Only half of postpartum women with HBV undergo follow-up testing

CHICAGO — Fifty percent of postpartum women who tested positive for hepatitis B virus during their pregnancy underwent follow-up laboratory testing, according to research presented here at Digestive Disease Week.

“To reduce chronic HBV, public health efforts are focused on preventing vertical transmission from mothers to infants,” Matthew S. Chang, MD, of Brigham and Women’s Hospital, said during his presentation. “Screening for HBV during pregnancy is standard of care in the United States, yet little is known about postpartum maternal HBV care. In our prior single-center study, less than 10% of mothers received postpartum HBV care.”

Chang and colleagues conducted a retrospective study of data from the Massachusetts Virtual Epidemiologic Network (MAVEN), a surveillance system for infectious diseases maintained by the Massachusetts Department of Public Health. They identified mothers who tested positive for hepatitis B surface antigen (HBsAg) during their first pregnancy and determined characteristics of those who did not receive postpartum HBV care.

From 2007 to 2012, 983 pregnant women tested positive for HBsAg, for an HBV prevalence of 0.23% based on available data in Massachusetts. Most of the women (67%) tested positive during the first trimester, 22% during the second trimester and 11% during the third trimester. Nearly half (45%) of the women were Asian/Pacific Islander, 24% were black and 10% were white. More than half (61%) were non-US born.

Half of the women had laboratory follow-up after the pregnancy. These women were younger, with a mean age of 29 years vs. 31 years for those who did not have follow-up testing. Women with follow-up data also were more likely to have more than one pregnancy during the study period (41% vs. 1%). However, only 42% of the women with follow-up had HBV DNA levels checked.

Among the half who did not have any follow-up reported, 26% had only received the initial HBsAg test, whereas 74% also had other HBV lab reports.

“Mothers with more opportunities to interact with the health care system due to younger age at index pregnancy or more than one pregnancy during the study period appeared to be more likely to have HBV follow-up testing,” Chang said. “Lack of follow-up testing may be a health system problem in Massachusetts rather than a patient-specific issue.”

For more information:

Chang M. #700. Presented at: Digestive Disease Week 2014; May 3-6, 2014; Chicago.

Disclosure: Chang reports no relevant financial disclosures.