Abstract
BackgroundOur study aims to describe how obstetricians manage pregnant women infected with chronic hepatitis B in a region with a large high-risk population.MethodsWe performed a cross-sectional study among practicing obstetricians in Santa Clara County, California. All obstetricians practicing in Santa Clara County were invited to participate in the study. Obstetricians were recruited in person or by mail to complete a voluntary, multiple choice survey on hepatitis B (HBV). Survey questions assessed basic HBV knowledge and obstetricians’ self-reported clinical practices of the management of HBV-infected pregnant women. Pooled descriptive analyses were calculated for the cohort, as well as, correlation coefficients to evaluate the association between reported clinical practices and hepatitis B knowledge.ResultsAmong 138 obstetricians who completed the survey, 94% reported routinely testing pregnant women for hepatitis B surface antigen (HBsAg) with each pregnancy. Only 60.9% routinely advised HBsAg-positive patients to seek specialist evaluation for antiviral treatment and monitoring and fewer than half (48.6%) routinely provided them with HBV information. While most respondents recognized the potential complications of chronic HBV (94.2%), only 21% were aware that chronic HBV carries a 25% risk of liver related death when left unmonitored and untreated, and only 25% were aware of the high prevalence of chronic HBV in the foreign-born Asian, Native Hawaiian and Pacific Islander population. Obstetricians aware of the high risk of perinatal HBV transmission were more likely to test pregnant women for HBV DNA or hepatitis B e-antigen in HBV-infected women (r = 0.18, p = 0.033). Obstetricians who demonstrated knowledge of the long-term consequences of untreated HBV infection were no more likely to refer HBV-infected women to specialists for care (r = 0.02, p = 0.831).ConclusionOur study identified clear gaps in the practice patterns of obstetricians that can be readily addressed to enhance the care they provide to HBV-infected pregnant women.
Highlights
Our study aims to describe how obstetricians manage pregnant women infected with chronic hepatitis B in a region with a large high-risk population
The Advisory Committee on Immunization Practices (ACIP) further recommends: antenatal reporting of hepatitis B surface antigen (HBsAg)-positive pregnant women to public health departments, providing a laboratory copy of the HBsAg test result to the planned delivery hospital to prevent transcription errors, post-vaccination hepatitis B virus (HBV) testing (PVST) for infants born to infected mothers, and appropriate counseling and referral of HBsAg-positive pregnant women for medical management [2]
Of 278 obstetricians invited to participate in the study, the response rate was 64.7% (n = 180)
Summary
Our study aims to describe how obstetricians manage pregnant women infected with chronic hepatitis B in a region with a large high-risk population. The ACIP further recommends: antenatal reporting of HBsAg-positive pregnant women to public health departments, providing a laboratory copy of the HBsAg test result to the planned delivery hospital to prevent transcription errors, post-vaccination HBV testing (PVST) for infants born to infected mothers, and appropriate counseling and referral of HBsAg-positive pregnant women for medical management [2]. Despite these recommendations, only half of the estimated 25,000 HBsAg-positive women that give birth each year are referred for enrollment in the perinatal HBV prevention program for case management [10]. The percentage of infants born to HBsAg-positive women that received PVST has remained low and an estimated 800–1000 infants still become chronically infected each year [10]
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