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Supervisors names
Claire Thorne
Manolis Bagkeris
Background
Hepatitis B virus (HBV) infection is an international public health challenge, causing around 820,000 deaths annually, with vertical transmission representing an important transmission route. Interventions to prevent vertical transmission are HBV vaccination from birth (+/- hepatitis B immunoglobulin) and antenatal antiviral treatment, depending on risk profile and setting. In England, coverage of antenatal HBV screening is over 99% and around 0.4% of pregnant women are living with chronic HBV; much of this disease burden is concentrated among women born in high HBV prevalence settings (1, 2). Around 12% of pregnant women with chronic HBV have markers of higher infectivity for vertical transmission (2). Use of antiviral treatment in pregnancy has been increasing in this group over the past decade since guidelines recommended its use. England received WHO validation for meeting the criteria for elimination of hepatitis B vertical transmission in 2022 (1).
Understanding is currently incomplete regarding risk of adverse pregnancy and newborn outcomes in women living with chronic HBV and their infants, such as preterm delivery, small-for-gestational age infants and stillbirth, and the potential impact of treatment. For example, evidence is inconsistent regarding risk of delivering preterm (3), whilst a 2014 audit in England reported 8.2 stillbirths per 1000 births among women living with HBV, which is around double the general rate in the UK (3). Such information is needed to support the delivery of equitable and effective care.
Aim: To investigate the frequency of and risk factors for adverse pregnancy and neonatal outcomes in women living with chronic HBV and their infants in England
Outcomes to be assessed will include pregnancy complications such as pre-eclampsia and gestational diabetes and birth / neonatal outcomes including preterm delivery, low birthweight, small-for-gestational age, stillbirth and neonatal mortality. The potential role of inequalities will be addressed.
Methods
National surveillance of HBV in pregnancy in England has been conducted by the Integrated Screening Outcomes Surveillance Service (ISOSS) (4) for the Infectious Diseases in Pregnancy Screening Programme since April 2021. This PhD will utilise data from ISOSS (a pseudonymised dataset for research purposes will be requested) and be conducted in partnership with ISOSS and the UK Health Security Agency. Co-supervision will be provided by Dr Sema Mandal, Deputy Director of UKHSA Blood Safety, Hepatitis, STI, and HIV Division and Consultant Epidemiologist in Immunisation and Hepatitis. Statistical analyses will include multivariable modelling. Patient and public involvement and engagement activities within the project will allow the research to be shaped to reflect patient priorities and to build partnerships.
References
(1) UKHSA. Hepatitis B in England – 2023 report. Working to eliminate hepatitis B as a public health threat. https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
(2) Bailey H et al. Characteristics, treatment and care of pregnant women living with hepatitis B in England: findings from a national audit. Epidemiol Infect, 2023;151:e50.
(3) Oliveira D et al. A systematic review of the maternal and neonatal complications in hepatitis B infection. J Clin Virol, 2020; 133:104680.
(4) https://www.ucl.ac.uk/integrated-screening-outcomes-surveillance/
Contact
Claire Thorne claire.thorne@ucl.ac.uk