Antiviral therapy cessation ups risk of ALT flares in pregnant women with CHB
Alanine aminotransferase (ALT) flares are common during pregnancy and postpartum in previously treated women with chronic hepatitis B (CHB), particularly in those who discontinued antiviral therapy before pregnancy, during first trimester or at delivery, a recent study has found.
“Thus, these pregnant women should be monitored closely throughout pregnancy and the early postpartum period,” the investigators said.
ALT flares (95–1,064 U/L) during pregnancy occurred in 16 percent (7/43) of women who ceased treatment before pregnancy and in 31 percent (4/13) of those who stopped treatment during first trimester, many of whom had high hepatitis B virus (HBV) DNA levels (4.9–8.0 log IU/mL). There were no flares (0/11) among women who continued treatment.
In addition, there were postpartum ALT flares (104–1,584 U/L) in 0 percent (0/15) of women who were completely untreated during pregnancy, 29 percent (2/7) of those who ceased treatment in first trimester, 33 percent (3/9) of those who discontinued treatment at delivery, and 22 percent (4/18) of those who continued treatment postpartum.
“[L]arger studies are needed to further characterize the natural history of HBV infection during pregnancy and postpartum,” the investigators said.
In this multicentre, retrospective study, 67 pregnancies in 56 CHB women treated before and/or during pregnancy were included. Frequency, severity and resolution of ALT flare (≥5× upper limit of normal or ≥3× baseline, whichever was higher) were the main endpoints.
“Antiviral therapy is recommended for pregnant women with CHB and HBV DNA >200,000 IU/mL, but there is less consensus on management of women who discontinue therapy in anticipation of pregnancy or who become pregnant while on therapy,” the investigators noted.