Management and Outcomes of Chronic Hepatitis B in Pregnancy: A Retrospective Study from a Tertiary Center in Singapore

Introduction Hepatitis B virus (HBV) infection remains a leading cause of chronic viral hepatitis, particularly in Asia. Vertical transmission during pregnancy is a key contributor to chronic HBV prevalence, and maternal screening with HBV DNA quantification enables the identification of high-risk cases. Antiviral therapy is recommended for pregnant women with HBV DNA levels >200,000 IU/mL to reduce the risk of perinatal transmission. This study aimed to determine the prevalence of high maternal viral load in chronic HBV, assess the initiation of antiviral therapy, and evaluate hepatic flares following treatment cessation postpartum. Methods We conducted a retrospective audit of pregnant women with chronic HBV infection referred to a gastroenterology specialist clinic in Singapore from August 2015 to December 2022. Data were collected from electronic medical records. The audit was approved by the institutional board. Results Data from 112 patients were analysed. The mean age was 34.6 years (standard deviation (SD) ± 4.4). A total of 25.9% had HBV DNA levels >200,000 IU/mL, with a mean alanine aminotransferase (ALT) of 31.1 U/L, compared to 19.5 U/L in those with lower viral loads. Among high viral load patients, 89.7% (n=26) were started on antiviral therapy; 3 declined treatment. Two patients with a lower viral load but elevated ALT were also treated. Mean gestational age at delivery was 37.7 weeks (SD ± 2.3). Postpartum follow-up revealed 10 cases of hepatitis flare. Eight patients agreed to the re-initiation of treatment. No serious adverse events were reported. Conclusion A significant proportion of pregnant women with chronic HBV had high viral loads, necessitating treatment. Tenofovir disoproxil fumarate (TDF) was safe and well-tolerated. Postpartum monitoring is essential due to the risk of hepatic flares following treatment cessation.