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Peripartum Maternal Hepatitis B Care in a U.S. Nationwide Dataset
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2019 Nov/Dec
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Source: J Clin Gastroenterol. 53(10):e424-e430
[PDF-142.37 KB]
Details:
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Alternative Title:J Clin Gastroenterol
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Personal Author:
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Description:Background:
Hepatitis B virus (HBV) screening during pregnancy is standard of care to prevent vertical transmission to infants, yet the mothers themselves may not receive appropriate follow-up.
Goals:
Using a national database, we sought to determine rates of maternal peripartum follow-up with a HBV specialist and identify factors associated with a lack of follow-up.
Method:
We identified women who delivered 2000–2012 and were diagnosed with HBV according to International Classification of Diseases-9 codes using a national database (Optum) derived from commercial insurance claims with ~46 million members ages 0–64 in all 50 states. Our primary outcome was follow-up during or after pregnancy with a HBV specialist (gastroenterology/infectious diseases).
Results:
The prevalence of HBV was 0.27% (2,558/959,747 pregnancies), and median follow-up was 45 months. Only 21% of women had peripartum HBV specialist follow-up. On multivariable regression, predictors of peripartum follow-up at 1-year included younger age (odds ratio [OR] 0.97 per year [95% confidence interval (CI): 0.94, 0.99]), Asian race/ethnicity (OR 1.56 versus white [95% CI: 1.13, 2.17]), and residing in the Northeast (OR 1.70 [95% CI: 1.09, 2.66]) and Midwest (OR 1.73 [95% CI: 1.07, 2.81]) versus West. Predictors of testing for HBV DNA and ALT at 1-year included Asian race (OR 1.72 [95% CI: 1.23, 2.41]), a PCP visit within 2 years of delivery (OR 1.63 [95% CI: 1.19, 2.22]), and peripartum HBV specialist follow-up within 1-year (OR 15.68 [95% CI: 11.38, 21.60]).
Conclusions:
Maternal HBV specialist follow-up rates were extremely low in this large, diverse cohort representing all United States regions. Referral to a HBV specialist was the strongest predictor of appropriate postpartum HBV laboratory testing. Follow-up rates may be even lower in uninsured populations.
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Pubmed ID:30148764
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Pubmed Central ID:PMC6387864
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