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Implicações perinatais da hepatite B crónica : experiência de um centro terciário
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Introdução: A infeção pelo vírus da hepatite B (VHB) constitui um problema de saúde pública global e a sua transmissão ocorre predominantemente por via vertical. A carga viral elevada associa-se a maior risco de transmissão vertical. O risco de evolução para doença crónica é tanto maior quanto mais precocemente tiver sido adquirida a infeção. Objetivos e Métodos: Este estudo observacional retrospetivo pretende caracterizar a população de grávidas com diagnóstico de Hepatite B, cujo parto ocorreu no CHULN-HSM no período compreendido entre janeiro de 2020 e dezembro de 2022 e avaliar a condução clínica destas gestações, o impacto da infeção na gestação e vice-versa e a taxa de transmissão vertical da infeção. Resultados: Foram incluídas 64 grávidas, considerando-se 65 gestações e 67 nascimentos. A gestante tipo nesta população tem cerca de 32 anos, tem excesso de peso, já teve pelo menos um parto e é oriunda dos PALOPs. Apenas 57% destas gestações foram vigiadas na consulta de Obstetrícia do HSM e deste grupo, 47% grávidas foram acompanhadas em consulta de Gastroenterologia. Nenhuma das gestantes tinha diagnóstico de cirrose hepática. Em 5 das gestações (8%) foi instituída terapêutica com tenofovir. A idade gestacional média na altura do parto foi 39 semanas, tendo ocorrido 4 partos pré-termo (6,2%). A maioria dos partos ocorreram por via vaginal (71,6%). Não foi possível obter dados sobre a transmissão vertical da infeção por VHB. Conclusão: Este trabalho reforça que é possível e recomendável acompanhar a evolução da hepatite B durante a gestação por forma a instituir medidas profiláticas atempadas contra a transmissão vertical do VHB. O foco está na adequada referenciação e vigilância partilhadas destas doentes, por Obstetrícia e Gastroenterologia, bem como na correta aplicação das medidas preventivas ao recém-nascido. Este trabalho destaca ainda a necessidade de centralização de registos para produção de evidência científica de melhor qualidade.
Background: Hepatitis B virus (HBV) infection is a global public health problem, and its transmission occurs predominantly through vertical transmission. High viral load is associated with a higher risk of vertical transmission. The risk of progression to chronic disease is greater the earlier the infection is acquired. Aims and Methods: This retrospective observational study aims to characterize the population of pregnant women diagnosed with Hepatitis B, whose delivery took place at CHULN-HSM between January 2020 and December 2022, and to assess the clinical management of these pregnancies, the impact of the infection on pregnancy and vice versa, and the rate of vertical transmission of the infection. Results: A total of 64 pregnant women were included, resulting in 65 pregnancies and 67 births. The typical pregnant woman in this population is around 32 years old, overweight, has had at least one previous delivery, and originates from PALOP countries. Only 57% of these pregnancies were monitored at the Obstetrics clinic of HSM and out of this group, 47% of the pregnant women were followed up in the Gastroenterology clinic. None of the pregnant women had a diagnosis of hepatic cirrhosis. In 5 out of the pregnancies (8%), tenofovir therapy was administered. The average gestational age at the time of delivery was 39 weeks, with 4 preterm births (6.2%) occurring. The majority of deliveries were vaginal (71.6%). Data regarding vertical transmission of HBV infection could not be obtained. Conclusion: This study reinforces that it is possible and recommended to monitor the progression of hepatitis B during pregnancy in order to establish timely prophylactic measures against vertical transmission of HBV. The focus is on appropriate referral and shared surveillance of these patients by Obstetrics and Gastroenterology, as well as the correct application of preventive measures to the newborn. This study also highlights the need for centralized records to generate higher-quality scientific evidence.
Background: Hepatitis B virus (HBV) infection is a global public health problem, and its transmission occurs predominantly through vertical transmission. High viral load is associated with a higher risk of vertical transmission. The risk of progression to chronic disease is greater the earlier the infection is acquired. Aims and Methods: This retrospective observational study aims to characterize the population of pregnant women diagnosed with Hepatitis B, whose delivery took place at CHULN-HSM between January 2020 and December 2022, and to assess the clinical management of these pregnancies, the impact of the infection on pregnancy and vice versa, and the rate of vertical transmission of the infection. Results: A total of 64 pregnant women were included, resulting in 65 pregnancies and 67 births. The typical pregnant woman in this population is around 32 years old, overweight, has had at least one previous delivery, and originates from PALOP countries. Only 57% of these pregnancies were monitored at the Obstetrics clinic of HSM and out of this group, 47% of the pregnant women were followed up in the Gastroenterology clinic. None of the pregnant women had a diagnosis of hepatic cirrhosis. In 5 out of the pregnancies (8%), tenofovir therapy was administered. The average gestational age at the time of delivery was 39 weeks, with 4 preterm births (6.2%) occurring. The majority of deliveries were vaginal (71.6%). Data regarding vertical transmission of HBV infection could not be obtained. Conclusion: This study reinforces that it is possible and recommended to monitor the progression of hepatitis B during pregnancy in order to establish timely prophylactic measures against vertical transmission of HBV. The focus is on appropriate referral and shared surveillance of these patients by Obstetrics and Gastroenterology, as well as the correct application of preventive measures to the newborn. This study also highlights the need for centralized records to generate higher-quality scientific evidence.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Vírus da Hepatite B Hepatite B Gravidez Transmissão vertical Profilaxia Obstetrícia