OBJECTIVES: Chronic hepatitis B virus (HBV) infection is a worldwide public issue, especially in Asia and Africa area. However, the association between hepatitis B surface antigen (HBsAg) positivity during pregnancy and gestational diabetes mellitus (GDM) retains uncertain, and published individual studies had conflicting results. In order to examine the association between HBsAg positivity during pregnancy and GDM, we conducted a systematic review and meta-analysis

METHODS: We searched Medline and EMBASE for cohort studies and case-control studies that reported the association between maternal HBsAg positivity and GDM. We pooled adjusted Odds Ratio (aOR) and unadjusted OR respectively, using random-effect generic inverse variance method. We assessed risk of bias using the QUIPS tool, and conducted five pre-specified subgroup analyses. We also performed a sensitivity analysis to evaluate the robustness of our study.

RESULTS: Totally, 23 cohort studies involving 3,529,223 patients were included, of 22 studies reported the prevalence rate of GDM was 6.48% (1868/28829) in positive-HBsAg pregnant women and 3.41% (119283/3500394) in negative-HBsAg pregnant women. Meta-analysis of unadjusted and adjusted effect estimates showed that HBsAg positivity during pregnancy was associated with higher risk of developing GDM (unadjusted OR 1.35, 95% CI 1.17 to 1.56, I2 = 82.6%; adjusted OR 1.47, 1.22 to 2.81.76, I2 = 62%). Among pre-specified subgroup analysis, significant differences were found in diagnostic rate of GDM and risk of bias in study participation subgroups. By sensitivity analysis, there were unchanged results after omitting the doubtful studies.

CONCLUSIONS: Given the volume population infected with HBsAg worldwide, and the potential harms of GDM on pregnant women and prenatal birth, more rigorous management could be considered for pregnant women with HBV infection. Future studies are needed for further exploring the physiological mechanism of HBV infection and GDM, and the appropriate interventions should be adopted to reduce the risk of adverse outcomes.