The effect of intrahepatic cholestasis in pregnancy combined with different stages of hepatitis B virus infection on pregnancy outcomes: a retrospective study

Abstract Background and Aims : To investigate the impact of intrahepatic cholestasis of pregnancy (ICP) with hepatitis B virus (HBV) infection on pregnancy outcomes. Methods: We selected 512 pregnant women, collected the data including maternal demographics, main adverse pregnancy outcomes and maternal HBV infected markers HBeAg and HBV-DNA loads status, then have a comparative analysis. Results: There were 319 cases of isolated ICP, 113 cases of chronic hepatitis B (CHB) combined with ICP, 80 cases of asymptomatic HBV carriers combined with ICP. All HBV-infected pregnant women with ICP were divided into hepatitis B e antigen (HBeAg)-positive group (102 cases) and HBeAg-negative group (91 cases), according to the level of the serum HBeAg status; and into high viral load group (92 cases), moderate viral load group (46 cases) and low viral load group (55 cases) according to the maternal HBV-DNA level. CHB+ICP group had a higher level of serum total bile acids, transaminase, bilirubin as well as a higher percentage of premature delivery, neonatal transfer and meconium-stained amniotic fluid (MSAF) compared with the other two groups(P<0.05), but there were no significant differences in the the above indicators between the group of isolated ICP and asymptomatic HBV carriers with ICP.Among the HBV-infected patients with ICP, HBeAg-positive group had a higher level of serum transaminase, bilirubin and bile acid as well as shorter gestational weeks of delivery, lower birth weight of newborns and a higher rate of neonatal intensive care unit (NICU) admission than HBeAg-negative group ( P <0.05); Those with a high viral load (HBV-DNA>10 6 IU/ml) had a higher level of transaminase, bilirubin, and bile acid as well as shorter gestational weeks of delivery, lower birth weight of newborns and a higher rate of NICU admission compared with those with a low or moderate viral load ( P <0.05). Conclusion: ICP combined with CHB patients have more severe liver damage, a higher percentage of preterm birth and NICU admission. HBeAg-positive status and a high HBV-DNA load will increase the severity of conditions in HBV-infected pregnant women with ICP. Patients who have CHB combined with ICP, HBeAg-positive or a high viral load should be treated more actively.