Effect of viral load on pregnancy outcomes in chronic hepatitis B infection.

AIM: This study aimed to evaluate perinatal and neonatal outcomes in pregnant women with chronic hepatitis B virus infection based on infection status and to identify cut-off values based on hepatitis B virus DNA viral load to predict composite adverse perinatal/neonatal outcomes. METHODS: Pregnant women with chronic hepatitis B virus who delivered at Hacettepe University between 2010 and 2018 were evaluated retrospectively. We included 95 patients. The patients were classified into two groups based on laboratory findings and viral load: group 1 (n = 63), immune inactive; and group 2 (n = 32), immune active. Maternal age, gravidity, parity, gestational week at birth, birth weight, 5th minute APGAR scores and composite perinatal and neonatal outcomes were compared between groups. RESULTS: Gestational week at birth, birth weight and 5th minute APGAR score in group 2 were lower than those in group 1 (P < 0.001, P < 0.005 and P < 0.001, respectively). The rates of composite adverse perinatal/neonatal outcome, preterm birth, fetal growth restriction, oligohydramnios, pre-eclampsia, admission to the neonatal intensive care unit, small for gestational age and 5th minute APGAR score less than 7 were significantly higher in group 2 (P < 0.001). Hepatitis B virus DNA viral load of 17 515 IU/mL (72.7% sensitivity, 78.1% specificity) and 17 515 IU/mL (81.8% sensitivity, 80.8% specificity) were determined to be cut-off values for composite adverse perinatal and neonatal outcomes, respectively. CONCLUSION: Care should be taken in patients with a viral load of greater than 17 515 IU/mL, and pregnancy should be postponed until the inactive phase of the disease for optimal results.

Chemotherapy during Pregnancy: Cases of Hodgkin's and Non-Hodgkin's Lymphoma, Chronic Myeloid Leukemia, Breast Cancer, Nasopharyngeal Cancer, and Choriocarcinoma.

BACKGROUND: The use of chemotherapeutics during pregnancy is a dilemma for both the patient and the clinician. We report here our 11 years' experience with the use of chemotherapy during pregnancy. PATIENTS: 13 patients undergoing chemotherapy during their current pregnancy were evaluated. The medical data of 5 patients with hematologic malignancies (2 Hodgkin's, 2 non-Hodgkin's lymphoma, and 1 chronic myeloid leukemia), 6 patients with breast cancer, 1 patients with nasopharyngeal cancer, and 1 patient with choriocarcinoma were retrospectively obtained from the 'perinatal database' of Hacettepe University for the period of January 2002 through March 2016. RESULTS: 4 patients had a medical termination due to teratologic effects. 4 patients had a vaginal delivery, and 5 patients delivered by caesarean section. The 9 newborns who had been exposed to chemotherapeutics were free of congenital anomalies. However, 1 of them died in the early neonatal period due to multi-organ failure (nasopharyngeal cancer). During the 2-year follow-up, we encountered 1 maternal mortality, which was due to multi-organ failure in a non-Hodgkin's lymphoma patient. CONCLUSION: Physicians must pay attention to potential teratologic problems, and should carefully balance maternal and fetal risks. Selected chemotherapeutic agents can be given in the 2nd and 3rd trimester without any major teratogenic risk. All 9 newborns in our study were free of anomalies, although 1 of them died in the neonatal period.