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Peer-reviewedCC BY 4.0Frontiers in Public Health

Risk factors for postpartum alanine aminotransferase elevation in women with chronic hepatitis B infection: a systematic review and meta-analysis

  • Chengxuan Yao1
  • Xiang Gao2
  • Yunxia Zhu2
  • Xiaohui Zhang1
  • Shuiweizhi Dai1
  • Jinhua Wang2
  • Yu Chen1
  • Huaibin Zou1
  1. 1Fourth Department of Liver Disease Center, Beijing YouAn Hospital, Capital Medical University
  2. 2Department of Obstetrics and Gynecology, Beijing YouAn Hospital, Capital Medical University
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Abstract

Background: Postpartum alanine aminotransferase (ALT) elevation is common in women with chronic hepatitis B (CHB) infection and may adversely affect maternal recovery and long-term disease outcomes. However, the risk factors associated with postpartum ALT elevation remain inconsistent across studies.

Methods: We conducted a systematic review and meta-analysis in accordance with the PRISMA guidelines; the registration number is CRD420251208005. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WanFang databases were searched from their inception to 1 January 2026.

Results: A total of 17 cohort studies involving 6,876 women with CHB were included. The meta-analysis demonstrated that hepatitis B e-antigen (HBeAg) positivity (odds ratio [OR] = 3.03; 95% CI [1.91–4.81]), higher baseline hepatitis B virus (HBV) DNA levels (OR = 1.39; 95% CI [1.04–1.86]), and elevated antepartum ALT levels were significantly associated with postpartum ALT elevation. A subgroup analysis revealed that antepartum ALT elevation, defined as a categorical variable (ALT >1 ULN), showed a strong association with postpartum ALT elevation (OR = 5.54, 95% CI 3.78–8.12), whereas continuous ALT increase showed a smaller effect size. Increasing maternal age was associated with a reduced risk of postpartum ALT elevation (OR = 0.93, 95% CI 0.87–0.99).

Conclusion: HBeAg positivity, high baseline HBV DNA levels, and elevated antepartum ALT levels are key risk factors for postpartum ALT elevation in women with CHB. Additionally, younger maternal age may confer increased susceptibility.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251208005 , Identifier: CRD420251208005.

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Cite

BibTeXRIS
BibTeX
@article{yao2026risk,
  title = {{Risk factors for postpartum alanine aminotransferase elevation in women with chronic hepatitis B infection: a systematic review and meta-analysis}},
  author = {Chengxuan Yao and Xiang Gao and Yunxia Zhu and Xiaohui Zhang and Shuiweizhi Dai and Jinhua Wang and Yu Chen and Huaibin Zou},
  journal = {Frontiers in Public Health},
  year = {2026},
  month = oct,
  doi = {10.3389/fpubh.2026.1956281},
  url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1956281/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Risk factors for postpartum alanine aminotransferase elevation in women with chronic hepatitis B infection: a systematic review and meta-analysis
AU  - Chengxuan Yao
AU  - Xiang Gao
AU  - Yunxia Zhu
AU  - Xiaohui Zhang
AU  - Shuiweizhi Dai
AU  - Jinhua Wang
AU  - Yu Chen
AU  - Huaibin Zou
PY  - 2026
DA  - 2026/10/14
JO  - Frontiers in Public Health
DO  - 10.3389/fpubh.2026.1956281
UR  - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1956281/full
AB  - Background: Postpartum alanine aminotransferase (ALT) elevation is common in women with chronic hepatitis B (CHB) infection and may adversely affect maternal recovery and long-term disease outcomes. However, the risk factors associated with postpartum ALT elevation remain inconsistent across studies.  Methods: We conducted a systematic review and meta-analysis in accordance with the PRISMA guidelines; the registration number is CRD420251208005. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WanFang databases were searched from their inception to 1 January 2026.  Results: A total of 17 cohort studies involving 6,876 women with CHB were included. The meta-analysis demonstrated that hepatitis B e-antigen (HBeAg) positivity (odds ratio [OR] = 3.03; 95% CI [1.91–4.81]), higher baseline hepatitis B virus (HBV) DNA levels (OR = 1.39; 95% CI [1.04–1.86]), and elevated antepartum ALT levels were significantly associated with postpartum ALT elevation. A subgroup analysis revealed that antepartum ALT elevation, defined as a categorical variable (ALT >1 ULN), showed a strong association with postpartum ALT elevation (OR = 5.54, 95% CI 3.78–8.12), whereas continuous ALT increase showed a smaller effect size. Increasing maternal age was associated with a reduced risk of postpartum ALT elevation (OR = 0.93, 95% CI 0.87–0.99).  Conclusion: HBeAg positivity, high baseline HBV DNA levels, and elevated antepartum ALT levels are key risk factors for postpartum ALT elevation in women with CHB. Additionally, younger maternal age may confer increased susceptibility.  Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251208005 , Identifier: CRD420251208005.
SN  - 2296-2565
ER  -