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Mothers receive inadequate systemic HBV care following pregnancy

A majority of mothers with chronic hepatitis B virus infection post-pregnancy received inadequate care, especially in terms of timely liver function test measurements and screening for hepatocellular carcinoma, according to a retrospective study.

“The emphasis on preventing vertical transmission to the infant from the chronically infected mother is appropriate, but should not neglect the follow-up care of the mother, particularly since maternal health is critical for optimal infant outcomes,” the researchers wrote.

Researchers examined the quality-of-care 243 hepatitis B surface antigen (HBsAg)-positive mothers received post-pregnancy after receiving prenatal care at Massachusetts General Hospital.

Results showed that 37% of mothers were first diagnosed with HBV during a prenatal visit and had no prior knowledge of being positive for HBV. Forty-nine percent of overall patients never saw a specialist.

Thirty-two percent of patients did not undergo alanine aminotransferase measurement within the last year of follow-up. Three-percent of women overall had never had ALT measured. Patients who were followed by a liver specialist were threefold more likely to undergo timely ALT measurement compared with those not seen by a liver specialist (OR = 3.32; 95% CI, 1.75-7.97).

HBV DNA was not measured in a timely manner in 34% of patients and not measured at all in 26%. Multivariate analysis showed that women were 3.7 times more likely to have a timely ALT measurement (P = .001) and 8.1 times more likely to have a timely HBV DNA if they were followed by a liver specialist (P < .001).

The researchers wrote that patients with chronic HBV have a more than 100-fold increased risk for developing hepatocellular carcinoma compared with a person who does not have HBV. Of these mothers, 42% were deemed at high-risk for HCC (n = 72), based on AASLD criteria. However, HCC screening was performed in only 33% of them and 38% had timely alpha-fetoprotein (AFP) measurement.

Multivariate analysis showed that being followed by a liver specialist increased odds for having timely ultrasound (OR = 37.43; 95% CI, 4.51-310.42) or timely AFP measurement performed (OR = 16.66; 95% CI, 2.39-115.95).

“As HBV infection is already being identified during prenatal visits, quality improvement measures that include obstetricians, primary care providers and hepatologists are needed to ensure that women are appropriately engaged into HBV care post-pregnancy,” the researchers wrote. – by Suzanne Reist and Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.