Comparative effectiveness of antiviral therapy according to immune status among pregnant women with chronic hepatitis B virus infection: a retrospective cohort study

PURPOSE: This study evaluates phase-specific antiviral efficacy of tenofovir disoproxil fumarate (TDF) in pregnant women with hepatitis B virus (HBV) infection, comparing immune-tolerant (IT), inactive carrier (IC), and their corresponding gray zone (GZ-A, GZ-C). Perinatal outcomes and mother-to-child transmission (MTCT) risks were also assessed across these phases. METHODS: = 226). Among them, 365 women received TDF antiviral therapy during mid-to-late pregnancy. Primary endpoints included complete virological response rate (CVR) and reductions in HBV DNA and HBsAg from baseline, measured at delivery and 6 months postpartum. RESULTS: < .01). CONCLUSION: TDF effectively suppresses viral replication in pregnant women with HBV infection, including historically undertreated GZ subgroups, without compromising pregnancy safety. These findings provide a reference for phase-specific management strategies to optimize perinatal HBV care.