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Peripartum Maternal Hepatitis B Care in a US Nationwide Data Set.

Publication ,  Journal Article
Chang, MS; Wharam, JF; Zhang, F; LeCates, RF; Morton-Eggleston, E; Tuomala, RE; Rutherford, AE; Mutinga, ML; Andersson, KL; Brown, RS; Oken, E ...
Published in: J Clin Gastroenterol
2019

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.

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Published In

J Clin Gastroenterol

DOI

EISSN

1539-2031

Publication Date

2019

Volume

53

Issue

10

Start / End Page

e424 / e430

Location

United States

Related Subject Headings

  • United States
  • Prevalence
  • Prenatal Care
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Infectious Disease Transmission, Vertical
  • Humans
  • Hepatitis B, Chronic
  • Gastroenterology & Hepatology
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Chang, M. S., Wharam, J. F., Zhang, F., LeCates, R. F., Morton-Eggleston, E., Tuomala, R. E., … Oken, E. (2019). Peripartum Maternal Hepatitis B Care in a US Nationwide Data Set. J Clin Gastroenterol, 53(10), e424–e430. https://doi.org/10.1097/MCG.0000000000001122
Chang, Matthew S., J Frank Wharam, Fang Zhang, Robert F. LeCates, Emma Morton-Eggleston, Ruth E. Tuomala, Anna E. Rutherford, et al. “Peripartum Maternal Hepatitis B Care in a US Nationwide Data Set.J Clin Gastroenterol 53, no. 10 (2019): e424–30. https://doi.org/10.1097/MCG.0000000000001122.
Chang MS, Wharam JF, Zhang F, LeCates RF, Morton-Eggleston E, Tuomala RE, et al. Peripartum Maternal Hepatitis B Care in a US Nationwide Data Set. J Clin Gastroenterol. 2019;53(10):e424–30.
Chang, Matthew S., et al. “Peripartum Maternal Hepatitis B Care in a US Nationwide Data Set.J Clin Gastroenterol, vol. 53, no. 10, 2019, pp. e424–30. Pubmed, doi:10.1097/MCG.0000000000001122.
Chang MS, Wharam JF, Zhang F, LeCates RF, Morton-Eggleston E, Tuomala RE, Rutherford AE, Mutinga ML, Andersson KL, Brown RS, Ukomadu C, Oken E. Peripartum Maternal Hepatitis B Care in a US Nationwide Data Set. J Clin Gastroenterol. 2019;53(10):e424–e430.

Published In

J Clin Gastroenterol

DOI

EISSN

1539-2031

Publication Date

2019

Volume

53

Issue

10

Start / End Page

e424 / e430

Location

United States

Related Subject Headings

  • United States
  • Prevalence
  • Prenatal Care
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Infectious Disease Transmission, Vertical
  • Humans
  • Hepatitis B, Chronic
  • Gastroenterology & Hepatology
  • Female