Hepatitis B virus serology in pregnant women: transmittal of results from obstetricians to pediatricians in California

[Knowledge of obstetricians about the vertical transmission of hepatitis B virus]

CONTEXT

Vertical transmission is responsible for 35%-40% of the new cases of hepatitis B worldwide and it is associated with an increased risk of chronic hepatitis B, cirrhosis and hepatocellular carcinoma.

OBJECTIVE

To describe obstetricians' knowledge on the recommended measures to the diagnosis of the infection by the hepatitis virus B in pregnant women and to prevent the transmission of this infection to the babies of infected mothers.

METHODS

Obstetricians registered at the 'Sociedade de Ginecologia e Obstetrícia da Bahia', Salvador, BA, Brazil were randomly selected and invited to answer a questionnaire with questions regarding their academic formation, workplace, contact with medical students and their practices about the hepatitis virus B. Individuals who were not currently working as obstetricians or were not living in the state of Bahia were excluded from the study. Data were analyzed with the EpiInfo software with a 95% confidence interval.

RESULTS

Three hundred and one obstetricians answered the questionnaire: 90.3% of them recognized that the hepatitis virus B could be transmitted vertically and 81.7% routinely screened their patients for hepatitis virus B infection during prenatal consultations; 66.0% considered HBsAg the best serological marker to be employed on the screening. Only 13.0% systematically recommended the vaccination against hepatitis virus B and the administration of immunoglobulin to the newborns of infected mothers in the first 12 hours of life. The frequency of correct answers about the vertical transmission of hepatitis virus B, the best serological marker for screening and the management of infected mothers and their newborns was higher among professionals who had the 'Título de Especialista em Ginecologia e Obstetrícia (TEGO)' than among the remaining ones (P = 0.018, P = 0.001 and P = 0.002, respectively).

CONCLUSION

We observed that the knowledge of the obstetricians about the diagnosis and management of hepatitis virus B infection during pregnancy is not adequate, reinforcing the need of continuous medical education programs on the infections that can be transmitted vertically.

Performance of US hospitals on recommended screening and immunization practices for pregnant and postpartum women

OBJECTIVE

Recommendations by most national advisory committees on immunization include evaluating all pregnant women for chronic hepatitis B virus infection and immunity to rubella. It is recommended that all pregnant women be screened for hepatitis B surface antigen during an early prenatal visit and that rubella vaccine be administered in the postpartum period to women not known to be immune. This study determined the extent to which hospitals with labor and delivery services adhere to these recommendations.

METHODS

We conducted a mail survey of a stratified random sample of all US medical-surgical hospitals to (1) determine the proportion of hospitals with hepatitis B screening policies and rubella immunization programs and (2) identify significant factors associated with the presence of these policies and programs. Hospitals were stratified by number of beds (<100, 100-499, and > or =500) and affiliation with a medical school.

RESULTS

Of 986 institutions surveyed, 858 (87%) responded. Of these, 635 (74%) were labor and delivery hospitals. Approximately half of these (51%) had hospital policies related to screening pregnant women for the hepatitis B surface antigen. Twenty-one percent had rubella immunization programs for postpartum women. Only 14% of labor and delivery hospitals were in full compliance with published recommendations for hepatitis B surface antigen screening and rubella postpartum vaccination. Hospitals were more likely to be compliant if they had more than 100 beds, were private rather than public institutions, were affiliated with a medical school, and were in states with laws regarding hepatitis B surface antigen screening of pregnant women.

CONCLUSIONS

Almost half, and more than three quarters, of hospitals were not in compliance with hepatitis B screening and rubella postpartum immunization recommendations, respectively. Hospitals should develop and implement policies for these preventive services.