# The Effect of Hepatitis B Infection on Levels of Fibrinogen, Protein C, and Protein S in Pregnant Women

## TL;DR

This study finds that pregnant women with hepatitis B have lower levels of key coagulation factors and higher liver enzyme levels compared to uninfected pregnant women.

## Contribution

The study identifies fibrinogen, protein C, and aPTT as potential diagnostic indicators for chronic hepatitis B in pregnant women.

## Key findings

- Hepatitis B-positive pregnant women had significantly lower levels of fibrinogen, protein C, and protein S compared to controls.
- Higher AST, ALP, and bilirubin levels were observed in hepatitis B-positive pregnant women.
- aPTT showed the highest diagnostic accuracy (AUC = 0.881) for detecting chronic hepatitis B in pregnant women.

## Abstract

Viral hepatitis has been associated with profound alterations in the coagulation system as well as liver biomarkers. Meanwhile, during pregnancy, the coagulation system also undergoes significant changes with an increase in the majority of the clotting factors and a decrease in natural anticoagulants. This study is aimed at evaluating the coagulation profile and liver biomarkers among hepatitis B‐infected pregnant women in a Ghanaian population.

This case–control study was conducted at Afrancho Polyclinic in the Ashanti Region, Ghana from January 2022 to July 2023. This study recruited 90 hepatitis B pregnant women as cases and 90 hepatitis B‐negative pregnant women as controls. A structured questionnaire was used to obtain sociodemographic, obstetric, and clinical data from each participant.

Levels of albumin, fibrinogen (4.09 [3.57–5.94] vs. 6.89 [5.43–9.08], p < 0.0001), protein C (2.46 [1.09–3.42] vs. 4.12 [2.96–6.07], p < 0.0001), and protein S (2.61 [2.20–3.36] vs. 2.98 [2.53–3.54], p = 0.036) were significantly reduced in the hepatitis B‐positive pregnant women than the negative controls. However, there were higher levels of AST, ALP, and bilirubins in hepatitis B‐positive pregnant women than the controls. Also, protein C and protein S had a significantly positive association with PT and aPTT, whereby a rise in protein C and protein S resulted in an increasing PT and aPTT, respectively (all p values < 0.05). Conversely, albumin had a negative correlation with both PT and aPTT (p value < 0.05). In a ROC analysis, aPTT had the highest area under the curve (AUC) value (AUC = 0.881) and the optimal clotting time at which aPTT indicated chronic hepatitis B was ≥ 35.7 s with sensitivity of 79.4% and specificity of 91.6%.

Pregnant women with hepatitis B infection present with significant changes in their coagulation parameters, natural anticoagulants, and liver biomarkers. Furthermore, fibrinogen, protein C, and aPTT showed accurate diagnostic potential in detecting chronic viral hepatitis B infection and may be valuable surrogate indicators for managing chronic hepatitis‐related complications.