Management of hepatitis B in pregnant women: Implications for API women

Background: Although New York State mandates HBsAg testing of all pregnant women during prenatal care in order to prevent mother-infant-transmission, little is known about the management of hepatitis B infection in this population. Objectives: To assess how HBV infection is managed in pregnancy. Methods: A retrospective review of all HBsAg+ women who received care in Prenatal Clinics at Bellevue and Gouveneur Hospitals in NYC between 2004-2006. Results: Out of 6417 pregnant women tested for HBsAg, 294(4.6%) were identified HBsAg+. Mean age was 26.6±4.9 years. >60% were APIs. Among them, 271 (92.2%) had ALT tested, and 263 (89.5%) had HBeAg tested. Only 13 (11.3%) of those with HBeAg- and 18 (12.6%) of those with HBeAg+ had HBV DNA evaluated by prenatal care providers. The evaluations showed that 95% had active viral replication, with 40% had viral load>10e5 copies/ml. Conclusion: The diagnosis of hepatitis B among pregnant women is an opportune time to provide evaluations for their risks and needs for treatment. Unfortunately, this did not occur in the majority of women in this study. Persons with active infection are prone to serious long-term consequences if left unmonitored or untreated. This is particularly a concern among API which account for 60% of the HBV-infected pregnant women. Recommendations for follow-up evaluation tests of women identified by prenatal HBV screening would be of tremendous benefits for this vulnerable population.