Relationship Between Different Hepatitis B Virus Infection Status and Gestational Diabetes Mellitus Prevalence Among Pregnant Women With Chronic HBV Infection

A Retrospective Study

Guanlun Zhou; Chao Chen; Guorong Han; Hongxiu Jiang; Minkai Cao


J Viral Hepat. 2022;29(8):596-603. 

In This Article

Abstract and Introduction


To investigate the relationships between different hepatitis B virus (HBV) infection status and gestational diabetes mellitus (GDM) and analyse the potential risk factors, we conducted an observational retrospective study in HBV-infected pregnant women to compare the differences of GDM prevalence and clinical outcomes between groups divided by HBV infection status. Spearman's correlation coefficient was used to evaluate the correlations among hepatitis B e antigen (HBeAg), HBV DNA and liver function. Logistic regression model was used to analyse the risk factors. In all, 1390 HBsAg-positive pregnant women were enrolled. HBeAg titre and HBV DNA, ALT and AST were correlated (r = 0.743, p < 0.001; r = 0.813, p < 0.001). Overall GDM prevalence was 21%. GDM prevalence of HBV-infected women with abnormal liver function was higher than those with normal liver function (26.8% vs. 20%, p = 0.027). Age over 35 years and abnormal liver function over 5 times ULN and 1–2 times ULN were independent risk factors for GDM prevalence with odds ratio (OR) of 1.858 (95% CI 1.227–2.815), 1.589 (95% CI 1.023–2.468) and 2.203 (95% CI 1.029–4.718), respectively. GDM prevalence in HBV-infected pregnancies with abnormal liver function was higher than those with normal liver function. Age over 35 years and abnormal liver function were independent risk factors for GDM in HBV-infected women.


Hepatitis B virus (HBV) infection is a global burden to the world, which is high endemic in China. The prevalence of HBV infection in adult population is 10%–12% in China, including women between 15 and 49, which is called at childbearing age.[1] Chronic HBV infection means hepatitis B surface antigen (HBsAg) positive lasting for more than 6 months. More often, HBsAg positivity are detected during pregnancy at first antenatal examination. Viral load fluctuation and hepatic flare often take place due to the suppressive status of immune system at the specific period of pregnancy. There may be at high risk to develop hepatic decompensation for pregnant mothers and mother-to-child transmission (MTCT) to infants without careful surveillance. MTCT is the most common mode of HBV transmission,[2] mainly as a result of maternal high viral loads. Offspring been infected via MTCT have higher potential to develop hepatic fibrosis, cirrhosis or even hepatocellular carcinoma.[3]

Diabetes mellitus (DM) is defined as metabolic diseases with high level of glucose in the blood. Persistent hyperglycaemia may cause chronic damage, dysfunction or even failure to multiple organs.[4] Gestational diabetes mellitus (GDM) is a special type of DM with onset or first recognition during pregnancy and may resolve after delivery or otherwise develop into type 2 diabetes.[5] GDM was reported to be related to macrosomia, neonatal hypoglycaemia, neonatal respiratory distress syndrome and congenital anomalies in offspring.[6] The aetiology of GDM has not been elucidated yet and is often considered to be correlated with insulin resistance.

Hepatitis B virus infection and DM have been investigated to have an interaction association. Several studies indicated that people infected with HBV have higher risk to develop DM.[7–9] Meanwhile, previous studies revealed higher potential of HBV infection among individuals with DM[10,11] and increased risk of hepatocellular carcinoma in HBV-infected patients combined with type 2 DM.[12,13] When it comes to the association between HBV infection and prevalence of GDM, the existing results are controversial, especially regarding different infection status.

The objective of the retrospective study was to explore whether different status of HBV infection could have an impact on the prevalence of GDM and conduct an analysis of potential risk factors.