USPSTF Emphasizes Importance of Screening for HBV Infection in Pregnant Women

Hepatitis B virus (HBV) infection in pregnant women can cause serious health consequences to infants at birth. About 40% of infants born to HBV-infected mothers in the United States will develop chronic HBV infection without postexposure prophylaxis, and approximately one-fourth will die from chronic liver disease.¹

Health care professionals can play an important role in screening pregnant women, providing routine vaccination to infants, and preventing perinatal transmission.

The US Preventive Services Take Force (USPSTF) has reaffirmed its 2009 recommendation to screen all pregnant women at their first prenatal visit for HBV (hepatitis B surface antigen [HBsAg]) infection.²This is considered a Grade A recommendation, meaning that evidence demonstrates a substantial benefit for the screening.²Women with unknown HBsAg status or with new or continuing risk factors for HBV infection (e.g. injection drug use or sexually transmitted infection) should be screened at the time of hospital admission or other delivery setting.²

New evidence shows that rates of maternal HBV infection have increased annually by 5.5% since 1998, and infected infants are more likely to develop chronic infection.²Universal prenatal screening substantially reduces perinatal transmission of HBV and decreases the risk of infants developing chronic HBV infection. Rates of prenatal screening for HBV infection range from 84%-88%, but screening rates during the first trimester are low, consisting of about 60% of commercially insured and 39% of Medicaid-enrolled patients.²This demonstrates that there is room for improvement in screening pregnant patients for HBV infection. Health care providers should educate their colleagues about these recommendations through continuing education programs.

Health care professionals can play an integral role in monitoring and treating HBV-positive mothers and their infants. Case management for HBV-positive mothers should include HBV DNA viral load testing and referral to specialty care for counseling and medical treatment.^1,2

It is generally recommended to start maternal antiviral therapy when the HBV DNA is > 200,000 IU/mL. Postexposure prophylaxis should be provided for infants born to infected mothers, which includes the hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth.^1,2

The vaccine series should be completed by 8 months, and serologic testing for infection and immunity should be performed at 9-12 months of age.²Infants born to mothers with unknown HBsAg status should receive hepatitis B vaccination within 12 hours of birth followed by HBIG prophylaxis.²All infants born to HBV-negative mothers should receive the hepatitis B vaccine within 24 hours of birth, and the series should be completed by 18 months.²

Reference

1. CDC. Viral hepatitis perinatal transmission. CDC website.https://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm. Last reviewed July 8, 2019. Accessed July 30, 2019.
2. Owens DK, Davidson KW, Krist AH, et al; US Preventive Services Task Force. Screening for hepatitis B virus infection in pregnant women. US Preventive Services Task Force Reaffirmation Recommendation Statement.JAMA. 2019;322(4):349-354. doi:10.1001/jama.2019.9365.