Matthew S Chang1, Ruth Tuomala2, Anna E Rutherford3, Muthoka L Mutinga3, Karin L Andersson4, Blaire E Burman5, Robert S Brown6, Emily Oken7, Chinweike Ukomadu3. 1. Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, MA. Electronic address: mchang5@partners.org. 2. Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. 3. Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, MA. 4. Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA. 5. Division of Gastroenterology, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA. 6. Center for Liver Disease and Transplantation, College of Physicians and Surgeons, Columbia University, New York, NY. 7. Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
Abstract
OBJECTIVE: We sought to determine rates of maternal postpartum hepatitis B virus (HBV) follow-up with a HBV specialist and identify factors associated with poor follow-up, as prior research has focused on infant outcomes and not maternal care. STUDY DESIGN: We conducted a retrospective review of data from Partners HealthCare system, the largest health care system in Massachusetts, and identified women with chronic HBV who delivered from 2002 through 2012. RESULTS: We identified 291 women (mean age 31.5 years, 51% Asian) with incident HBV during pregnancy. In all, 47% had postpartum follow-up with a HBV specialist, but only 19% also had appropriate laboratory tests (hepatitis B e antigen [HBeAg], hepatitis B e antibody, HBV DNA, and ALT) within 1 year of their HBV diagnosis. Mothers with HBV follow-up were more likely to have a primary care physician (PCP) within the Partners HealthCare system (66% vs 38%, P < .0001), a positive HBeAg (20% vs 8%, P = .004), and elevated AST values (17% vs 8%, P = .02). On multivariable logistic regression analysis, a mother who had a PCP (odds ratio, 2.50; 95% confidence interval, 1.37-4.59) or positive HBeAg (odds ratio, 4.45; 95% confidence interval, 1.64-12.06) had a greater likelihood of having HBV follow-up. CONCLUSION: Only 19% of HBV-infected mothers met care guidelines 1 year after being diagnosed with HBV. Inadequate postpartum HBV care affects women of all races/ethnicities. Women who had a PCP as well as those who were HBeAg positive were more likely to be referred for postpartum follow-up with a HBV specialist, suggesting that providers might be referring patients when they perceive HBV to be more serious or complex.
OBJECTIVE: We sought to determine rates of maternal postpartum hepatitis B virus (HBV) follow-up with a HBV specialist and identify factors associated with poor follow-up, as prior research has focused on infant outcomes and not maternal care. STUDY DESIGN: We conducted a retrospective review of data from Partners HealthCare system, the largest health care system in Massachusetts, and identified women with chronic HBV who delivered from 2002 through 2012. RESULTS: We identified 291 women (mean age 31.5 years, 51% Asian) with incident HBV during pregnancy. In all, 47% had postpartum follow-up with a HBV specialist, but only 19% also had appropriate laboratory tests (hepatitis B e antigen [HBeAg], hepatitis B e antibody, HBV DNA, and ALT) within 1 year of their HBV diagnosis. Mothers with HBV follow-up were more likely to have a primary care physician (PCP) within the Partners HealthCare system (66% vs 38%, P < .0001), a positive HBeAg (20% vs 8%, P = .004), and elevated AST values (17% vs 8%, P = .02). On multivariable logistic regression analysis, a mother who had a PCP (odds ratio, 2.50; 95% confidence interval, 1.37-4.59) or positive HBeAg (odds ratio, 4.45; 95% confidence interval, 1.64-12.06) had a greater likelihood of having HBV follow-up. CONCLUSION: Only 19% of HBV-infected mothers met care guidelines 1 year after being diagnosed with HBV. Inadequate postpartum HBV care affects women of all races/ethnicities. Women who had a PCP as well as those who were HBeAg positive were more likely to be referred for postpartum follow-up with a HBV specialist, suggesting that providers might be referring patients when they perceive HBV to be more serious or complex.
Authors: Blaire E Burman; Nizar A Mukhtar; Brian C Toy; Tung T Nguyen; Alice Hm Chen; Albert Yu; Peter Berman; Hali Hammer; Daniel Chan; Charles E McCulloch; Mandana Khalili Journal: Dig Dis Sci Date: 2013-09-20 Impact factor: 3.199
Authors: Danny Chu; Ju Dong Yang; Anna S Lok; Tram Tran; Eduardo Bruno Martins; Elizabeth Fagan; Franck Rousseau; W Ray Kim Journal: Gut Liver Date: 2013-06-11 Impact factor: 4.519
Authors: Allison J Kwong; Matthew S Chang; Ruth E Tuomala; Laura E Riley; Julian N Robinson; Muthoka L Mutinga; Karin L Andersson; Robert S Brown; Emily Oken; Chinweike Ukomadu; Anna E Rutherford Journal: Matern Child Health J Date: 2018-09
Authors: Matthew S Chang; J Frank Wharam; Fang Zhang; Robert F LeCates; Emma Morton-Eggleston; Ruth E Tuomala; Anna E Rutherford; Muthoka L Mutinga; Karin L Andersson; Robert S Brown; Chinweike Ukomadu; Emily Oken Journal: J Clin Gastroenterol Date: 2019 Nov/Dec Impact factor: 3.062
Authors: Matthew S Chang; Kerri Barton; Molly Crockett; Ruth E Tuomala; Anna E Rutherford; Muthoka L Mutinga; Karin L Andersson; Robert S Brown; Emily Oken; Chinweike Ukomadu Journal: J Clin Gastroenterol Date: 2016-07 Impact factor: 3.062