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. 2015 Mar;212(3):365.e1-7.
doi: 10.1016/j.ajog.2014.09.032. Epub 2014 Sep 30.

Postpartum care for mothers diagnosed with hepatitis B during pregnancy

Matthew S Chang  1 , Ruth Tuomala  2 , Anna E Rutherford  3 , Muthoka L Mutinga  3 , Karin L Andersson  4 , Blaire E Burman  5 , Robert S Brown Jr  6 , Emily Oken  7 , Chinweike Ukomadu  3
Affiliations

Postpartum care for mothers diagnosed with hepatitis B during pregnancy

Matthew S Chang et al. Am J Obstet Gynecol. 2015 Mar.

Abstract

Objective: We sought 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 Partners HealthCare system, the largest health care system in Massachusetts, and identified women with chronic HBV who delivered from 2002 through 2012.

Results: We identified 291 women (mean age 31.5 years, 51% Asian) with incident HBV during pregnancy. In all, 47% had postpartum follow-up with a HBV specialist, but only 19% also had appropriate laboratory tests (hepatitis B e antigen [HBeAg], hepatitis B e antibody, HBV DNA, and ALT) 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 HealthCare system (66% vs 38%, P < .0001), a positive HBeAg (20% vs 8%, P = .004), and elevated AST values (17% vs 8%, P = .02). On multivariable logistic regression analysis, a mother who had a PCP (odds ratio, 2.50; 95% confidence interval, 1.37-4.59) or positive HBeAg (odds ratio, 4.45; 95% confidence interval, 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.

Keywords: adherence; compliance; guidelines; prophylaxis.

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Conflict of interest statement

Disclosures: CU is an employee of Novartis. The remaining authors report no conflicts of interest.

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