title: Discontinuity of care for mothers with chronic hepatitis B diagnosed during pregnancy.
abstract: Assiduous measures are taken to prevent perinatal transmission of hepatitis B virus (HBV) to infants; it is unclear whether the mothers receive appropriate care for their chronic HBV. We sought to assess the quality of HBV care in hepatitis B surface antigen (HBsAg)-positive mothers following pregnancy. HBsAg-positive women (n = 243) who had sought prenatal care at Massachusetts General Hospital were retrospectively identified and charts reviewed. The primary outcome was adherence to the American Association for the Study of Liver Diseases (AASLD) and American College of Obstetricians and Gynecologists guidelines. Over one-third (37%) of women were first diagnosed with HBV infection at a prenatal visit. One-third (32%) did not undergo timely liver function test measurements. HBV DNA was never measured in 26% and was untimely in 34% of patients. One-third (34%) of the women were at high-risk for HCC based on AASLD criteria, yet only 33% of these women underwent timely imaging. Nearly half (49%) never saw a liver specialist for their HBV care. In multivariate analysis, women were 3.7 times more likely to have a timely ALT and 8.1 times more likely to have a timely HBV DNA if they were followed by a liver specialist (P = 0.001, <0.001). We demonstrate remarkably inadequate and discontinuous HBV care for chronically infected mothers following pregnancy. As HBV infection is already being identified prenatally, quality improvement measures encompassing obstetricians, primary care providers and hepatologists are needed to ensure that HBV-infected women are linked to care postpregnancy.
authors.affiliation: Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Rajbhandari
authors.affiliation: Bureau of Infectious Disease, Massachusetts Department of Public Health, Hinton State Laboratory Institute, Jamaica Plain, MA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Barton
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Juncadella
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: A K
authors.initials: AK
authors.lastname: Rubin
authors.affiliation: Department of Medicine, Salem Hospital, Salem, MA, USA.
authors.forename: T
authors.initials: T
authors.lastname: Ajayi
authors.affiliation: Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: A N
authors.initials: AN
authors.lastname: Ananthakrishnan
authors.affiliation: Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: R T
authors.initials: RT
authors.lastname: Chung
mesh_terms: D000328:Adult; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000628:therapy* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008404:Massachusetts; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006514:Hepatitis B Surface Antigens
keywords: chronic Hepatitis B; pregnancy; quality improvement