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Hepatitis B prevalence in an unregistered prenatal population. Implications for neonatal therapy
N S Silverman1, M J Darby, S L Ronkin
1Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University Hospital, Philadelphia, PA 19107-5083.
Study Objective:
To evaluate the risk and associated cofactors for hepatitis B infection in inner-city pregnant women not registered for prenatal care.
Design:
Fifteen-month survey of 208 patients not registered for prenatal care, compared with 1555 women registered for prenatal care during the same period.
Setting:
An urban university hospital prenatal clinic and labor unit.
Results:
Unregistered patients had a significantly higher rate of hepatitis B surface antigen positivity than patients who had registered with the clinic (6.7% vs 0.8%; P less than .0001). Unregistered patients with positive results of urine drug screening (46%) had a relative risk for seropositivity of 29.2%, compared with registered patients who did not have histories of illicit drug use (95% confidence interval, 25.9% to 32.4%), while registered patients with past histories of drug use had a relative risk of 6.7%, compared with the reference group that did not have histories of drug use (95% confidence interval, 1.8% to 24.0%).
Conclusions:
Among inner-city pregnant women not registered for prenatal care, a positive result of urine drug screening is a rapidly available marker for increased risk of hepatitis B surface antigen positivity. Infants born to unregistered women with positive results of urine drug screening before maternal hepatitis B surface antigen results are available may warrant empiric initiation of hepatitis B virus-specific prophylaxis.