=6.691],rate of assisted reproduction(14.63% vs.5.49%,χ2=4.066),proportion of abnormal liver function(13.41% vs.4.40%,χ2=4.618),antiviral treatment during pregnancy (34.14% vs.19.78%,χ2=4.561) and proportion of HBV DNA loads >105IU/mL(35.36% vs.20.88%,χ2=4.515)between study group and control group (all P<0.05).The incidences of gestational hypertension(12.20% vs.3.30%), gestational diabetes mellitus(14.63% vs.5.49%),placenta previa(9.76% vs.2.20%),placental implantation(3.66% vs.0), hydramnio (12.20% vs.3.30%), fetal distress (14.63% vs.5.49%) and preterm birth(14.63% vs.5.49%)were also statistically significant between two groups (χ2=4.914, 4.066, 4.524, 3.838, 4.914, 4.066 and 4.066,all P<0.05).The incidence of cesarean section again(50.00%), postpartum hemorrhage(14.63%)and postpartum anemia(19.51%) were significantly higher in the study group than that in the control group(35.16%,4.40% and 8.79%,χ2=3.892, 5.387 and 4.149,all P<0.05).Compared with the control group, the incidence of low birth weight(14.63% vs.5.49%), neonatal asphyxia(19.51% vs.6.59%)and neonatal HBV infection rate(15.85% vs.6.59%)were higher in the study group (χ2=4.066, 6.486 and 3.883,all P<0.05).Conclusions The clinical characteristics of re-pregnant women with chronic hepatitis B virus infection are more complex and suffer greater risk of pregnancy, so antenatal care should be further reinforced after the comprehensive implementation of two-child policy.