Post-partum care of women with hepatitis B and their babies.

Abstract

Introduction: Pregnant women with chronic hepatitis B (CHB) are at risk of transmitting virus in the perinatal period and may experience post-partum hepatic flares. There are accepted guidelines to manage immune prophylaxis (IPT) in the newborn, but these do not extend to testing response to immunization and there are few recommendations to guide monitoring of the mother postpartum. Our aim was to assess the post-partum care provided to CHB mothers and their babies born at a single Australian center. Method(s): 82 CHB women who delivered live infants at Monash Health between 2008 and 2013 participated in a telephone interview. Demographic and HBV specific data were extracted from medical records. The endpoints assessed were rates of specialist referral for antenatal and post partum surveillance of CHB, completion of infant vaccination and follow up serologic testing. Multivariate logistic regression analysis was utilized to identify the predictors for engagement with specialist care, administration of IPT, completion of the HBV vaccination schedule and serological testing of the baby. Result(s): 17.14% of CHB mothers were newly diagnosed on routine antenatal screening. 62.5% of women were referred for specialist antenatal management of CHB. HBe antigen status was documented in 22% of women. Viral load was tested in 34% of women in the third trimester, 39% of whom had HBV viral load >=7 log10 IU/ml. 4 patients with high viral load were not offered antiviral therapy, 2 were treated with short term tenofovir and 1 refused treatment. 20.59% of CHB mothers did not receive post-partum specialist care and 7.35% failed to attend a scheduled appointment. 89% of babies completed all 4 HBV vaccinations in the first 6 months of life. The rate of serologic testing by 1 year of age was 15.8% for HBsAb and 19.5% for HBsAg. There was no statistically significant association between administration of IPT, completion of the vaccination schedule and serologic testing of the baby with maternal age, ethnicity, parity, disease state and engagement with specialist care. 63% of mothers reported satisfaction with the level of information provided about the implications of CHB infection during pregnancy and 75% of women requested further information in future pregnancies. Conclusion(s): We have identified shortfalls in the management and follow-up of CHB mothers and their babies including low rates of maternal disease characterization and surveillance, referral for antenatal and postpartum specialist care and follow-up serologic testing of the child. It is our recommendation that this should be included in all guidelines.