It is well-known that acute hepatitis B virus (HBV)
infection in adults is usually self-limiting, of which only
5%-10% develop to chronic HBV infection, and about
1% progress to acute liver failure [1]. However, in certain
special populations, such as pregnant women, the clinical
course of acute hepatitis B (AHB) is still largely unclear.
Although a few studies have investigated the impact of
pregnancy on AHB, few of them included matched controls
[2-8]. Age, sex, and host immunity status are important
factors influencing the clinical manifestation and
outcome of acute HBV infection [9]. Clinical features and
HBV serological outcome in pregnant AHB patients, such
as hepatitis B surface antigen (HBsAg) loss and seroconversion,
have not fully been elucidated.
The clinical presentation and natural history of HBV
infection is mediated through complex interactions between
the virus and the host immune response [10]. In
acute HBV infection, both host innate immunity and
HBV specific adaptive immunity play important roles in
viral clearance [10,11]. Impaired immunity due to various
causes may influence the course of AHB [9,12-14].
During pregnancy, the maternal immune system is altered
to tolerate the genetically different fetus, and hormonal
factors may also play a significant role in altering
immune regulation or viral replication [15]. An early
study by Mohite et al. reported that the T cell response
to HBsAg was weaker in pregnant women than in adults