This study has been completed.
This project recruited pregnant women with hepatitis B infection from Monash Health and the Royal Women’s Hospital and followed them through their pregnancy and for 12 months post partum assessing changes in their innate immune system and the impact this has on hepatitis B infection. In addition, blood samples were collected from the mother at multiple time points to assess liver function and changes in hepatitis B viral load. The findings demonstrated a high rate of postpartum flares in hepatitis as demonstrated by abnormal liver function tests.  Recruitment is complete with over 100 women with hepatitis B infection recruited in total who have been followed post partum.

Publications
Giles ML, Visvanathan K, Lewin S, Bowden S, Locarnini S, Spelman T, Sasadeusz J.
Gut. 2014 Nov 27. pii: gutjnl-2014-308211. doi: 10.1136/gutjnl-2014-308211. [Epub ahead of print]PMID:25431458
[PubMed – as supplied by publisher]

Background Unique immunological changes occur during pregnancy; the impact of which, on virological and biochemical markers of hepatitis B infection is not well established. Rapid changes in the immunological profile post partum and consequent rebound of the inflammatory response may result in hepatic flares.

Methods Women with chronic hepatitis B were recruited during pregnancy into this observational study. Demographic and clinical data were collected together with virological and biochemical parameters at two time points during pregnancy (early and late) and two time points post partum (between 6 weeks and 12 weeks and at 12 months). Outcomes analysed included changes in HBV DNA, hepatitis B e antigen (HBeAg) status and flares of hepatitis.

Results One hundred and twenty-six women were recruited. Twenty-seven women out of 108 with postpartum bloods (25%) met our definition of a postpartum flare (ALT range 38–1654). Using univariate analysis HBeAg status, younger age, gravida and parity were associated with a flare. On multivariate analysis HBeAg positivity at baseline fell just outside of statistical significance in predicting a postpartum flare (p=0.051).

Conclusions 25% of women with chronic hepatitis B will demonstrate increased liver inflammation in the postpartum period. This is usually asymptomatic and resolves spontaneously. This is more likely if the woman is HBeAg-positive at baseline (2.56 times the risk), although flares also commonly occur in HBeAg-negative women.

Chronic Hepatitis B Infection and Pregnancy.
Giles ML, Visvanathan K, Lewin SR, Sasadeusz J.
Obstet Gynecol Surv. 2012 Jan;67(1):37-44.
PMID: 22278077 [PubMed – as supplied by publisher]

Antiviral therapy for hepatitis B infection during pregnancy and breastfeeding.
Giles M, Visvanathan K, Sasadeusz J.
Antivir Ther. 2011;16(5):621-8.
PMID: 21817183 [PubMed – in process]

Conference abstracts
Clinical outcomes, virological changes and flares in women with chronic Hepatitis B virus infection during pregnancy and postpartum.
Giles M, Visvanathan K, Lewin S, Spelman T, Locarnini S, Bowden S, Sasadeusz J.
47th Annual Meeting of the European Association for the Study of the Liver (EASL), Barcelona, Spain, 2012.

TLR2 and TLR7/8 activation predict which patient will have a post partum flare and examination of the dynamics of innate immune responses and associated virological parameters during and after pregnancy.
Visvanathan K, Skinner N, Locarnini S, Bowden S, Lewin S, Giles M, Sasadeusz J.
47th Annual Meeting of the European Association for the Study of the Liver (EASL), Barcelona, Spain, 2012.

Characterisation of the innate immunological responses of HBV infection during and after pregnancy.
Visvanathan K,  Powell AJ, Skinner NA, Gemelli C, Giles M, Sasadeusz J.
62nd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD), San Francisco, CA, USA 2011.

Characterisation of the innate immunological responses of HBV infection during and after pregnancy.
Visvanathan K,  Powell AJ, Skinner NA, Gemelli C, Giles M, Sasadeusz J.
46th Annual Meeting of the European Association for the Study of the Liver (EASL), Berlin, Germany 2011.

The Impact of Pregnancy on Virological and Biochemical Markers of Hepatitis B Infection and Post Partum Hepatitis Flares.
Giles M, Visvanathan K, Sasadeusz J.
46th Annual Meeting of the European Association for the Study of the Liver (EASL), Berlin, Germany 2011.

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