J Matern Fetal Neonatal Med. 2026 Dec;39(1):2650950. doi: 10.1080/14767058.2026.2650950. Epub 2026 Apr 6.
ABSTRACT
PURPOSE: This study evaluates phase-specific antiviral efficacy of tenofovir disoproxil fumarate (TDF) in pregnant women with hepatitis B virus (HBV) infection, comparing immune-tolerant (IT), inactive carrier (IC), and their corresponding gray zone (GZ-A, GZ-C). Perinatal outcomes and mother-to-child transmission (MTCT) risks were also assessed across these phases.
METHODS: In this retrospective study, 717 pregnant women with HBV infection from Nanjing, China (2021-2023) were stratified into IT (n = 317), IC (n = 76), GZ-A (n = 98), and GZ-C (n = 226). Among them, 365 women received TDF antiviral therapy during mid-to-late pregnancy. Primary endpoints included complete virological response rate (CVR) and reductions in HBV DNA and HBsAg from baseline, measured at delivery and 6 months postpartum.
RESULTS: TDF significantly reduced HBV DNA levels across all groups (p < .001), with the highest CVR rate observed in GZ-A (41.94% vs. 15.88% in IT at 6 months postpartum, p = .002). Despite higher rates of transient liver dysfunction in GZ-A (22.45% vs. 12.62% in IT, p = .007), no group exhibited increased MTCT or adverse pregnancy outcomes (APOs, p > .05). HBsAg decline was most pronounced in GZ-C at 6 months postpartum (Δ = 0.69 log10 IU/mL vs Δ = 0.47 log10 IU/mL in IC, p < .01).
CONCLUSION: TDF effectively suppresses viral replication in pregnant women with HBV infection, including historically undertreated GZ subgroups, without compromising pregnancy safety. These findings provide a reference for phase-specific management strategies to optimize perinatal HBV care.
PMID:41942346 | DOI:10.1080/14767058.2026.2650950
