Poster 1834 Health Care Disparity in Delivering Optimal Care to Chronic Hepatitis B Pregnant Mothers
Author Insight from Rasham Mittal, MD, Kaiser Permanente Los Angeles Medical Center
What’s new here and important for clinicians?
Roughly 24,000 chronic hepatitis B (CHB) pregnant women give birth in United States every year. Since perinatal acquisition of CHB contributes significantly to prevalence of CHB, it becomes imperative to provide optimal antenatal care to these mothers. We aimed to determine if health care disparities exist in antenatal care of CHB pregnant mothers at a large, integrated health care system in United States.
We looked at 4 Quality Metrics
- Antenatal hepatitis Be antigen (HBeAg)
- Antenatal hepatitis B virus (HBV) viral load
- Specialist consultation visit
- Infant HBsAg serological testing at 9-18 months
Antenatal hepatitis B antigen (HBeAg) serology testing was performed in 274 (59.3%) patients and hepatitis B virus (HBV) viral load was tested in 156 (33.8%), mothers only. Only 93 (20.1%) mothers had a specialist consultation during their pregnancy. Among these 93 mothers, 90 consulted gastroenterologists and 3 hepatologists. Additionally, 104 (26.2%) infants born to these CHB mothers had no HBsAg serological testing at 9-18 months’ follow-up.
Infant immunoprophylaxis failure leading to vertical transmission has been reported in mothers with hepatitis B e-antigen (HBeAg) and high viremia. It can result in a vertical transmission rate of 8%–30%. In the absence of diligent antenatal HBeAg or HBV viral load testing, many of the CHB pregnant mothers with high viremia might not be offered anti-retroviral therapy, which has been proposed as a promising intervention to reduce the vertical transmission.
Post-vaccination serological testing (PVST) is a vital component of managing these infants to assess the adequacy of infant immune response. It is essential for both caring of infants with an inadequate immune response and monitoring the advancement towards possibly zeroing down the vertical transmission (VT) rate. PVST is a critical measure for assessing adequacy of recommended care in this subset of population.
The American College of Obstetrician and Gynecologists (ACOG) recommends referring CHB pregnant mothers to specialists experienced in the management of chronic liver disease. Our findings of disparity in standard care of CHB pregnant mothers and their infants suggest that there is a critical need to create a more superior and effective multidisciplinary health care provider’s network.
What do patients need to know?
CHB pregnant mothers must get their HBV DNA/ HBeAg tested with PCP/ OBGYN during pregnancy.
Infants born to CHB pregnant mothers must be tested for HbsAg at 9-18 months of age.
Author Contact Rasham Mittal, MD, Kaiser Permanente Los Angeles Medical Center
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