Peripartum Maternal Hepatitis B Care in a US Nationwide Data Set. Issue 10 (November 2019)

• Record Type: Journal Article
• Authors: Chang, Matthew S.; Wharam, J. Frank; Zhang, Fang; LeCates, Robert F.; Morton-Eggleston, Emma; Tuomala, Ruth E.; Rutherford, Anna E.; Mutinga, Muthoka L.; Andersson, Karin L.; Brown, Robert S.; Ukomadu, Chinweike; Oken, Emily
• Is Part Of: Journal of clinical gastroenterology. Volume 53:Issue 10(2019)
• Publication Date: 2019-11
• Subjects: administrative claims -- inadequate -- administrative data -- pregnancy; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Digestive organs -- Diseases; Gastroenterology; Periodicals; Periodicals; 616.33005
• DOI: 10.1097/MCG.0000000000001122
• Languages: English
• ISSNs: 0192-0790

Abstract

Abstract : Background: Hepatitis B virus (HBV) screening during pregnancy is standard of care to prevent vertical transmission to infants, yet the mothers themselves may not receive appropriate follow-up. Goals: Using a national database, we sought to determine rates of maternal peripartum follow-up with a HBV specialist and identify factors associated with a lack of follow-up. Materials and Methods: We identified women who delivered in 2000 to 2012 and were diagnosed with HBV according to International Classification of Diseases-9 codes using a national database (Optum) derived from commercial insurance claims with ∼46 million members ages 0 to 64 in all 50 states. Our primary outcome was follow-up during or after pregnancy with a HBV specialist (gastroenterology/infectious diseases). Results: The prevalence of HBV was 0.27% (2558/959, 747 pregnancies), and median follow-up was 45 months. Only 21% of women had peripartum HBV specialist follow-up. On multivariable regression, predictors of peripartum follow-up at 1-year included younger age [odds ratio (OR), 0.97/y; 95% confidence interval (CI), 0.94, 0.99], Asian race/ethnicity (OR, 1.56 vs. white; 95% CI, 1.13, 2.17), and residing in the Northeast (OR, 1.70; 95% CI, 1.09, 2.66) and Midwest (OR, 1.73; 95% CI, 1.07, 2.81) versus West. Predictors of testing for HBV DNA and alanine aminotransferase at 1 year included Asian race (OR, 1.72; 95% CI, 1.23, 2.41), a primary care physician visit within 2 years of delivery (OR, 1.63; 95% CI, 1.19, 2.22), and peripartum HBV specialist follow-up within 1 year (OR, 15.68; 95% CI, 11.38, 21.60). Conclusions: Maternal HBV specialist follow-up rates were extremely low in this large, diverse cohort representing all United States regions. Referral to a HBV specialist was the strongest predictor of appropriate postpartum HBV laboratory testing. Follow-up rates may be even lower in uninsured populations. Abstract : Supplemental Digital Content is available in the text.