Abstract: Objective To investigate the risk of hepatitis during pregnancy and postpartum in pregnant women carrying chronic hepatitis B virus (HBV) and the value of nucleoside analogues (NAs) intervention.Methods A total of 300 pregnant women with HBV admitted to our hospital from January 2020 to January 2022 were enrolled in the study. The patients were divided into observation group (232 cases) and control group (68 cases) according to their willingness to be treated.The chitosanase 3-like protein 1 (CHI3L1) were tested at 6 weeks of gestation, alanine aminotransferase (ALT), HBV DNA and hepatitis B e antigen (HBeAg) were also tested at different time points. The control group received only hepatoprotective therapy, while the observation group was given long-term NAs intervention if hepatitis attack or CHI3L1>79 ng/ml [oral tenofovir at 300 mg/d once/d if hepatitis flares or CHI3L1 > 79 ng/mL; or oral tenofovir at 300 mg/d once/d from the 24th week of gestation if no hepatitis symptoms were present and discontinued after delivery]. The ALT level, HBV DNA negative rate, HBeAg negative rate and hepatitis attack rate were compared between the 2 groups at each time point.Results With the extension of NAs intervention time, the HBV DNA negative rate and HBeAg negative rate in the observation group were significantly increased, and all the indicators at 36 weeks of pregnancy were better than other time points [6 weeks of pregnancy (3.45%, 0.00%), 12 weeks of pregnancy (26.29%, 3.88%), 24 weeks of pregnancy (43.97%, 5.60%), and 36 weeks of pregnancy (70.26%, 7.76%)]. There was no difference in the control group at 6 weeks of gestation (4.41%, 0.00%), 12 weeks of pregnancy (8.82%, 4.41%), 24 weeks of pregnancy (11.76%, 7.35%), and 36 weeks of pregnancy (13.24%, 8.82%) (P>0.05%). The total rate of hepatitis attacks during pregnancy and postpartum in the observation group (21.55%) was significantly lower than that in the control group (73.53%), P<0.05.Conclusion Regardless of NAs intervention, HBV carriers have hepatitis attacks during pregnancy and postpartum, and the attack rate is higher at 6 weeks after delivery, while individualized NAs intervention during pregnancy and postpartum is effective in reducing the total hepatitis attack rate.

Key words: Chronic hepatitis B virus, Pregnant women, Pregnancy, Postpartum, Hepatitis, Nucleoside analogues