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Byline: Rabiah Anwar, Kashif Razzaq and Ayesha Imran


Objective: To determine the frequency of hepatitis B viral markers among pregnant women attending Military Hospital Rawalpindi.

Study Design: Cross sectional study.

Place and Duration of Study: Department of Gynaecology and Obstetrics, Military Hospital Rawalpindi from Feb 2013 to Jul 2013.

Material and Methods: A total of 9149 pregnant ladies were inducted in our study by non-probability convenient sampling in the Department of Gynae/Obs, Military Hospital Rwp during the study period and were tested for Hepatitis B surface antigen by enzyme linked immunosorbant assay (ELISA).

Results: The mean +- SD age of the study group was 27.5 +- 3.24 years. Frequency of hepatitis B surface antigen in pregnant ladies was 4.69%.

Conclusion: The frequency of hepatitis B infection is quite high in pregnant women in Pakistan therefore proper screening of HBV and management programs must be introduced in all pregnant women attending ante natal clinics.

Keywords: Hepatitis B surface antigen, Pregnant ladies.


Hepatitis B virus is a double stranded deoxyribonucleic acid (DNA) virus belonging to hepadnaviridae family. The incubation period is six weeks to six months1. The route of transmission is parenteral, sexual and exposure to HBsAg positive blood or other body fluids from carriers of HBV or from those who have acute hepatitis B2. Chronic hepatitis B virus infection is an important cause of chronic liver disease which may lead to cirrhosis, decompensated liver disease, and/or hepatocellular carcinoma.

Worldwide about 2 billion people are infected with hepatitis B virus. Out of them 350 million are chronically infected. Fifty million new cases are diagnosed annually3. Over 50% 350 million carriers of chronic hepatitis B (CHB) acquire infection perinatally. In hepatitis B e antigen (HBeAg) positive mother, rate of vertical transmission increases to 90%4. Because of induction of an immune tolerant state, perinatally acquired infection results in chronic hepatitis B infection. For global eradication of hepatitis B virus (HBV) infection, adoption of strategies for prevention of perinatal transmission is important.

The objective of this study was to assess the frequency of hepatitis B viral markers among pregnant women attending Military Hospital Rawalpindi so that focus can be made on strategies aimed at decreasing maternal-fetal transmission of hepatitis B.


This cross sectional study was conducted in Gynaecology and Obstetrics department of Military Hospital from Feb 2013 to Jul 2013. Military Hospital Rawalpindi is a referral, tertiary care hospital catering for large number of army and civilian personnels. Administrative and ethical permission from concerned authorities was sought.

Data Collection Procedure

All pregnant ladies attending for antenatal care facilities were included in the study through non-probability convenient sampling. Total 9149 pregnant ladies participated in our study. Screening for HBsAg is a part of routine antenatal laboratory investigations and is done after informed consent. It is tested by enzyme linked immunosorbant assay (ELISA) in the laboratory of Military Hospital Rawalpindi. All the cases were evaluated by detailed history including demographics, obstetrical record and potential risk factors for acquisition of HBV infection. The data was noted down on predesigned proforma by the principle author and her team. Confidentiality of HBSAg positive cases was maintained.

Data were analyzed using statistical software SPSS version 10. Mean and standard deviation were used to describe quantitative variables like age. Frequency and percentage were calculated for qualitative variables like positivity of HBsAg cases.


Total of 9149 pregnant ladies were enrolled in our 6 months study period. The mean +- SD age of the study group was 27.5 +- 3.24 years. HBsAg was found to be positive in 430 cases (4.6%). Pattern of age distribution along with minimum and maximum values is shown in fig-1.


Hepatitis B is a liver disease caused by HBV. Its severity ranges from mild illness, lasting a few weeks (acute) to serious long-term (chronic) disease which can cause cirrhosis or cancer1. When acute infection occurs in first trimester, vertical transmission occurs in about 10% of neonate but if infection occurs in third trimester, upto 80-90% of neonates acquire HBV5. HBsAg doesnot cross placental barrier but is usually acquired at birth or shortly thereafter. Therefore presence of HBsAg in cord blood indicates intrauterine infection. Transplacental transmission is associated with maternal HBeAg positivity, HBsAg titers, HBV DNA level, and history of threatened preterm labour6.

Antenatal screening for HBV has become standard in antenatal care because of availability of safe and effective vaccine against HBV. HBV screening enables us to identify infants requiring immunoprophylaxis with HBV vaccine and hepatitis B immunoglobulin (HBIG)7. Universal screening for HBsAg in all pregnant ladies should be done. Because if risk factors based screening is done, upto 50% HBsAg-positive individual may be missed8.

The prevalence of hepatitis B surface antigen (HBsAg) positive pregnant ladies varies with geographical location and ethnicity. In United State of America, HBsAg prevalence is 6% in Asian women, 1% in African-American, 0.6% in non- Hispanic whites and 0.1% in Hispanics9. HBsAg was found in 1.7% of pregnant women in Brazil10.

Whereas a study in Africa revealed that HBsAg was positive in 4.6% of pregnant Nigerian women11 and in 5.6% of pregnant women of Sudan12.

A study done in the countries of Persian Gulf showed the seroprevalence of HBsAg among pregnant women as 7.1% in Oman, 1.0% in Qatar and 1.5% in UAE13.

According to a study by Denis et al conducted in France, HBsAg was positive in 0.29% of the pregnant women of French origin, 7.15% of Southeast Asian origin, and 6.52% for Sub Saharan African origin14.

In a study done in six regions of Italy, HBsAg was positive in 1.1% of pregnant women born in Italy, but it was 5.9% among immigrants15.

Pakistan is highly endemic for HBV with nine million people infected with HBV and its infection rate is on a steady rise due to lack of proper health care facilities, poor economical status and less public awareness about the transmission of major communicable diseases including HBV, HCV and HIV16.

In our country, there are estimated 7-9 million carriers of hepatitis B virus (HBV) with a carrier rate of 3-5%. Five studies showed the HBV prevalence of 5.872% +- 4.984% in pregnant women17 - 21.

A very high frequency of [greater than or equal to]12% HBV infections in pregnant females has been reported in Bahawalpur, Hyderabad and Rahim Yar Khan reigons22-24.

Globally, over 160 countries endorse universal infant vaccination, particularly in reigons where HBV is endemic. WHO recommends the 1st dose of HBV vaccine within 24 hours of birth and 2 to 3 subsequent doses as part of routine immunization schedule. Hepatitis B immunoglobulin (HBIG) passive immunization in conjunction with HBV vaccination may also be administered to infants born to HBeAg-positive mothers. However, WHO acknowledges the limitations related to cost and supply of HBIG in certain endemic areas4. The Centre for Disease Control (CDC) also advises one dose of HBV vaccine given shortly after birth with or without HBIG25 and breast feeding is promoted as breast feeding does not transmit infection.


The frequency of hepatitis B infection is quite high in pregnant women in Pakistan therefore proper screening of HBV and management programs must be introduced in all pregnant women attending ante natal clinics.


This study has no conflict of interest to declare by any author.


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Publication:Pakistan Armed Forces Medical Journal
Geographic Code:9PAKI
Date:Dec 31, 2016

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