Introduction Chronic hepatitis B (HBV) is a major cause of liver disease worldwide. It is estimated 0.4% of pregnant women in England have hepatitis B. The UK pregnancy screening programme includes hepatitis B and has an uptake of 97%. Infants born to hepatitis B infected mothers are at risk of perinatal transmission and it is important to identify those requiring antiviral treatment in the third trimester in order to reduce this risk. National policy recommends immunisation of infants, with vaccine +/- immunoglobulin. NICE guidance suggests that all hepatitis B positive pregnant women should be assessed by a specialist within 6 weeks. Approximately 5000 babies are born at Maidstone and Tunbridge Wells annually and mothers found to have HBV at pregnancy screening are referred to GB. The objectives of this study were to identify the demographics of patients in the antenatal screening clincis and associated outcomes in terms of further management and maternal case management.
Methods Between 2005 and 2015, 33 mothers were identified as having hepatitis surface antigen (HBsAg) positivity. The mothers were identified through two separate databases held by GB and the antenatal screening midwife. Data was obtained retrospectively from patient, laboratory and imaging records. These included age, ethnicity, date of HBsAg positivity, new or known diagnosis, interval to Hepatology clinic review and "did not attend" rate. The HBV serological profile, history of antiviral treatment and subsequent follow up were determined.
Results The predominant ethnicities in this cohort of hepatitis B positive mothers were Eastern European (27%) and African (24%). Of the 33 mothers, 45% did not volunteer a known diagnosis of hepatitis B until identification at screening, 27% received a new diagnosis through screening and it remained unclear whether the remaining 27% knew about their diagnosis or not. 42% of patients were seen in Hepatology clinic within 6 weeks of referral. 15% of mothers did not attend their first clinic appointment and as a result 80% of these did not have HBV DNA checked during or after pregnancy. The only eligible patient for treatment did not attend her appointment to initiate therapy. Vaccination of new born babies was 100%, and two also received immunoglobulins. After delivery, 39% did not attend their follow up appointments.
Conclusion The majority of HBV positive mothers were born outside the UK, with the largest group from Eastern Europe. There was considerable clinic non-attendance both at initial appointment and more strikingly post-delivery. The disappointing rates of patient engagement in the Hepatology clinic are perhaps due to the language barrier or cultural considerations. Areas to improve the service might include better use of interpreters, counselling and educational materials.
Disclosure of Interest None Declared
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