— Christine M. Kukka, Project Manager, HBV Advocate
While health officials have campaigned long and hard to vaccinate infants born to HBV-infected women within hours of birth to prevent infection of newborns, doctors appear to forget the mothers' infections after they give birth, according to a blistering report published in the September issue of the American Journal of Obstetrics and Gynecology.
A Massachusetts study followed 291 HBV-infected women enrolled in the Partners HealthCare system who gave birth between 2002 and 2012. These women were treated at two of the best hospitals in the country, but they found only 19% of the women received adequate follow-up care for hepatitis B after childbirth. Their average age was 31, nearly all spoke English and had private insurance, so access to health care was not an issue. If these women failed to get adequate care, poor women with inadequate insurance and language barriers probably fare even worse, doctors suggest.
Researchers reported only 47% of the women enrolled in the study had follow-up with an HBV specialist after giving birth. Of this group, only 19% were then tested for hepatitis B "e" antigen (HBeAg), the hepatitis B "e" antibody, viral load (HBV DNA) or had their liver enzymes tested to determine if they had liver damage within one year of their HBV diagnosis, which medical guidelines recommend.
Mothers who had adequate medical follow-up were more likely to have tested positive for HBeAg and had signs of liver damage. This suggests doctors, including liver specialists, followed guidelines only when they thought the infection was causing liver damage based on superficial indicators, researchers noted.
"Having a primary care provider and being HBeAg-positive, a marker of more aggressive HBV, were associated with postpartum HBV specialty follow-up," they wrote. "This finding suggests that nonpatient factors, such as obstetrician knowledge of HBV, may play an important role in adherence to postpartum HBV follow-up care. Future studies are needed to confirm our findings in other health care settings and to evaluate physician and system-related factors affecting postpartum follow-up care."
Labels: childbirth, post-partum treatment, treatment after pregnancy
