HBV Screening Helps Babies More than Moms
Routine screening for hepatitis B virus (HBV) during pregnancy
enables most infants to be protected against infection,
but underserved mothers often do not receive education
about or care for their own infection, researchers reported
this week at DDW 2011.
hepatitis B transmission can be effectively prevented using
available HBV vaccines and in some cases administered antibodies
(hepatitis B immune globulin, or HBIG).
health officials recommend that pregnant women should be tested
for HBV so that their babies can receive prophylactic therapy
if needed. Ideally, such testing would also lead to the women
themselves receiving hepatitis B education, further testing,
and appropriate care, but this often does not happen, according
to research presented at the Digestive Disease Week meeting
(DDW) this week in Chicago.
is an edited excerpt from a press release issued by DDW describing
the study and its findings.
Antenatal Screening for Hepatitis B in an Urban NYC Population
Provides Appropriate Care for Infants But Not for HBsAg
to new research at Columbia Presbyterian Medical Center,
high rates of chronic hepatitis B infection (HBV) are found
in pregnant minority and immigrant women in the New York
City area, and most of them do not receive education, appropriate
follow-up testing or referral, which is considered the standard
of care for all persons newly identified as HBV carriers.
Results showed that while all but one infant was protected
from infection in this study, nearly 90 percent of the women
-- the majority of whom were immigrant or non-English speaking
-- did not receive education about hepatitis, further laboratory
testing or subsequent care. The study also showed a surprisingly
high rate of chronic HBV across this population of women
of child-bearing age. These results are especially notable,
said lead investigator Blaire E. Burman, MD, an internal
medicine resident at Columbia Presbyterian Medical Center,
because nearly 75 percent of those who screened positive
were Hispanic, many from the Dominican Republic, a population
overrepresented in this population, but a group not traditionally
considered high risk for viral hepatitis.
The study also found that subpopulations of largely immigrant
and underserved patients are living with chronic HBV and
are at serious risk for morbidity and mortality. The study
identified a population of young and vulnerable patients
living with a chronic disease that they know little about,
and are unlikely to receive the standard of care in terms
of surveillance and treatment. Given the lack of follow-up
testing and imaging, it is unclear what percentage of these
infected women would qualify for and benefit from therapy.
Additionally, immigrant populations that are not listed
as "high risk" under current screening guidelines
may in fact have high rates of chronic HBV infection. It
is imperative to identify carriers who do not have regular
access to medical care, not just young women, but the rest
of their families.
"Prenatal screening is a golden opportunity to identify
chronic hepatitis B infection in young mothers at risk for
life-threatening complications, including liver failure
and liver cancer," Dr. Burman said. "We need to
use prenatal testing to engage patients with intervention
and prevention of future morbidity and mortality."
Dr. Burman added that there is very little research in this
area, and no previous studies specifically looked at the
follow-up of women who screened positive for HBV during
pregnancy, the subsequent care received and their outcomes.
She cautioned that this research applies only to the largely
underserved and immigrant population who receive prenatal
care at the two urban hospitals studied, and that it cannot
be applied to women with private insurance and established
Digestive Disease Week 2011 (DDW) is the largest international
gathering of physicians, researchers, and academics in the
fields of gastroenterology, hepatology, endoscopy, and gastrointestinal
surgery. Jointly sponsored by the American Association for
the Study of Liver Diseases, the American Gastroenterological
Association (AGA) Institute, the American Society for Gastrointestinal
Endoscopy, and the Society for Surgery of the Alimentary
Tract, DDW takes place May 7-10, 2011, in Chicago, IL. The
meeting showcases more than 5,000 abstracts and hundreds
of lectures on the latest advances in GI research, medicine
Burman, MS Chang, and RS Brown. Routine Antenatal Screening
for Hepatitis B in an Urban NYC Population Provides Appropriate
Care for Infants but Not for HBsAg Positive Women Blaire Digestive
Disease Week (DDW 2011). Chicago. May 7-11, 2011. Abstract
Disease Week. Routine Antenatal Screening for HBV in an Urban
NYC Population. Press release. May 10, 2011.