Management of hepatitis B in pregnant women and infants: a multicentre audit from four London hospitals

BMC Pregnancy and Childbirth

Eleni Nastouli⁶  Andrew D Millar²  Deepak Suri⁸  William MC Rosenberg¹  Geoffrey Dusheiko¹  Michael Jacobs⁴  Claire Thorne⁵  Andrew Fox-Lewis²  Tabitha Mahungu⁶  Marina Basarab⁶  Dianne Irish⁷  Gauri Godbole³ 

[1] Institute of Liver and Digestive Health, Division of Medicine, University College London, London, UK;Department of Hepatology, North Middlesex University Hospital NHS Trust, London, UK;Department of Clinical Microbiology and Virology, University College London Hospitals NHS Foundation Trust, 60 Whitfield Street, London W1T 4EU, UK;Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK;Department of Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, University College London, London, UK;Department of Clinical Microbiology and Virology, University College London Hospitals NHS Foundation Trust, London, UK;Department of Virology, Royal Free London NHS Foundation Trust, London, UK;Department of Gastroenterology and Hepatology, University College London Hospitals NHS Foundation Trust, London, UK

关键词: High risk;    Antivirals;    Hepatitis B;    Pregnancy;    Infection;   

Others  :  1131947
DOI  :  10.1186/1471-2393-13-222

 received in 2013-09-14, accepted in 2013-11-25,  发布年份 2013

【 摘 要 】

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.

Conclusion

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.

【 授权许可】

   
2013 Godbole et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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