Hepatitis B Virus: Screening -- Pregnant Women


General

Grade: A The USPSTF recommends the service. There is high certainty that the net benefit is substantial. Offer or provide this service.

Specific Recommendations

The USPSTF recommends screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit.

Frequency of Service

Screen pregnant women at thier first prenatal visit.

Risk Factor Information

No information available.


Clinical

Clinical Considerations

Patient Population Under Consideration

This recommendation applies to all pregnant women.

Screening Tests

Screening for HBV infection by testing for HBsAg should be performed in each pregnancy, regardless of previous hepatitis B vaccination or previous negative HBsAg test results.

Timing of Screening

A test for HBsAg should be ordered at the first prenatal visit with other recommended screening tests. At the time of admission to a hospital, birth center, or other delivery setting, women with unknown HBsAg status or with new or continuing risk factors for HBV infection (such as injection drug use or evaluation or treatment for a sexually transmitted disease) should receive screening.

Treatment

Infants born to HBV-infected mothers should receive hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth. Infants born to mothers with unknown HBsAg status should receive hepatitis B vaccine within 12 hours of birth, followed by hepatitis B immune globulin as soon as possible (but not later than 7 days after birth) if the mother tests positive for HBsAg.

Pregnant women who test positive for HBsAg should be referred to an appropriate case-management program and should be provided with or referred for counseling and medical management of HBV infection. Counseling should include information about prevention of HBV transmission to sexual partners and household contacts and reassurance regarding the safety of breastfeeding in infants who receive appropriate prophylaxis.

Other Considerations

Implementation

Screening for HBV infection in pregnant women is necessary but not sufficient to prevent disease transmission to newborns. To realize the maximum benefit from screening, primary care clinicians and delivery settings must establish effective systems for the accurate and timely transfer of maternal HBsAg test results to the labor, delivery, and newborn medical records.

Research Needs/Gaps

Research is needed to assess the effect of long-standing universal childhood hepatitis B vaccination on the magnitude of benefit of screening for HBV infection in U.S.-born pregnant women. Research is also needed to determine the net health benefit to the mother and infant of treating pregnant women whose chronic HBV infections are identified by prenatal screening.


Rationale

Rationale

Importance

An estimated 24 000 infants are born each year to women in the United States who are infected with HBV. Between 30% and 40% of all chronic HBV infections result from perinatal transmission. Chronic HBV infections increase long-term morbidity and mortality by predisposing infected persons to cirrhosis of the liver and liver cancer.

Detection

The principal screening test for detecting maternal HBV infection is the serologic identification of hepatitis B surface antigen (HBsAg). Immunoassays for detecting HBsAg have a reported sensitivity and specificity greater than 98%.

Benefits of Detection and Early Intervention

The USPSTF found convincing evidence that universal prenatal screening for HBV infection substantially reduces perinatal transmission of HBV and the subsequent development of chronic HBV infection. The current practice of vaccinating all infants against HBV infection and providing postexposure prophylaxis with hepatitis B immune globulin administered at birth to infants of mothers infected with HBV substantially reduces the risk for acquiring HBV infection.

Harms of Detection and Early Intervention

The USPSTF found no published studies that describe harms of screening for HBV infection in pregnant women. The USPSTF concluded that the potential harms of screening are no greater than small.

USPSTF Assessment

The USPSTF concludes that there is high certainty that the net benefit of screening pregnant women for HBV infection is substantial.


Others

Recommendations of Others The American Academy of Family Physicians strongly recommends screening for HBV infection in pregnant women at their first prenatal visit. This recommendation is available at http://www.aafp.org/online/en/home/clinical/exam.html. The American College of Obstetricians and Gynecologists recommends routine screening of all pregnant women with HBsAg. The American Academy of Pediatrics recommends HBsAg testing for all pregnant adolescents "at the time a pregnancy is discovered, regardless of hepatitis B immunization history and previous results of tests for HBsAg and antibody to HBsAg." This recommendation is available at http://aapredbook.aappublications.org/cgi/content/full/2006/1/2.9.2. The Centers for Disease Control and Prevention recommends that all pregnant women be tested routinely for HBsAg during an early prenatal visit (for example, first trimester) in each pregnancy, even if they have been previously vaccinated or tested. This recommendation is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a1.htm?s_cid=rr5416a1_e.


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