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We evaluated the incidence, determinants and outcomes of<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content>flare in a multicultural cohort of pregnant<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content>\u2010infected women in the United States.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective cohort study of pregnant hepatitis B surface antigen\u2010positive women cared for at hospital\u2010based clinics of 4 medical centres in Southeastern Pennsylvania from 2006 to 2015. The main outcome was incident<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content>flare (alanine aminotransferase [<jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content>] \u22652 times upper limit of normal) during pregnancy or within 6\u00a0months after delivery. Among patients with flare, we determined development of jaundice (total bilirubin \u22652.5\u00a0mg\/dL) and hepatic decompensation. Multivariable logistic regression was used to estimate odds ratios (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>s) of<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content>flare for risk factors of interest, including timing of flare (during pregnancy versus post\u2010delivery), nulliparity, younger age,<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content>e antigen (<jats:styled-content style=\"fixed-case\">HB<\/jats:styled-content>eAg) status, and lack of anti\u2010<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content>therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 310 pregnant predominantly African<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content>\u2010infected women with 388 pregnancies, the incidence of<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content>flare was 14% (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 10\u201018%) during pregnancy and 16% (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 11\u201024%) post\u2010delivery. Jaundice developed in 12% and hepatic decompensation in 2%. Positive<jats:styled-content style=\"fixed-case\">HB<\/jats:styled-content>eAg was associated with<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content>flare (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>, 2.55; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 1.04\u20106.20).<jats:styled-content style=\"fixed-case\">HBV DNA<\/jats:styled-content>was measured in 55% of patients, and only 50% were referred for<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content>specialty care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Pregnancy\u2010associated hepatitis B flare occurred in 14% during pregnancy and 16% post\u2010delivery and rarely led to hepatic decompensation. Positive<jats:styled-content style=\"fixed-case\">HB<\/jats:styled-content>eAg was the main risk factor identified. Women did not have adequate<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content>monitoring or follow\u2010up during pregnancy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.13594","type":"journal-article","created":{"date-parts":[[2017,9,20]],"date-time":"2017-09-20T15:42:38Z","timestamp":1505922158000},"page":"813-820","source":"Crossref","is-referenced-by-count":43,"title":["Incidence, determinants and outcomes of pregnancy\u2010associated hepatitis B flares: A regional hospital\u2010based cohort\u00a0study"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6663-6253","authenticated-orcid":false,"given":"Tatyana","family":"Kushner","sequence":"first","affiliation":[{"name":"Division of Gastroenterology\/Hepatology University of California San Francisco San Francisco CA USA"},{"name":"Division of Gastroenterology Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA USA"},{"name":"Department of Biostatistics, Epidemiology and Informatics Perelman School of Medicine University of Pennsylvania Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela A.","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics Perelman School of Medicine University of Pennsylvania Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankush","family":"Kalra","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Department of Medicine Thomas Jefferson University Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lora","family":"Magaldi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Medicine Drexel University Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Monpara","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Medicine Drexel University Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gurneet","family":"Bedi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Medicine Penn State Hershey Medical Center Hershey PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Krok","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Medicine Penn State Hershey Medical Center Hershey PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sierra","family":"Centkowski","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA 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