title: Management of hepatitis B in pregnant women and infants: a multicentre audit from four London hospitals.
abstract: BACKGROUND
  Pregnant 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  HBsAg 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.
  
  
  CONCLUSIONS
  In 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.
authors.affiliation: Department of Clinical Microbiology and Virology, University College London Hospitals NHS Foundation Trust, London, UK. gaurigodbole@doctors.org.uk.
authors.forename: Gauri
authors.initials: G
authors.lastname: Godbole
authors.forename: Dianne
authors.initials: D
authors.lastname: Irish
authors.forename: Marina
authors.initials: M
authors.lastname: Basarab
authors.forename: Tabitha
authors.initials: T
authors.lastname: Mahungu
authors.forename: Andrew
authors.initials: A
authors.lastname: Fox-Lewis
authors.forename: Claire
authors.initials: C
authors.lastname: Thorne
authors.forename: Michael
authors.initials: M
authors.lastname: Jacobs
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Dusheiko
authors.forename: William M C
authors.initials: WM
authors.lastname: Rosenberg
authors.forename: Deepak
authors.initials: D
authors.lastname: Suri
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Millar
authors.forename: Eleni
authors.initials: E
authors.lastname: Nastouli
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D004279:DNA, Viral / Q000097:blood; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006509:Hepatitis B / Q000175:diagnosis / Q000188:drug therapy* / Q000635:transmission*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D006526:Hepatitis C / Q000175:diagnosis; D003699:Hepatitis D / Q000175:diagnosis; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008131:London; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy*; D011295:Prenatal Care / Q000592:standards* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens