Abstract: Objective To explore the effects of liver function index and HBV DNA load on adverse pregnancy outcome in pregnant women with chronic hepatitis B (CHB), and to provide reference for perinatal management. Methods A total of 156 pregnant women with CHB admitted to the obstetrics and gynecology department of Haian People's Hospital from January 2019 to December 2022 were included in the study group. According to the serum alanine aminotransferase (ALT) level, they were divided into ALT ≥ 160 U/L group and ALT < 160 U/L group. They were divided into high total bilirubin (TBil) group ( ≥ 17.1 μmol/L) and normal TBil group ( < 17.1 μmol/L). According to HBV DNA load, they were divided into high HBV DNA load group ( ≥ 1×10⁶ copies/mL) and low HBV DNA load group (< 1×10⁶ copies/mL). 70 healthy pregnant women who gave birth in hospital during the same period were included in the control group. All the study groups were given oral treatment of Pofol tenofovir fumarate until delivery. Pregnant women were treated with human hepatitis B immunoglobulin (HBIG) blocking therapy, and newborns were treated with HBIG and hepatitis B vaccine blocking therapy. The baseline data and serological indicators of the two groups were detected and compared, the incidence of adverse pregnancy outcomes in each subgroup was compared, and the influencing factors of adverse pregnancy outcomes in CHB pregnant women were analyzed by logistic regression. Results In the study group, the incidence rates of gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), preeclampsia (PE), premature rupture of membranes (PROM), fecal amniotic fluid, neonatal asphyxia, postpartum hemorrhage, neonatal hyperbilirubinemia (HNB) were 27.56%, 5.77%, 12.18%, 19.51%, 11.54%, 8.97%, 17.95%, 10.90%. HbA1c level was 6.02±0.78% in the study group, which was higher than 5.71%, 2.86%, 4.29%, 7.14%, 4.29%, 2.86%, 5.49±0.71%, 4.29%, 2.86%, 5.49±0.71% in control group. The difference was statistically significant (t/χ²=3.764, 2.845, 3.159, 2.780, 3.086, 3.264, 3.347, 3.026, 5.218, all P<0.05). The levels of ALT, TBil, and HBV DNA load in the study group were 93.24±7.36U/L, 22.59±3.18 μmol/L, 1.26±0.34×10⁶ copies/mL, respectively, which were higher than those in the control groups (27.56±4.81 U/L, 14.82±2.05 μmol/L, 0×10⁶ copies/mL) with the statistically significant difference (t=9.524, 2.7.275, 11.793, P<0.001). In CHB pregnant women, the incidence rates of PROM, neonatal asphyxia, postpartum hemorrhage and HNB in ALT≥160 U/L group were 36.84%, 15.79%, 42.11% and 31.58%, which were higher than those in ALT < 160 U/L group (11.68%, 8.03%, 14.60% and 8.03%). The difference was statistically significant (χ²=4.651, 3.291, 4.425, 5.047, all P<0.05). The incidence rates of fecal amniotic fluid contamination, neonatal asphyxia, postpartum hemorrhage and HNB in the high TBil group were 30.77%, 23.08%, 53.85% and 38.46%, which were higher than those in the normal TBil group (9.79%, 7.69%, 14.69% and 8.39%). The difference was statistically significant (χ²=4.862, 4.375, 4.809, 5.286, all P<0.05). The incidence rates of PROM, fecal amniotic fluid staining, neonatal asphyxia, postpartum hemorrhage and HNB in the high-load group were 25.00%, 19.23%, 15.38%, 28.85%, 19.23%, higher than those in the low-load group (9.62%, 7.69%, 5.77%, 12.50%, 6.73%). The difference was statistically significant (χ²=3.548, 3.472, 3.718, 3.297, 4.186, all P<0.05). logistic regression analysis showed that ALT≥160 U/L, TBil≥17.1 μmol/L and HBV DNA≥1×10⁶ copies/mL were the influential factors for adverse pregnancy outcomes in CHB pregnant women (P<0.05). Conclusion The higher the serum ALT, TBil and HBV DNA load of CHB pregnant women, the higher the incidence of adverse pregnancy outcomes, which can provide reference for perinatal management.

Key words: Pregnant women, CHB, Liver function, Viral load, Adverse pregnancy outcome