Introduction
Methods
P (Population) | E (Exposure) | C (Comparison) | O (Outcomes) | T (Type of Studies) |
---|---|---|---|---|
The target population included all pregnant women without any restrictions | The intended exposure or cause was the presence of infection or hepatitis B virus in pregnant women | The comparison group included healthy pregnant women without hepatitis B infection | The intended Outcomes included neonatal death, miscarriage, eclampsia or preeclampsia, preterm birth, gestational diabetes, and other outcomes reported in selected cohort studies | The type of studies included only cohort studies |
References | Authors (Years) Country | Type of study | Study population | Sample size | Neonatal death | Eclampsia | Number of Pre-Eclampsia (Positive pregnancies) | Maternal age (Yrs, mean ± SD) | Gestational age (weeks, mean ± SD) | Gestational hypertension | Parity | GDM | Preterm birth |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
[38] | Zhang (2020) China | Retrospective cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-positive = 9699 HBsAg-negative = 73,076 | NR | NR | HBsAg-positive = 139 (1.43%) HBsAg-negative = 1302 (1.78%) | HBsAg-positive = 30.33 ± 4.50 HBsAg-negative = 30.28 ± 4.45 | HBsAg-positive = 38.18 ± 2.96 HBsAg-negative = 38.17 ± 3.51 | HBsAg-positive = 157 HBsAg-negative = 1421 | 1 = HBsAg-positive = 82 (0.85%) HBsAg-negative = 760 (1.04%) > 1 = HBsAg-positive = 9617 (99.15%) HBsAg-negative = 72,316 (98.96%) | HBsAg-positive = 1663 HBsAg-negative = 11,982 | NR |
[22] | Tan (2016) China | Retrospective cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-positive = 948 HBsAg-negative = 21,426 | NR | NR | HBsAg-positive = 33 (3.5%) HBsAg-negative = 523 (2.4%) | < 35 = HBsAg-positive = 813 (85.8) HBsAg-negative = 18 876 (88.1) HBsAg-positive = 135 (14.2) HBsAg-negative = 2550 (11.9) | 39 (38–39) | HBsAg-positive = 9 HBsAg-negative = 288 | Nulliparity = HBsAg-positive = 713 (75.2) HBsAg-negative = 16 489 (77.0) Multiparity = HBsAg-positive = 235 (24.8) HBsAg-negative = 4937 (23.0) | HBsAg-positive = 112 HBsAg-negative = 1758 | NR |
[21] | Stokkeland (2017) Sweden | Retrospective cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-positive = 2990 HBsAg-negative = 1,090,979 | NR | NR | HBsAg-positive = 59 (1.97) HBsAg-negative = 30,030 (2.75) | ≤ 24 = HBsAg-positive = 506 HBsAg-negative = 156,906 25–34 = HBsAg-positive = 1780 HBsAg-negative = 709,970 ≥ 35 = HBsAg-positive = 7.4 HBsAg-negative = 226,587 | NR | NR | 1 = HBsAg-positive = 1014 HBsAg-negative = 488,887 2 = HBsAg-positive = 989 HBsAg-negative = 396,034 + 3 = HBsAg-positive = 987 HBsAg-negative = 206,058 | HBsAg-positive = 68 HBsAg-negative = 11,262 | HBsAg-positive = 175 HBsAg-negative = 53,452 |
[29] | Lok (2021) Hong Kong | Retrospective cohort | HBV negative = 79487HBV positive = 8402 | HBV negative = 105 HBV positive = 11 | HBV negative = 37 HBV positive = 5 | HBsAg-positive = 66 (0.78%) HBsAg-negative = 1103 (1.25%) | NR | NR | HBsAg-positive = 185 HBsAg-negative = 2366 | Nulliparity = HBsAg-positive = 4082 HBsAg-negative = 39,178 Multiparity = HBsAg-positive = 4320 HBsAg-negative = 40,309 | HBsAg-positive = 763 HBsAg-negative = 6877 | HBsAg-positive = 522 HBsAg-negative = 5299 | |
[25] | Chen (2022) United States | Retrospective cohort study | HBsAg-positive and HBsAg-negative pregnancies | Control = 28,499,085 HBV = 51,200 | NR | Control = 5.28% HBV = 4.48% | NR | NR | NR | NR | Control = 6.94% HBV = 12.94% | Control = 6.27% HBV = 5.52% | |
[37] | Yin (2021) China | Retrospective cohort study | HBsAg-positive and HBsAg-negative pregnancies | HBV negative = 36,500 HBV positive = 3039 | NR | NR | HBV negative = 924 HBV positive = 103 | NR | 38.55 ± 2.17 | HBV negative = 242 HBV positive = 18 | NR | HBV negative = 3529 HBV positive = 366 | HBV negative = 1720 HBV positive = 119 |
[23] | Bajema (2018) United States | Retrospective cohort study | HBsAg-positive and HBsAg-negative pregnancies | HBV negative = 22 410 HBV positive = 4391 | NR | HBV negative = 25 HBV positive = 9 | HBV negative = 1299 HBV positive = 177 | NR | NR | NR | 0 = HBsAg-positive = 1935 HBsAg-negative = 9249 > 1 = HBsAg-positive = 2388 HBsAg-negative = 12,790 | HBV negative = 1109 HBV positive = 389 | NR |
[36] | Xiong (2021) China | Retrospective cohort study | HBsAg-positive and HBsAg-negative pregnancies | HBV negative = 6,216 HBV positive = 795 | NR | NR | HBV negative = 132 HBV positive = 16 | HBV negative = 31 (28–34) HBV positive = 31 (28–34) | NR | NR | NR | HBV negative = 1585 HBV positive = 221 | HBV negative = 967 HBV positive = 141 |
[27] | Connell (2011) USA | Retrospective cohort study | HBsAg-positive and HBsAg-negative pregnancies | HBV negative = 1 668 911 HBV positive = 1458 | NR | NR | HBV negative = 4.46% HBV positive = 4.25% | NR | NR | HBsAg-negative = 57,744 HBsAg-positive = 40 | NR | HBsAg-negative = 11,849 HBsAg-positive = 29 | HBsAg-negative = 147,532 HBsAg-positive = 132 |
[18] | Lao (2007) China | Retrospective cohort study | HBsAg-positive and HBsAg-negative pregnancies | HBV negative = 12,547 HBV positive = 1138 | NR | NR | HBV negative = 2.8% HBV positive = 1.8% | HBsAg-negative = 30.3 ± 5.3 HBsAg-positive = 30.2 ± 5.2 | HBsAg-negative = 39.0 ± 1.8 HBsAg-positive = 38.9 ± 1.8 | NR | NR | HBsAg-negative = 1279 HBsAg-positive = 141 | |
[28] | Lao (2013) Hong Kong | Retrospective cohort study | HBsAg-positive and HBsAg-negative pregnancies | HBV negative = 77,936 HBV positive = 8636 | NR | NR | HBV negative = 1.1% HBV positive = 0.8% | HBsAg-negative = 29.9 ± 5.2 HBsAg-positive = 29.8 ± 5.1 | HBsAg-negative = 39.0 ± 1.8 HBsAg-positive = 38.9 ± 1.8 | HBsAg-negative = 545 HBsAg-positive = 52 | NR | HBsAg-negative = 5221 HBsAg-positive = 553 | HBsAg-negative = 4988 HBsAg-positive = 526 |
[50] | Lobstein (2011) Germany | Retrospectively | HBsAg-positive and HBsAg-negative pregnancies | HBV negative = 8,154 HBV positive = 39 | NR | HBV negative = 26 HBV positive = 0 | HBV negative = 160 HBV positive = 1 | NR | NR | NR | NR | HBsAg-negative = 36 HBsAg-positive = 0 | HBsAg-negative = 922 HBsAg-positive = 8 |
[31] | Reddick (2011) United States | Retrospective cohort study | HBsAg-positive and HBsAg-negative pregnancies | HBV negative = 296,773 HBV positive = 891 | NR | NR | HBV negative = 9729 HBV positive = 33 | NR | NR | NR | NR | HBV negative = 7464 HBV positive = 35 | HBsAg-negative = 35,991 HBsAg-positive = 197 |
[32] | Sirilert (2014) Thailand | Retrospective cohort study | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 22,331 HBsAg-positive = 1472 | NR | NR | HBsAg-negative = 1496 HBsAg-positive = 91 | HBV negative = 27.82 ± 7.36 HBV positive = 27.69 ± 5.67 | HBV negative = 37.74 ± 3.22 HBV positive = 37.37 ± 2.91 | NR | NR | HBsAg-negative = 1290 HBsAg-positive = 98 | HBsAg-negative = 2181 HBsAg-positive = 171 |
[34] | To (2003) Hong Kong | Retrospective | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 12,452 HBsAg-positive = 1340 | HBsAg-negative = 18 HBsAg-positive = 1 | HBsAg-negative = 6 HBsAg-positive = 0 | HBsAg-negative = 99 HBsAg-positive = 3 | NR | HBsAg-negative = 38.9 ± 2.91 HBsAg-positive = 38.9 ± 2.61 | HBsAg-negative = 447 HBsAg-positive = 27 | Nulliparity = HBsAg-positive = 622 (46.4) HBsAg-negative = 5952 (47.8) Multiparity = HBsAg-positive = 718 (53.5) HBsAg-negative = 6500 (52.2) | HBsAg-negative = 478 HBsAg-positive = 42 | NR |
[30] | Mak (2013) Hong Kong | Retrospective cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 8778 HBsAg-positive = 784 | NR | HBsAg-negative = 0 HBsAg-positive = 3 | HBsAg-negative = 142 HBsAg-positive = 9 | NR | NR | HBsAg-negative = 114 HBsAg-positive = 7 | NR | HBsAg-negative = 710 HBsAg-positive = 59 | HBsAg-negative = 205 HBsAg-positive = 19 |
[49] | Huang (2014) China | Cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 5734 HBsAg-positive = 461 | NR | NR | HBsAg-negative = 79 HBsAg-positive = 5 | NR | NR | HBsAg-negative = 336 HBsAg-positive = 35 | NR | NR | NR |
[40] | Zhuang (2017) China | Prospective cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 35,642 HBsAg-positive = 1113 | NR | HBsAg-negative = 1114 HBsAg-positive = 40 | NR | NR | NR | NR | HBsAg-negative = 2605 HBsAg-positive = 98 | HBsAg-negative = 2767 HBsAg-positive = 108 | |
[48] | Zheng (2021) China | Retrospective cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 12,813 HBsAg-positive = 1302 | NR | NR | HBsAg-negative = 255 HBsAg-positive = 35 | 39.17 ± 2.06 | NR | NR | HBsAg-negative = 1857 HBsAg-positive = 210 | HBsAg-negative = 1857 HBsAg-positive = 210 | |
[46] | Zhao (2020) China | Retrospective | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 29,648 HBsAg-positive = 3789 | NR | NR | NR | NR | NR | NR | 1 = HBsAg-negative = 11,821 HBsAg-positive = 1394 2 < = HBsAg-negative = 17,805 HBsAg-positive = 2391 | HBsAg-negative = 5263 HBsAg-positive = 757 | HBsAg-negative = 1336 HBsAg-positive = 190 |
[39] | Zhao (2022) China | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 89,686 HBsAg-positive = 10,355 | NR | NR | NR | NR | NR | NR | NR | HBsAg-negative = 13,048 HBsAg-positive = 1691 | ||
[35] | Wu (2020) China | Retrospective cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 18,354 HBsAg-positive = 1146 | NR | NR | NR | NR | HBsAg-negative = 38.69 ± 3.56 HBsAg-positive = 37.16 ± 3.92 | NR | NR | HBsAg-negative = 3289 HBsAg-positive = 260 | HBsAg-negative = 1502 HBsAg-positive = 128 |
[33] | Sun (2021) China | Cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 47,855 HBsAg-positive = 1624 | HBsAg-negative = 0.5 HBsAg-positive = 0.4 | HBsAg-negative = 2.8 HBsAg-positive = 2.7 | NR | HBsAg-negative = 38.9 ± 1.9 HBsAg-positive = 38.9 ± 1.6 | HBsAg-negative = 1.9 HBsAg-positive = 1.6 | NR | HBsAg-negative = 15.5 HBsAg-positive = 13.9 | HBsAg-negative = 7.8 HBsAg-positive = 8.1 | |
[24] | Bierhoff (2019) Myanmar-Thailand | Retrospective Cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 10,338 HBsAg-positive = 687 | HBsAg-negative = 44 HBsAg-positive = 3 | HBsAg-negative = 1000 HBsAg-positive = 65 | NR | HBsAg-negative = 39.0 ± 1.7 HBsAg-positive = 39.1 ± 1.7 | HBsAg-negative = 834 HBsAg-positive = 55 | NR | HBsAg-negative = 539 HBsAg-positive = 27 | NR | |
[26] | Chen (2022) China | Retrospective Cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 18,693 HBsAg-positive = 735 | HBsAg-negative = 1906 HBsAg-positive = 60 | NR | NR | HBsAg-negative = 28.97 (23.43–34.43) HBsAg-positive = 29.72 (23.94–34.91) | NR | HBsAg-negative = 755 HBsAg-positive = 27 | NR | HBsAg-negative = 1959 HBsAg-positive = 63 | NR |
[42] | Cui (2016) China | Prospective cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 20,491 HBsAg-positive = 513 | NR | NR | HBsAg-negative = 216 HBsAg-positive = 4 | HBsAg-negative = 27.03 ± 4.19 HBsAg-positive = 27.59 ± 4.02 | NR | NR | NR | HBsAg-negative = 232 HBsAg-positive = 6 | HBsAg-negative = 1,718 HBsAg-positive = 49 |
[45] | Wang, Li (2019) China | Retrospective Cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 7656 HBsAg-positive = 894 | NR | NR | NR | NR | NR | HBsAg-negative = 93 HBsAg-positive = 10 | HBsAg-negative = 358 HBsAg-positive = 33 | HBsAg-negative = 874 HBsAg-positive = 108 | |
[51] | Chen (2015) China | Retrospective Cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 428 HBsAg-positive = 380 | HBsAg-negative = 2 HBsAg-positive = 2 | NR | NR | NR | HBsAg-negative = 39.9 ± 1.7 HBsAg-positive = 39.8 ± 1.9 | NR | NR | NR | HBsAg-negative = 6 HBsAg-positive = 11 |
[41] | Cheung (2022) Hong Kong | Retrospective | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 521 HBsAg-positive = 158 | NR | NR | HBsAg-negative = 11 HBsAg-positive = 5 | NR | NR | HBsAg-negative = 18 HBsAg-positive = 3 | NR | HBsAg-negative = 123 HBsAg-positive = 27 | HBsAg-negative = 31 HBsAg-positive = 9 |
[47] | Peng (2019) china | Retrospective Cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 964 HBsAg-positive = 964 | NR | NR | NR | NR | NR | NR | NR | HBsAg-negative = 16.5% HBsAg-positive = 10.5% | NR |
[52] | Liu (2017) china | Retrospective cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 469,138 HBsAg-positive = 20,827 | NR | NR | NR | NR | NR | NR | NR | NR | HBsAg-negative = 24,422 HBsAg-positive = 1344 |
[44] | Thungsuk (2008) Thailand | Retrospective | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 170 HBsAg-positive = 154 | NR | NR | HBsAg-negative = 0 HBsAg-positive = 2 | NR | NR | HBsAg-negative = 3 HBsAg-positive = 3 | NR | HBsAg-negative = 4 HBsAg-positive = 5 | HBsAg-negative = 10 HBsAg-positive = 19 |
[43] | Tan (2017) China | Retrospective cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 21,024 HBsAg-positive = 923 | NR | NR | NR | NR | HBsAg-negative = 38.5 HBsAg-positive = 38.3 | NR | Nulliparity HBsAg-negative = 16,172 HBsAg-positive = 695 Multiparity HBsAg-negative = 4852 HBsAg-positive = 228 | HBsAg-negative = 1696 HBsAg-positive = 109 | HBsAg-negative = 1600 HBsAg-positive = 84 |
[54] | Xu (2021) China | Retrospective cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 52,094 HBsAg-positive = 2151 | NR | NR | NR | NR | NR | NR | 0 = HBsAg-negative = 40,464 HBsAg-positive = 1561 1 = HBsAg-negative = 11,337 HBsAg-positive = 565 2 > = HBsAg-negative = 284 HBsAg-positive = 4 | NR | HBsAg-negative = 2319 HBsAg-positive = 129 |
[53] | Salemi (2014) | Retrospective cohort | HBsAg-positive and HBsAg-negative pregnancies | HBsAg-negative = 2,213,722 HBsAg-positive = 3513 | NR | NR | NR | NR | NR | NR | Nulliparity HBsAg-negative = 935,227 HBsAg-positive = 1296 Multiparity HBsAg-negative = 1,274,813 HBsAg-positive = 2206 | NR | HBsAg-negative = 879,034 HBsAg-positive = 1492 |
Evaluating the risk of bias
Statistical analysis
Results
Gestational diabetes
Variables | Categories | No. study | Pooled RR (% 95 CI) | Heterogenity Assesment between sudies | Heterogenity Assesment between subgroup | Publication bias assesments | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
I2 (%) | P value | Q | Q | Pvalue | B | SE | P value | ||||
PreEclampsia | |||||||||||
Overall pooled estimate | 20 | 1.10 (1.04–1.16) | 92.06 | 0.00 | 239.28 | – | – | − 0.94 | 0.661 | 0.156 | |
Continent | Europe | 2 | 0.71 (0.55–0.92) | 0.00 | 0.89 | 0.02 | 53.44 | 0.00 | |||
Asia | 15 | 1.24 (1.17–1.32) | 92.14 | 0.00 | 178.05 | ||||||
American | 3 | 0.80 (0.72–0.90) | 74.28 | 0.02 | 7.78 | ||||||
Age | < 30 | 7 | 1.21 (1.10–1.34) | 43.54 | 0.10 | 10.63 | 19.45 | 0.00 | |||
> 30 | 4 | 0.82 (0.72–0.95) | 11.69 | 0.33 | 3.40 | ||||||
Gestational age | < 38 | 2 | 0.91 (0.75–1.12) | 0.00 | 0.67 | 0.18 | 2.57 | 0.11 | |||
> 38 | 8 | 1.09 (1.00–1.20) | 80.20 | 0.00 | 35.35 | ||||||
GDM | |||||||||||
Overall pooled estimate | 29 | 1.16 (1.13–1.18) | 92.89 | 0.00 | 393.94 | – | – | − 0.89 | 0.979 | 0.361 | |
Continent | Europe | 1 | 2.24 (1.76–2.85) | – | – | – | 108.08 | 0.00 | |||
Asia | 24 | 1.11 (1.09–1.14) | 91.58 | 0.00 | 273.13 | ||||||
American | 4 | 1.54 (1.44–1.65) | 76.44 | 0.01 | 12.73 | ||||||
Age | < 30 | 13 | 1.12 (1.08–1.16) | 94.80 | 0.00 | 249.95 | 1.29 | 0.26 | |||
> 30 | 7 | 1.16 (1.11–1.21) | 86.03 | 0.00 | 35.79 | ||||||
Gestational age | < 38 | 3 | 1.38 (1.24–1.54) | 65.84 | 0.05 | 5.85 | 14.62 | 0.00 | |||
> 38 | 11 | 1.11 (1.07–1.14) | 85.62 | 0.00 | 69.53 | ||||||
Preterm birth | |||||||||||
Overall pooled estimate | 27 | 1.17 (1.14–1.20) | 94.32 | 0.00 | 457.57 | – | – | − 0.72 | 0.883 | 0.417 | |
Continent | Europe | 2 | 1.27 (1.09–1.48) | 0.00 | 0.76 | 0.09 | 125.25 | 0.00 | |||
Asia | 20 | 1.07 (1.04–1.10) | 85.47 | 0.00 | 130.79 | ||||||
American | 5 | 1.48 (1.41–1.55) | 98.01 | 0.00 | 201.43 | ||||||
Age | < 30 | 12 | 1.02 (0.97–1.06) | 79.03 | 0.00 | 52.46 | 0.02 | 0.90 | |||
> 30 | 6 | 1.02 (0.96–1.09) | 85.73 | 0.00 | 35.03 | ||||||
Gestational age | < 38 | 3 | 1.30 (1.17–1.45) | 0.00 | 0.52 | 1.33 | 27.62 | 0.00 | |||
> 38 | 8 | 0.95 (0.91–1.00) | 74.05 | 0.00 | 26.97 | ||||||
Eclampsia | |||||||||||
Overall pooled estimate | 3 | 1.48 (0.95–2.29) | 0.00 | 0.87 | 0.28 | – | – | − 0.58 | 1.749 | 0.7387 | |
Gestationalhypertension | |||||||||||
Overall pooled estimate | 15 | 0.83 (0.77–0.90) | 12.78 | 0.31 | 16.05 | – | – | 0.00 | 0.604 | 0.997 | |
Eclampsia + PreEclampsia | |||||||||||
Overall pooled estimate | 4 | 0.85 (0.82–0.89) | 48.41 | 0.12 | 5.82 | – | – | 1.60 | 0.700 | 0.0220 | |
Abortion | |||||||||||
Overall pooled estimate | 2 | 0.97 (0.71–1.33) | 78.96 | 0.03 | 4.75 | – | – | – | – | – | |
Neonatal death | |||||||||||
Overall pooled estimate | 6 | 0.83 (0.67–1.03) | 0.00 | 0.95 | 1.18 | – | – | 0.22 | 0.711 | 0.755 |