This systematic review was planned to explore the association between viral hepatitis (HBV and HCV) during pregnancy and multiple maternal/perinatal adverse outcomes. METHODS:

Databases of MEDLINE (Ovid), EMBASE (Ovid), Web of Science, Chinese Biomedical Database Disk, China National Knowledge Infrastructure and Wanfang Platform were searched with Mesh terms and keywords from inception till Jan 1st, 2015. Random effect model and revised Newcastle-Ottawa Scale (NOS) were used to pool studies and assess risk of bias respectively. Furthermore, meta-regression was used to investigate heterogeneity sources of the association between viral hepatitis and adverse outcomes. Covariates included hepatitis types, publication languages, population sources, prospective collection of data and publication times. All statistics analyses were performed with STATA12.0 software. RESULTS:

A total of 113 studies were included from 17,611 searched references. The maternal HBV positivity showed higher risk of postpartum hemorrhage (RR 3.56, 95% CI 2.93-4.31), gestational diabetes (1.54, 1.26-1.87), cholestasis (2.0, 1.73-2.45), maternal death (1.73, 1.57-32.45), premature birth (2.40, 2.02-2.86), low birth weight (1.65, 1.34-2.04), premature rupture of fetal membranes  (1.76, 1.44-2.14), fetus growth restriction (1.47, 1.06-2.03) and perinatal death (2.10, 1.46-3.03). And the significant associations of maternal HCV and adverse outcomes were present on postpartum hemorrhage (4.99, 1.64-15.22), antepartum hemorrhage (1.8, 1.34-2.58), gestational diabetes (1.46, 1.23-1.73), cholestasis (26.33, 14.86-46.67), premature birth (1.61, 1.27-2.04), low birth weight (2.08, 1.32-3.28), premature rupture of fetal membranes (2.04, 1.33-3.11), congenital malformation (1.35, 1.02-1.80). Hepatitis types, publication languages and population origins were primary sources of heterogeneity. CONCLUSIONS:

Pregnant women with viral hepatitis could significantly increase the risk of several maternal and perinatal adverse outcomes. Such findings might provide helpful evidence for comprehensive understanding of viral hepatitis during clinical practice and thus take efficient prevention and treatment to reduce maternal and perinatal harm.