BACKGROUND AND PURPOSE:

• Evidence is conflicting as to whether chronic hepatitis B virus infection (HBV) may be associated with gestational diabetes mellitus (GDM)
  • Results have tended to show a positive relationship in populations more prone to GDM (e.g. Chinese, and Asian ethnicity)
• Giles et al. (BJOG, 2020) sought to ascertain if GDM was more common in women with chronic HBV in a non-Asian population

METHODS:

• Cross-sectional study
• Participants
  • All singleton births in Victoria, Australia between 2009 and 2017
• Study design and data analysis
  • Regression analysis was used to determine whether GDM is more common in women with HBV than in women without HBV
  • Results were adjusted to account for other GDM risk factors (i.e. maternal BMI, region of birth, maternal age, smoking and parity)
• Primary outcome
  • Risk for GDM diagnosis in women with and without chronic HBV infection
  • Risks comparing women with chronic HBV Asian country of birth vs Australian born

RESULTS:

• 670,944 patients included
  • GDM: 8.2%
  • Hepatitis B: 0.5%
• The highest incidence of GDM was in women with HBV and BMI >40: 37.1%
• Rate of GDM was higher in women with HBV (14.3%) vs without HBV (8.1%); P <0.001
• Region of origin: HBV infection
  • Was associated with an increased incidence of GDM in women from low prevalence HBV regions (e.g. Southern and Eastern Europe) 
  • Not associated with increased incidence of GDM in women born in high prevalence regions (e.g. Southern, Central and Southeast Asia)
• Incidence risk ratio (RR) for GDM for women with chronic HBV
  • (Unadjusted) RR: 1.75 (95% CI, 1.6 to 1.9)
  • Adjusted RR: 1.2 (95% CI, 1.1 to 1.3)

CONCLUSION:

• HBV infection appears to be a risk factor for developing GDM
  • This association remained after adjustment for known GDM risk factors
• The underlying mechanism is not well understood
  • One hypothesis is related to viral replication leading to increased insulin resistance due to elevated cytokine levels
• The authors suggest that based on these findings

…women with HBV and a high BMI should have early screening, and interventions currently considered to be best practice, such as healthy diet, weight control and exercise, should be encouraged

Learn More – Primary Sources:

Chronic hepatitis B infection and the risk of gestational diabetes: a cross-sectional study

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