Management of hepatitis B in pregnant women and infants: a multicentre audit from four London hospitals

Abstract

BackgroundPregnant women with hepatitis B virus (HBV) infection can transmit the infection to their infants, screening of patients and appropriate interventions reduce vertical transmission. This audit was conducted to assess adherence to the national guidelines for management of HBV infection in pregnancy.MethodsA retrospective audit was conducted on pregnant women diagnosed with hepatitis B on screening in antenatal clinics, across four hospitals in London over 2 years (2009–2010). Data was collected from antenatal records and discharge summaries using a standard audit form. The outcomes measured included HBV serological markers, HBV DNA, detection of other blood borne viruses and referral to hepatology services, administration of active and passive prophylaxis to infants at birth. Descriptive statistics are presented. Proportions were compared using the χ2 test and 95% confidence intervals (CI) were calculated for prevalence estimates. Analyses were conducted using STATA 12.ResultsHBsAg was detected in 1.05% (n = 401, 95% CI 0.95-1.16) of women attending an antenatal appointment, 12% (n = 48) of the women were at a high risk of vertical transmission (HBe Ag positive or antiHBe and HBeAg negative or HBV DNA >106 IU/ml). Only 62% (n = 248) women were referred to hepatology or specialist clinics and 29% (n = 13) of women of high infectivity were on antiviral agents. Testing for hepatitis C and delta virus was suboptimal. 75% (n = 36) of the infants at a high risk of acquisition of HBV received both active and passive prophylaxis.ConclusionIn certain sectors of London, implementation of the pathway for management of women with hepatitis B and their infants is suboptimal. National guidelines should be followed and improved intersectorial sharing of information is needed to reduce the risk of women of high infectivity being lost to follow up.

Antenatal maternal hepatitis B care is a predictor of timely perinatal administration of hepatitis B immunoglobulin

“…This included suboptimal rates of timely HBIg administration, assessment of maternal viral replication status, referral and engagement with specialist HBV care, completion of the infant HBV vaccine schedule and serological testing of the infant for CHB infection or immunity. According to International Guidelines, appropriate maternal HBV care includes referral to either an Infectious disease specialist or a Gastroenterologist/Hepatologist to assess the requirement for antiviral therapy, long‐term HBV and hepatocellular carcinoma (HCC) surveillance . The National Health Service in the UK recommends specialist review for all CHB mothers within 6 weeks of antenatal screening results .…”

“…The National Health Service in the UK recommends specialist review for all CHB mothers within 6 weeks of antenatal screening results . A multicentre retrospective audit of four UK hospitals identified a 60% rate of specialist referral for mothers with CHB . A single US centre found that 19% of CHB mothers received appropriate HBV care post‐partum .…”

“…According to International Guidelines, appropriate maternal HBV care includes referral to either an Infectious disease specialist or a Gastroenterologist/Hepatologist to assess the requirement for antiviral therapy, long-term HBV and hepatocellular carcinoma (HCC) surveillance. [3][4][5][18][19][20] The National Health Service in the UK recommends specialist review for all CHB mothers within 6 weeks of antenatal screening results. 19 A multicentre retrospective audit of four UK hospitals identified a 60% rate of specialist referral for mothers with CHB.…”

Reduction of Infectivity in Chronic Hepatitis B Virus Carriers among Healthcare Providers and Pregnant Women by Antiviral Therapy

“…However, identification of HBsAg-positive mothers is not enough because the necessary measures are often not taken. Even in developed countries like the UK [60] or New Zealand [61] viremia is often not determined and an indicated antiviral therapy not initiated. If the current possibilities of diagnosis and therapy would be implemented, mother-to-child transmission of HBV could be prevented completely.…”

10 Years Prevalence of Hepatitis B Infection Among Women Delivering at Kamc-Jeddah and Their Infants.

“…Saudi Arabia).Infection with hepatitis B in newborns of carrier mothers is the leading cause of development of chronicity state up to 80% of the disease, Interrupting of HBV transmission through administration a highly effective neonatal immune-prophylaxis by vaccination and intra-venous immunoglobulin (IVIG) in the first 24 hours of life has a major impact in reducing the prevalence of cases. Despite immune-prophylaxis there are still documented cases of vertical transmission of HBV (5). In study conducted in china (2014), Vertical transmission rate has been reported around (5.44%) of infants despite immune-prophylaxis.…”