Retrospective analysis of adverse pregnancy outcomes associated with hepatitis B virus infection

Hepatitis B virus (HBV) infection poses significant risks during pregnancy, potentially leading to adverse outcomes. This study evaluates the risk factors and associated biochemical parameters contributing to poor pregnancy outcomes in HBV-infected pregnant women. We conducted a retrospective case-control study encompassing 472 pregnant women with HBV infections treated at our hospital between May 2021 and May 2024. Participants were divided into two groups: those with adverse pregnancy outcomes (n = 158) and those with favorable outcomes (n = 314). Adverse outcomes included conditions such as Gestational Diabetes Mellitus (GDM), Hypertensive Disorders of Pregnancy (HDP), Intrahepatic Cholestasis of Pregnancy (ICP), Preterm Birth (PTB), Fetal Distress (FD), Postpartum Hemorrhage (PPH), Postpartum Anemia (PPA), Low Birth Weight (LBW), Macrosomia, Birth Defects, and Stillbirth. We analyzed liver function and coagulation indices, performed receiver operating characteristic (ROC) curve analysis to identify predictive thresholds, conducted subgroup analysis stratified by HBeAg status, and performed statistical analyses using SPSS and R software. Significant determinants of adverse pregnancy outcomes include advanced maternal age (OR = 1.114, 95% CI = 1.038–1.196, P = 0.003) and Hepatitis B e Antigen (HBeAg) positivity (OR = 7.506, 95% CI = 4.459–12.636, P < 0.001). Impaired liver function, indicated by elevated AST (OR = 1.016, 95% CI = 1.001–1.030, P = 0.034) and ALT (OR = 1.046, 95% CI = 1.023–1.070, P < 0.001), was more prevalent in the poor outcome group. Coagulation abnormalities such as prolonged PT (OR = 1.298, 95% CI = 1.069–1.577, P = 0.009) and elevated D-Dimer (OR = 5.079, 95% CI = 1.590-16.228, P = 0.006) were associated with adverse outcomes. Antiviral drug treatment was protective against poor outcomes (OR = 0.491, 95% CI = 0.292–0.828, P = 0.008). ROC analysis identified predictive thresholds for adverse outcomes. Subgroup analysis confirmed HBeAg-positive women exhibited significantly worse liver function, coagulation profiles, and higher rates of specific adverse outcomes (GDM, ICP, PTB, PPA) (P < 0.05). Advanced maternal age, HBeAg positivity, impaired liver function, and coagulation abnormalities are significant risk factors for adverse pregnancy outcomes in HBV-infected women. Antiviral treatment mitigates these risks. ROC-derived thresholds and HBeAg status provide valuable insights for risk stratification. These findings underscore the importance of comprehensive monitoring and management strategies, particularly for HBeAg-positive women, to improve pregnancy outcomes.