Postpartum care for mothers diagnosed with hepatitis B during pregnancy

Abstract

Objective To determine rates of maternal postpartum hepatitis B virus (HBV) follow-up with a HBV specialist and identify factors associated with poor follow-up, as prior research has focused on infant outcomes and not maternal care. Study Design We conducted a retrospective review of data from Partner’s HealthCare system, the largest health care system in Massachusetts, and identified women with chronic HBV who delivered from 2002 to 2012. Results We identified 291 women (mean age 31.5 years, 51% Asian) with incident HBV during pregnancy. Forty seven percent had postpartum follow-up with a HBV specialist, but only 19% also had appropriate laboratory tests (e antigen [HBeAg], e antibody [HBeAb], HBV DNA, and ALT) checked within 1 year of their HBV diagnosis. Mothers with HBV follow-up were more likely to have a primary care physician (PCP) within the Partners system (66% versus 38%, p<0.0001), a positive HBeAg (20% versus 8%, p=0.004), and elevated AST values (17% versus 8%, p=0.02). On multivariable logistic regression analysis, a mother who had a PCP (OR 2.50 [95% CI: 1.37–4.59]) or positive HBeAg (OR 4.45 [95% CI: 1.64–12.06]) had a greater likelihood of having HBV follow-up. Conclusion Only 19% of HBV infected mothers met care guidelines 1 year after being diagnosed with HBV. Inadequate postpartum HBV care affects women of all races/ethnicities. Women who had a PCP as well as those who were HBeAg positive were more likely to be referred for postpartum follow-up with a HBV specialist, suggesting that providers might be referring patients when they perceive HBV to be more serious or complex.

Knowledge, attitude, and practice towards Hepatitis B infection among nurses and midwives in two maternity hospitals in Khartoum, Sudan

“…MTCT of HBV can occur at three stages of pregnancy: intrauterine, intrapartum or postpartum, and the risk for MTCT of HBV increases with high maternal viral load, positive HBeAg status, preterm labour, prolonged labour and failure of immunoprophylaxis in siblings [10, 11]. The current standard of care for the prevention of MTCT of HBV infection includes an active and passive immunoprophylaxis with HBV immunoglobulin and vaccination administered immediately after birth to neonates of HBsAg positive mothers, and referral of mothers to hepatology clinics for assessment and follow up [11, 12].…”

Peripartum Care for Mothers Diagnosed with Hepatitis B During Pregnancy: A Survey of Provider Practices

“…However, not all women who are found to have HBV during pregnancy are referred to specialized care for follow-up care of their hepatitis, despite current recommendations (ACOG 2007). A retrospective study at Partners HealthCare system, the largest healthcare system in Massachusetts, found that 47% of women diagnosed with HBV perinatally had follow-up with an HBV specialist, but only 19% had appropriate HBV-related laboratory tests within 1 year of their HBV diagnosis (Chang 2015). A subsequent analysis of the Massachusetts Virtual Epidemiologic Network, a statewide surveillance database, showed that postpartum maternal HBV follow-up laboratory testing occurred in 50% of Massachusetts women — higher than previously estimated but nonetheless suboptimal (Chang 2016).…”

Antenatal maternal hepatitis B care is a predictor of timely perinatal administration of hepatitis B immunoglobulin

“…20 A single US centre found that 19% of CHB mothers received appropriate HBV care post-partum. 21 Our study uniquely interviewed these women in the post-partum phase to assess directly quality of care provided for CHB mothers and their babies against benchmark guidelines regarding maternal disease assessment and administration of IPT.…”