الفهرس 
AIM OF THE STUDYOnly 14 pages are availabe for public view
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Abstract
Viral hepatitis during pregnancy is closely related to high risks of maternal complications including premature contractions, placenta previa, preterm delivery, placental separation, premature rupture of membranes, vaginal bleeding, preterm labor, gestational diabetes mellitus and mortality with a high rate of vertical transmission leading to fetal and neonatal hepatitis.
About 70–90% of infants born to HBsAg and HBeAg, double-positive mothers who did not receive HBV vaccine will be infected and become HBsAg carriers within 6 months. The prenatal screening and vaccination of newborns of infected mothers can interrupt 85% to 90% of such mother-infant transmissions.
Objectives of the study
To estimate the prevalence of HBsAg among pregnant women and to identify the determinants of hepatitis B infection among pregnant women in Sa’ada governorate, Yemen.
Subjects and methods:
To carry out the study, a cross-sectional design was conductedto investigate the seroprevalence and associated risk factors of HBV among 300 pregnant women above 20 years of age attending the antenatal clinics in Al-Jomhori Hospital and Al-Salam Hospital. The data collection tools included:
1-A pre-designed structured interviewing questionnaire: to collect demographic data, medical history, obstetric history of pregnant women and risk factors for HBV infection.
2- Laboratory test: HBsAg test was performed by ELISA. The positive test was used to assess HBsAg prevalence among pregnant women.
The collected data were revised, coded and analyzed by using SPSS version 20. Multiple stepwise logistic regression, Mean with standard deviation, percent and Chi-square (X2) test were used as tests of significance.
Results
A- Description of the study sample:
Regarding sociodemographic characteristics of pregnant women, the age ranged between 20 and 45 years with a mean of 26.6 ± 6.2 years. Most of them (70.7%) were aged 20 to <30 years while 23.3% aged 30 to 40 years. The majority of pregnant women (82.3%) were from rural areas. Regarding their occupation, more than three quarters of pregnant women (89.0%) were housewives, 8.4% were students, and only 2.3% were employees. More than half (53.4%) of the pregnant women were illiterate, 18.0% had basic education, 14.3% could only read and write. Only 5.0% had university education.
According to medical history, the majority (84.3%) of pregnant women had no history of chronic diseases. Less than one quarter (22.0 %) of pregnant women had history of jaundice.
As regards obstetric history, more than half of pregnant women (59.6%) were in the 3rd trimester, while 19.7% and 20.7% were in the 1st trimester and in the 2nd trimester. In about one quarter of pregnant women (24.0%), the current pregnancy was their first, in 25% the current pregnancy was their 2nd, in 19% it was their 3rd and in 32% it was their 4th or more. About three quarters of pregnant women (72.4%) did not have any stillbirth. More than one third (36.8%) of women had history of abortion.Regarding the place of previous deliveries for pregnant women, two-thirds (66.7%) had their previous deliveries in health care facilities, 21.9% had their previous deliveries at home, while 11.4% had their previous deliveries at both. Among pregnant women who had previous deliveries, less than half (45.2%) were attended by a midwife, 20.2% were attended by a traditional daya, 16.7% were attended by a nurse, while only 7.5% were attended by a physician.
More than half (55.7 %) of pregnant women did not use a method of contraception. Nearly one quarter (23.7 %) used oral contraceptive pills, 14.3 % used injections, and 5.3% used oral and injectable contraceptives. Only 1.0 % used intrauterine devices (IUDs).
Regarding the distribution of pregnant women according to some risk factors of hepatitis B, only 10.0% of pregnant women had history of blood transfusion, among them 83.3%, 13.3% and 3.3% received one, two and three or more blood transfusions respectively. Regarding history of surgery, 14.7% of pregnant women had history of surgery. More than one-third (38.7%) had visited dental clinics. Among those who visited the dental clinics, 43.1% visited the clinics for filling, 23.3% of them their purpose of dental visits were extraction and filling, 21.6% for extraction, 6.0% for scaling, and 5.2% for scaling and filling. Only 2.3% of pregnant women had history of tattooing. More than two third of pregnant women (70.3%) reported that their husbands did not have HBV infection, 2.0% of them reported that their husbands were infected.
B- The prevalence of HBsAg among pregnant women:
Of the 300 pregnant women enrolled in the study, HBsAg were detected in nine (3.0 %) of women.
C- Determinants of HBV infection among pregnant women:
The prevalence of HBsAg decreased with the increase in age. Pregnant women who lived in urban areas had slightly higher prevalence of HBsAg compared to those who lived in rural areas. Regarding occupation, 12.0% of pregnant women who were students were HBsAg positive, while 2.2% of housewives were positive. The highest prevalence (5.6%) was among pregnant women who had basic education. None of pregnant women who received higher education was positive.
Regarding obstetric history and the prevalence of HBsAg, it could be noticed that the prevalence of HBsAg decreased with the increased in gestational age. The highest prevalence (6.7%) of HBsAg was among pregnant women whose the current pregnancy was their 2nd, while 4.2% and 1.8% among those whom the current pregnancy was their 1st and 3nd. Among women who had previous deliveries, all HBsAg positive women were among those who had no history of stillbirth. Regarding the pregnant women who had history of abortion, 2.4% were HBsAg positive, while 2.8% of pregnant women had no history of abortion were HBsAg positive. 3.3% of those who had one abortion were HBsAg positive.
Only 2.0% of women who had previous deliveries at home were positive for HBsAg, while 2.6% and 3.8% of those who had previous deliveries at a health facility and at both were positive for HBsAg. Among those who had previous delivery, none of women who were attended by a physician tested positive for HBsAg.
As regards the use of contraceptives, the highest prevalence (4.7%) of HBsAg was among pregnant women who used injectable contraceptives, followed by those who did not used any type of contraceptives (3%), while 2.8% of those who used oral contraceptive pills were positive for HBsAg.
Regarding the distribution of pregnant women according to the prevalence of HBsAg and certain risk factors, almost equal proportions of pregnant women with positive HBsAg were detected among those with and without of history of blood transfusion (3.3% and 3% respectively). Regarding history of surgery, 4.5% of pregnant women who had history of surgery were HBsAg positive, compared to 2.7% of them who had no history of surgery.
Regarding dental clinic visits, 6.0% of pregnant women who had visited dental clinics were HBsAg positive, while 1.1% who had not visited dental clinics were HBsAg positive. Among pregnant women who visited dental clinics, the HBsAg was detected among 10% of women who visited the clinics for filling and among 28.6% who visited the clinics for scaling. The difference was statistically significant.
Only 1.9% of pregnant women who reported that their husbands had no HBV infection were positive for HBsAg, while 6.0% of pregnant women who did not know whether their husbands had or did not have HBV infection were positive for HBsAg.
Logistic regression analysis showed that only one variable was significantly affecting the prevalence of hepatitis B among pregnant women; it was dental clinic visits (OR=5.89, CI=1.183- 29.322).
Conclusion
The prevalence of HBV among pregnant women was 3%, which is considered as an intermediate endemicity. Factors associated with the prevalence of HBsAg among pregnant women were dental clinic visits, and purpose of the visit.
Recommendations
The main recommendations include that all pregnant women should be screened for hepatitis B virus infection, infants and new born must be systematically immunized against hepatitis B virus infection and provision and maintenance of infection prevention and control program especially in dental sittings.