title: Postpartum care for mothers diagnosed with hepatitis B during pregnancy.
abstract: OBJECTIVE
  We sought to determine rates of maternal postpartum hepatitis B virus (HBV) follow-up with a HBV specialist and identify factors associated with poor follow-up, as prior research has focused on infant outcomes and not maternal care.
  
  
  METHODS
  We conducted a retrospective review of data from Partners HealthCare system, the largest health care system in Massachusetts, and identified women with chronic HBV who delivered from 2002 through 2012.
  
  
  RESULTS
  We identified 291 women (mean age 31.5 years, 51% Asian) with incident HBV during pregnancy. In all, 47% had postpartum follow-up with a HBV specialist, but only 19% also had appropriate laboratory tests (hepatitis B e antigen [HBeAg], hepatitis B e antibody, HBV DNA, and ALT) within 1 year of their HBV diagnosis. Mothers with HBV follow-up were more likely to have a primary care physician (PCP) within the Partners HealthCare system (66% vs 38%, P < .0001), a positive HBeAg (20% vs 8%, P = .004), and elevated AST values (17% vs 8%, P = .02). On multivariable logistic regression analysis, a mother who had a PCP (odds ratio, 2.50; 95% confidence interval, 1.37-4.59) or positive HBeAg (odds ratio, 4.45; 95% confidence interval, 1.64-12.06) had a greater likelihood of having HBV follow-up.
  
  
  CONCLUSIONS
  Only 19% of HBV-infected mothers met care guidelines 1 year after being diagnosed with HBV. Inadequate postpartum HBV care affects women of all races/ethnicities. Women who had a PCP as well as those who were HBeAg positive were more likely to be referred for postpartum follow-up with a HBV specialist, suggesting that providers might be referring patients when they perceive HBV to be more serious or complex.
authors.affiliation: Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, MA. Electronic address: mchang5@partners.org.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Tuomala
authors.affiliation: Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Rutherford
authors.affiliation: Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Muthoka L
authors.initials: ML
authors.lastname: Mutinga
authors.affiliation: Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Karin L
authors.initials: KL
authors.lastname: Andersson
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: Blaire E
authors.initials: BE
authors.lastname: Burman
authors.affiliation: Center for Liver Disease and Transplantation, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
authors.forename: Emily
authors.initials: E
authors.lastname: Oken
authors.affiliation: Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Chinweike
authors.initials: C
authors.lastname: Ukomadu
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005762:Gastroenterology; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008404:Massachusetts; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011181:Postnatal Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000628:therapy*; D011320:Primary Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation; D012189:Retrospective Studies
keywords: adherence; compliance; guidelines; prophylaxis