Correlations between maternal hepatitis B virus carrier status and Down’s syndrome prenatal screening indicators and their effects on the screening results

Abstract

The aim of this study was to determine the correlation between maternal hepatitis B virus (HBV) carrier status and pregnancy-associated serum screening indicators, as well as their implications on the prenatal screening results of Down’s syndrome (DS). This retrospective cohort study included two groups, namely the healthy gravidas group (n = 19804) and the maternal HBV carrier group (n = 792). Serum pregnancy-associated plasma protein A (PAPP-A), alpha-fetoprotein (AFP), and free beta subunit of human chorionic gonadotropin (free β-hCG) levels, as well as the foetal nuchal translucency (NT) thickness, were measured. Multivariatebinary logistic regression analysis was used to evaluate the association between the HBV carrier status and prenatal screening biomarkers. The PAPP-A multiple of the medium (MoM) and free β-hCG MoM in the first trimester were significantly higher in the HBV carrier group than in the control group (both P < .05). Multivariate binary logistic regression analysis showed that HBV carrier status was identified as a risk factor for PAPP-A and the intrahepatic cholestasis of pregnancy (ICP), with adjusted odds ratios (aOR) of 1.363 (1.216–1.527) and 3.255 (2.356–4.499), respectively. Pregnant women with HBV carrier status had higher influence on serum PAPP-A level and ICP, and the risk calculation algorithm for DS in HBV carriers should be corrected in the first trimester of pregnancy.

IMPACT STATEMENT

• What is already known on this subject? The maternal serum levels of pregnancy-associated plasma protein A (PAPP-A), alpha-fetoprotein (AFP), and free beta subunit of human chorionic gonadotropin (free β-hCG), as well as the foetal nuchal translucency (NT) thickness, have been collectively used in the prenatal screening of Down’s syndrome (DS), Edward’s syndrome (ES), and open neural tube defects (ONTD). However, many factors, including the maternal age; maternal weight; gestational age; race; history of smoking and so on can affect those serum biomarker levels. Our aim is to know whether there is a difference for HBV status to pregnancy-associated serum screening indicators hoes.

• What the results of this study add? The PAPP-A multiple of the medium (MoM) and free β-hCG MoM in the first trimester were significantly higher in the HBV carrier group than in the control group (both p < .05). Multivariate binary logistic regression analysis showed that the PAPP-A and intrahepatic cholestasis of pregnancy (ICP) were risk factors for HBV carriers, with aORs of 1.363 (1.216–1.527) and 3.255 (2.356–4.499), respectively.

• What the implications are of these findings for clinical practice and/or further research? The PAPP-A MoM in maternal HBV carriers was significantly higher than that in healthy gravidas, and the risk calculation algorithm for DS in maternal HBV carriers should be corrected in the first trimester of pregnancy.

Keywords:

• Alpha-fetoprotein
• Down’s syndrome
• hepatitis B virus carrier
• odds ratio
• pregnancy-associated plasma protein A
• prenatal screening

Acknowledgements

The authors are grateful to all participants and contributors. The authors thank Songhe Chen from Hangzhou Women’s Hospital, and Xiao Lu from Department of Hangzhou Biochemical Technologies for their contribution to case collection, data match, and statistical analysis. The authors also thank International Science Editing (http://www.internationalscienceediting.com) for editing this manuscript.

Ethics approval and consent to participate

The study has been conducted under the approval of the Human Research Ethics Committee of the Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital) (No. [2020] Medical Ethics Review A (10)-11), and the procedures have been performed in accordance with the Declaration of Helsinki. Written informed consent to participate in the study was obtained from all patients enrolled in the study.

Author contributions

L. L. H. and Y. M. C. conceptualised and refined the study design and methodology. W. W. N. and Y. J. C. conducted all analyses and prepared tables and figures with assistance from Data Analysis Department. D. J. Y. wrote the entire manuscript and performed literature review. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.