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The characteristics and predictors of postpartum hepatitis flares in women with chronic hepatitis B

The American Journal of Gastroenterologyvolume 113pages686693 (2018) | Download Citation




We aimed to characterize postpartum disease flares among treatment-naive mothers with chronic hepatitis B (CHB). CHB mothers were enrolled and compared with non-infected mothers in terms of postpartum alanine aminotransferase (ALT) abnormalities.


Demographic, virological, and biochemical parameters were collected up to postpartum week 16, with flares and exacerbations defined as ALT levels 5–10 and >10 times the upper limit of normal, respectively. Outcome assessments included ALT flares or exacerbation and their predictive parameters.


Among 4236 patients enrolled, 869 and 3367 had no infection (group A) and had CHB (group B), respectively. Infected mothers were further stratified into two subgroups by the presence (B1, n = 1928) or absence (B2, n = 1439) of detectable serum levels of hepatitis B virus (HBV) DNA (lowest level of quantitation, 100 IU/mL). A significantly higher frequency of abnormal ALT levels was observed in group B vs. group A (28.27 vs. 20.37%, p < 0.001). ALT events mainly occurred in group B1 (flares, 115/1928, 5.96%; exacerbations, 57/1928, 2.96%). The ALT levels had a bimodal pattern, with peaks at postpartum weeks 3–4 and 9–12. On multivariate analysis, elevated ALT levels and detectable levels of HBV DNA at delivery were independent risk factors for postpartum disease flares. Further subgroup analysis in group B1 demonstrated that a cut-off HBV DNA level of 5 log10 IU/mL at delivery predicted ALT events (positive predictive value, 14.4%; negative predictive value, 98.2%).


Postpartum ALT level elevation is common in CHB patients. ALT flares or exacerbations are mainly observed in mothers with elevated ALT or HBV DNA levels ≥5 log10 IU/mL at delivery.

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Additional information

W Yi and CQ Pan contributed equally to this work.


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The authors thank the research coordinators and physicians at the Second Division of Liver Diseases in the Department of Medicine, Ditan Hospital for their support on the study.

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Author notes

  1. W Yi and CQ Pan contributed equally to this work.


  1. Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China

    • Wei Yi
    • , Ming Liu
    •  & Yu-Hong Hu
  2. Division of Gastroenterology and Hepatology, Department of Medicine, NYU Langone Health, New York University School of Medicine, New York, NY, USA

    • Calvin Q. Pan
  3. Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China

    • Ming-Hui Li
    •  & Yao Xie
  4. Department of Biostatistics, Beijing Ditan Hospital, Capital Medical University, Beijing, China

    • Gang Wan
  5. Information Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China

    • Ying-Wei Lv
  6. Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

    • Zhen-Yu Zhang


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Guarantor of the article

Dr. Yao Xie.

Specific author contributions

WY, YX, and Z-YZ proposed the concept and supervised the data collection. CQP and WY contributed to the study design and performed the statistical analyses with support from GW. CQP wrote the manuscript with assistance from WY. CQP further revised the draft with inputs from all coauthors, performed critical reviews, communicated with the journal, and addressed comments from reviewers. WY, Y-WL, GW, M-HL, ML, and Y-HH contributed to data collection. All the authors vouch for the veracity and completeness of the data presented and agreed to submit the manuscript for publication.

Financial support

This study was funded by the Beijing Healthcare System for the “High-level Technical Personnel Training Project” (grant no. 2015-3-106), the Beijing Municipal Science and Technology Commission (grant no. Z151100004015122), and the National Natural Science Foundation of China (grant no. 81571455).

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Corresponding authors

Correspondence to Zhen-Yu Zhang or Yao Xie.

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