Maternal and Fetal Outcomes in Pregnant Women with Chronic Hepatitis B Infection Attending Antenatal Clinic Care at Victoria Chitepo Provincial Hospital from August 2024 to July 2025, Mutare, Zimbabwe

Abstract

Background: Chronic Hepatitis B Virus (HBV) infection remains a significant global public health challenge, affecting an estimated 360 million individuals worldwide and contributing to over 600,000 annual deaths. In high-endemic regions like Zimbabwe, pregnant women with chronic HBV infection represent a critical reservoir for vertical transmission, which is the primary driver of the long-term disease burden. Preliminary data from Victoria Chitepo Provincial Hospital (VCPH) suggested a chronic HBV prevalence among pregnant women exceeding the national average, necessitating a focused investigation into the associated maternal and fetal risks. Objective: This study aimed to assess the maternal and fetal outcomes in pregnant women with chronic HBV infection attending Antenatal Clinic (ANC) care at VCPH in Mutare, Zimbabwe, over the period from August 2024 to July 2025. Methods: A retrospective cross-sectional study design was employed. A total of 300 pregnant women attending ANC at VCPH were randomly sampled and screened for chronic HBV infection (HBsAg positivity). Data on demographic characteristics, clinical parameters (e.g., viral load, liver function tests), maternal outcomes (e.g., liver flares, mode of delivery, preterm birth), and fetal outcomes (e.g., birth weight, NICU admission, vertical transmission) were collected via structured interviewer-administered questionnaires and review of medical records. Statistical analysis, primarily using the Chi-square test and logistic regression, was conducted to determine the association between maternal HBV status and adverse outcomes. Results: The study identified a high prevalence of chronic HBV infection, with 26.7% (n=80) of the sampled pregnant women testing positive for HBsAg. Statistical analysis revealed that HBV-positive women experienced significantly higher rates of adverse maternal outcomes compared to their uninfected counterparts. Specifically, chronic HBV infection was significantly associated with an increased risk of liver flares (χ²(1, N=300) = 4.18, p = .041), preterm birth (PTB) (χ²(1, N=300) = 11.83, p < .001), and the need for Cesarean section (CS) (χ²(1, N=300) = 7.06, *p* = .008). Furthermore, high maternal viral load (HBV DNA > 200,000 IU/mL) was identified as the strongest independent predictor of negative maternal and fetal outcomes, with an Adjusted Odds Ratio (AOR) of up to 4.88 for Low Birth Weight (LBW). Neonates born to infected mothers were significantly more likely to present with LBW and require admission to the Neonatal Intensive Care Unit (NICU). Despite these risks, the overall perinatal transmission rate was observed to be 6.3%, which was attributed to the timely administration of immunoprophylaxis and the hepatitis B birth-dose vaccination protocol implemented at the hospital. However, the study noted persistent challenges, including limited access to comprehensive viral load testing and gaps in patient education regarding adherence to antiviral therapy, often compounded by poor transport management for sample logistics. Conclusion and Recommendations: The hyper-endemic prevalence of chronic HBV and its significant association with adverse maternal and fetal outcomes at VCPH underscore a critical public health need. The study strongly recommends the expansion of comprehensive screening protocols to include routine viral load testing, the implementation of risk-stratified antiviral treatment for high-risk pregnant women, and the strengthening of the universal hepatitis B birth-dose vaccination program. These evidence-based strategies are vital to reducing vertical transmission, improving overall maternal and neonatal health, and supporting Zimbabwe’s national goals for viral hepatitis elimination.