Peripartum Care for Mothers Diagnosed with Hepatitis B During Pregnancy: A Survey of Provider Practices
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Peripartum Care for Mothers Diagnosed with Hepatitis B During Pregnancy: A Survey of Provider Practices Allison J. Kwong1 · Matthew S. Chang1,2,9 · Ruth E. Tuomala3 · Laura E. Riley4 · Julian N. Robinson3 · Muthoka L. Mutinga2 · Karin L. Andersson5 · Robert S. Brown Jr.6 · Emily Oken7 · Chinweike Ukomadu2,8 · Anna E. Rutherford2
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Objectives Hepatitis B (HBV) remains a significant public health burden, despite effective therapy. Routine HBV screening is recommended during pregnancy to reduce the risk of vertical transmission, but the rates of follow-up care peri-partum are low. The aim of this study was to evaluate physician practices and knowledge regarding HBV in women diagnosed perinatally. Methods A survey was distributed to obstetricians and midwives within the Partners HealthCare system at Brigham and Women’s Hospital and Massachusetts General Hospital. Results Of 118 survey respondents (response rate 56%), 97% reported that they always tested for hepatitis B, and 77% referred new diagnoses of HBV during pregnancy to a HBV specialist for further care. Only 10% of respondents reported that there was formal referral mechanism in place to facilitate follow-up care for mothers diagnosed with hepatitis B infection. 91% of survey respondents selected hepatitis B surface antigen as the correct screening test, and 76% selected hepatitis B immune globulin with vaccination for the newborn as the correct prophylaxis regimen. Only 40 and 51% of respondents accurately identified serologies that were consistent with acute and chronic infection, respectively. Conclusions for Practice Routine screening for HBV in this population presents an important opportunity to identify cases and to reduce the public health burden of this disease. Providers were somewhat knowledgeable about HBV, but the lack of formal referral mechanism may explain why HBV follow-up is suboptimal in this healthcare system. Supplemental provider education and formal linkage to care programs may increase rates of follow-up HBV care. Keywords Hepatitis B · Linkage to care · Peri-partum care
Significance
Introduction
This study builds on prior data from our group regarding suboptimal follow-up care for mothers diagnosed with hepatitis B infection during pregnancy (Chang et al. 2015). We administered a survey of practicing obstetric providers at two large academic centers in Massachusetts and identified gaps in knowledge and resources regarding the peripartum diagnosis and management of new hepatitis B infection.
The prevalence of hepatitis B virus (HBV) infection in the United States is estimated to be as high as 2.2 million persons, and HBV remains a significant public health hazard (Kowdley et al. 2012). To reduce the risk of vertical transmission, routine HBV screening is recommended during pregnancy so that antiviral treatment can be started if necessary and the newborn can receive prophylaxis at the time of delivery (Lin and Vickery 2009). Prophylaxis for the children o
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