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Postpartum Laboratory Follow-up in Women With Hepatitis B in Massachusetts From 2007 to 2012
Matthew S Chang1, Kerri Barton, Molly Crockett
1*Division of Gastroenterology, Hepatology, and Endoscopy ‡Department of Obstetrics and Gynecology, Brigham and Women's Hospital †Bureau of Infectious Disease, Massachusetts Department of Public Health §Division of Gastroenterology, Massachusetts General Hospital ¶Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA ∥Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, New York, NY.
Goals:
To determine postpartum hepatitis B virus (HBV) laboratory testing rates and identify factors associated with a lack of follow-up testing in Massachusetts.
Background:
Screening for HBV infection in pregnant women is standard of care. Guidelines recommend that patients with chronic HBV have ongoing care and laboratory testing, but little is known about postpartum maternal HBV care outcomes.
Study:
We conducted a retrospective cohort study using Massachusetts Virtual Epidemiologic Network, an electronic public health surveillance system maintained by the Massachusetts Department of Public Health. We identified women who tested hepatitis B surface antigen positive during their first reported (index) pregnancy in Massachusetts from 2007 to 2012 and measured HBV-related laboratory tests reported to Massachusetts Department of Public Health during and after pregnancy.
Results:
We identified 983 hepatitis B surface antigen positive pregnant women. Half (492/983) did not have evidence of additional postpartum HBV laboratory testing following their index pregnancy. Women who had postpartum laboratory tests reported were younger [mean age (SD): 29 (5.3) vs. 31 (5.5) y, P=0.0001] and more likely to have >1 pregnancy during the study period (41% vs. 1%, P<0.0001). There were no differences in race, ethnicity, and US born status. On multivariable logistic regression, older age predicted a lower likelihood of having postpartum laboratory testing (odds ratio, 0.77; 95% confidence interval, 0.70-0.90).
Conclusions:
Postpartum maternal HBV follow-up laboratory testing occurred in only half of Massachusetts women and did not vary by race, ethnicity, or US born status. Our results were limited to a single state surveillance database, which likely underestimates the number of tests ordered.
