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

BackgroundPostpartum 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.MethodsWe 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.ResultsA 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).ConclusionHBeAg 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 registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251208005, Identifier: CRD420251208005.