Evaluating the relationship between hepatitis B viral activity and gestational diabetes mellitus: A prospective cohort study.

BACKGROUND: Hepatitis B infection has been associated with the development of gestational diabetes but the underlying mechanism is not known. OBJECTIVE: To examine associations between viral activity, gestational diabetes mellitus (GDM), and insulin resistance in pregnant people with chronic hepatitis B infection (HBV). DESIGN: Prospective cohort study across three tertiary maternity centres in Melbourne, Australia, between May 2021 and April 2023. METHODS: Participants were followed prospectively through pregnancy to evaluate subsequent GDM diagnosis. Demographics, pregnancy outcomes, and markers of viral activity were compared between those with GDM versus those without. Logistic regression analysis was performed pre- and post-adjustment for known confounders. Sub-group analysis of participants from South East Asia (SEA) was performed. Outcome measures included GDM diagnosis, insulin resistance (Homeostatic Model Assessment Insulin Resistance score (HOMA-IR) score), HBV activity as measured by liver function tests, HBV viral load, hepatitis B e antigen, and quantitative hepatitis B surface antigen (quantHBsAg). RESULTS: A total of 113 women were recruited. One third (38/112, 33.9%) developed GDM, mostly diagnosed on isolated postprandial hyperglycaemia (25/38, 65.8%). Over half were born in SEA (66/113, 58.4%). Mean quantHBsAg was significantly lower in those with GDM (p = 0.044). No other associations were identified between GDM or HOMA-IR and markers of hepatic activity on multivariate logistic regression analysis and on sub-group analysis of those born in SEA. CONCLUSIONS: QuantHBsAg was significantly lower in those with GDM; otherwise, no association between GDM and measures of HBV viral activity was found. QuantHBsAg may be useful as an early pregnancy marker for GDM risk and warrants further research.

Opioid poisoning during pregnancy: prevalence, characteristics, and neonatal outcomes.

While it has been postulated that opioid poisoning during pregnancy may cause adverse maternal and neonatal outcomes, the harm associated with opioid poisoning during pregnancy has not been robustly examined. Pregnant women admitted to hospital or presenting to the emergency department (ED) in Western Australia (WA) with a diagnosis of opioid poisoning were identified by linking state midwifery records with hospital and ED administrative data. Maternal and neonatal outcomes were compared with opioid poisoning that occurred in the 12 months prior to conception or the 12 months following birth. Between 2003 and 2018, 57 neonates were born to women who had experienced opioid poisoning during pregnancy (14.1 per 100,000 births) in WA. The incidence of opioid poisoning in the year prior to pregnancy (IRR: 3.04, 95%CI: 2.30, 4.02) and the year following pregnancy (IRR: 1.96, 95%CI: 1.46, 2.64) was significantly higher than during pregnancy. Opioid poisoning during pregnancy was less likely to involve multiple substances and be intentional (rather than accidental). Neonatal conditions associated with in utero hypoxia were significantly less common in neonates born to women who experience opioid poisoning prior to pregnancy compared with during pregnancy (OR: 0.17, 95%CI: 0.04, 0.80). Opioid poisoning in pregnancy was not associated with an increased risk of other serious adverse neonatal outcomes. Opioid poisoning during pregnancy is uncommon and less likely to be intentional and involve multiple substances. Opioid poisoning during pregnancy is likely associated with an increased risk of conditions associated with in utero hypoxia.

Prevalence and Perinatal Outcomes Following In Utero Exposure to Prehospital Emergency Methoxyflurane: A 17-Year Retrospective Cohort Study.

OBJECTIVE: To examine the prevalence of exposure and perinatal outcomes associated with in utero exposure to methoxyflurane. DESIGN, SETTING AND POPULATION: Whole-population ambulance data in Western Australia (WA) were linked to the statutory perinatal data collection to identify pregnant women transferred by ambulance between 2000 and 2016. The proportion of neonates in WA exposed to methoxyflurane, fentanyl or no analgesia during an ambulance transfer was calculated. Perinatal outcomes of pregnancies exposed to methoxyflurane (n=1579) were compared to those exposed to fentanyl (n=203) or no analgesia (n=10524) using multivariable logistic regression modelling. Perinatal outcomes were considered overall and by trimester of exposure. MAIN OUTCOME MEASURES: Primary outcomes were the prevalence of in utero methoxyflurane exposure and Apgar score on the day of delivery. RESULTS: In the study period, 0.4% of all neonates born in WA were exposed to methoxyflurane in utero. Methoxyflurane exposure on the day of delivery (n=657) was not associated with an increased likelihood of a low Apgar score at five minutes compared with no analgesia (n=2667) (OR 1.23, 95% CI 0.91-1.67). Whereas fentanyl exposure (n=22) was associated with an increased likelihood of low Apgar score compared with methoxyflurane (OR 3.67, 95% CI 1.18-11.48). CONCLUSIONS: Methoxyflurane is commonly used by ambulance services to treat pain in pregnant women in WA. While not recommended for use in pregnancy, pregnancies exposed to methoxyflurane did not have an increased risk of adverse perinatal outcomes in this study.