Miscarriages In HBV Patients - Time To Ponder

Introduction: Hepatitis B virus (HBV) infection poses a significant global public health challenge. It is associated with increased miscarriage rate and studies also has confirmed that the miscarriage rate is higher in women with HBV, with one study finding a 71% increase in miscarriage risk in HBV carriers compared to a control group. Another study found a significantly higher rate of miscarriage in pregnant HBV carriers (9.66%) compared to the control group (5.81%). The potential contributing factors are HBV infection of embryos. Studies have detected HBV mRNA fragments in embryos from mothers with HBV, suggesting that direct infection of the embryo could be a cause of miscarriage and congenital malformations. HBV infection is associated with an increased risk of other complications that can contribute to miscarriage, such as gestational diabetes mellitus (GDM) and preeclampsia. Aims and objectives: To determine miscarriage rate m pregnant patients with confirmed HBV infection. Materials & Methods: It was a prospective study conducted at Medical Gastroenterology in collaboration with Obstetrics & Gynecology, PGIMS, Rohtak over a period of eight years and eleven months from 1.1.2017 to 30.11.2025. Three hundred (300) pregnant patients who were confirmed to be positive for Hepatitis B antigen (HbsAg) test on Enzyme linked Immunoassay test (ELISA) and HBV DNA quantitative on PCR testing and anti HCV antibody & anti-HIV antibody negative were enrolled in the study and followed. These three hundred patients were followed throughout pregnancy, delivery, post-partum period. The data of these 300 HBV confirmed pregnant patients was analysed in final analysis. Results: Out of these 300 HBV patients, 104 patients (34.66%) had miscarriage. In these 104 patients with miscarriage, majority belonged to 21-30 yrs age group (74%). Majority of miscarriages were seen in first trimester of pregnancy (63.46%) and out of it also, maximum was seen in second month of pregnancy. Majority (58%) had single miscarriage followed by twice miscarriage and multiple ones were least common. Majority patients (80%) were non-cirrhotic with normal fibroscan score i.e. below 7 Kpa, followed by patients in F1 - F3 group but none was cirrhotic. One characteristic finding in our pool was that majority of patients (80.76%) were inactive carrier with low HBV viral load i.e. > 102-3 I.U./ml, Conclusion: Our study is an eye opener as it not only re-confirms the findings already available in literature regarding more prevalence of miscarriages in HBV females in comparison to normal population but also hints at more gravity of problem, then what is being thought and understood. Moreover, in comparison to HCV, HBV related miscarriages occur even at low viral load also. Keywords: HbsAg, HBV DNA Quantitative, Miscarriage. Pre-term delivery, Breast feeding, anti-viral treatment