Low Rates of Peripartum Hepatitis B Care for Mothers in the United States
Study investigators concluded that rates of peripartum follow-up with gastroenterology/infectious disease specialists among women with hepatitis B were extremely low.
Although screening for hepatitis B during pregnancy to prevent vertical transmission to newborns is standard care, peripartum follow-up rates for mothers who screen positive for hepatitis B are low in the United States, according to a study published in the Journal of Clinical Gastroenterology.
Researchers conducted a large and diverse cohort study aimed at determining rates of peripartum follow-up with a hepatitis B specialist for women who screened positive for hepatitis B during pregnancy and to identify factors related to the likelihood or lack of follow-up. Women with hepatitis B who delivered between 2000 and 2012 were identified using Optum, a national commercial insurance claim database with approximately 46 million members in all 50 states.
Of 959,747 total pregnancies, 2558 (.27%) women had hepatitis B, and only 21% of these women had peripartum follow-ups with a gastroenterology/infectious disease specialist. Predictors of 1-year peripartum follow-up included Asian ethnicity (odds ratio (OR) 1.56 vs white; 95% CI, 1.13-2.17), younger age (OR .97/year; 95% CI, .94-.99), and living in the Midwest (OR=1.73; 95% CI, 1.07-2.81) or Northeast (OR=1.70; 95% CI, 1.09-2.66) vs the West. Predictors for hepatitis B virus DNA and alanine aminotransferase testing at 1 year included peripartum follow-up with gastroenterology/infectious disease specialist within 1 year (OR=15.68; 95% CI, 11.38-21.60), visit with primary care physician within 2 years (OR=1.63; 95% CI, 1.19-2.22), and Asian race (OR=1.72; 95% CI, 1.23-2.41).
Study investigators concluded that rates of peripartum follow-up appointments with gastroenterology or infectious disease specialists among women with hepatitis B were extremely low. Further, "[r]eferral to a HBV specialist was the strongest predictor of appropriate postpartum HBV laboratory testing. Follow-up rates may be even lower in uninsured population."
Chang MS, Wharam JF, Zhang F, et al. Peripartum maternal hepatitis B care in a US nationwide data set [published online August 24, 2018]. J Clin Gastroenterol. doi: 10.1097/MCG.0000000000001122