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Peripartum Maternal Hepatitis B Care in a US Nationwide Data Set
- Source :
- J Clin Gastroenterol
- Publication Year :
- 2019
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2019.
-
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.
- Subjects :
- Adult
medicine.medical_specialty
Databases, Factual
Referral
Prenatal care
medicine.disease_cause
Article
03 medical and health sciences
Hepatitis B, Chronic
0302 clinical medicine
Pregnancy
Ethnicity
Prevalence
Humans
Medicine
Pregnancy Complications, Infectious
Hepatitis B virus
business.industry
Obstetrics
Age Factors
Gastroenterology
Primary care physician
Prenatal Care
Odds ratio
Hepatitis B
medicine.disease
Infectious Disease Transmission, Vertical
United States
030220 oncology & carcinogenesis
Cohort
Female
030211 gastroenterology & hepatology
business
Subjects
Details
- ISSN :
- 01920790
- Volume :
- 53
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Gastroenterology
- Accession number :
- edsair.doi.dedup.....2e95ba6819a81708d8e13684da367039
- Full Text :
- https://doi.org/10.1097/mcg.0000000000001122