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Screening for Hepatitis B Virus Infection in Pregnant Women: An Updated Systematic Review for the U.S. Preventive Services Task Force
Evidence Synthesis, No. 179
Investigators: Jillian T. Henderson, PhD, MPH, Elizabeth M. Webber, MS, and Sarah I. Bean, MPH.
Structured Abstract
Objective:
To update the 2009 U.S. Preventive Services Task Force (USPSTF) “A” recommendation on screening for hepatitis B virus (HBV) infection in pregnancy, we systematically reviewed evidence on the benefits (Key Question [KQ] 1) and harms (KQ 2) of universal screening programs for HBV infection in pregnant women, and the benefits (KQ 3) and harms (KQ 4) of case management programs to prevent perinatal transmission.
Data Sources:
We conducted a literature search of MEDLINE, PubMed Publisher-Supplied Records, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, the Cumulative Index for Nursing and Allied Health Literature, Embase, and PsycInfo from January 1, 1986 to May 3, 2018.
Study Selection:
We screened 5,688 titles and abstracts and 499 full-text articles to identify eligible studies based on a priori inclusion and exclusion criteria.
Data Analysis:
Two investigators independently appraised any article that met inclusion criteria using design-specific criteria. We abstracted and narratively synthesized included study data.
Results:
No studies were identified for KQs 1 or 2 that addressed either the effects of screening programs on perinatal HBV transmission or the potential harms of screening. Two fair-quality observational studies that compared perinatal transmission rates over time were included for KQ 3. One study reported outcomes of case management for infants with data reported to the national Perinatal Hepatitis B Prevention Program (PHBPP), administered by the Centers for Disease Control and Prevention (CDC). In the PHBPP, 155,081 infants born to HBV-positive women were identified for case management from 1994 to 2008; perinatal transmission outcomes were available for infants born from 1999 to 2008 who received serologic testing (N=55,362). A statistically significant decline in the perinatal transmission rate was observed; perinatal transmission was reported for 1.9 percent of case-managed infants in 1999 and 0.8 percent in 2008 (p<0.001). Over the study period, the number of infants born to HBV-positive women increased in the United States, and an increasing proportion of infants born to HBV-positive women were enrolled in the PHBPP for case management (p<0.001). Serologic testing within 24 months of birth also increased across the time period (p=0.001). The second study reported outcomes of case management for infants born to HBV-positive women in a large regional health care organization in the United States. The health system case management program reported on 4,446 infants born to HBV-positive women from 1997 to 2010. Over this period, 85 percent of infants were tested for HBV, and a decreasing trend in perinatal transmission was reported (incident rate ratio, 0.90 [95% confidence interval, 0.82 to 1.00]). Overall rates of perinatal transmission were very low (25 of 3,353 of infants tested [0.75%]). More than 97 percent of case-managed infants received HBV vaccination and hepatitis B immune globulin within 12 hours of birth. No studies were identified for KQ 4 to assess potential harms of case management.
Limitations:
Our review was narrowly focused on evidence of the effectiveness of screening or case management on prevention of perinatal transmission in contexts where prenatal screening and universal vaccination for HBV at birth are established practice. The included observational studies’ findings on declining perinatal transmission trends could be influenced by secular changes in other public health activities (e.g., universal HBV vaccination) or by improvements within case management program implementation and interventions (e.g., antiviral medication). Changes in data collection and reporting methods used in the studies could also introduce bias.
Conclusions:
Perinatal transmission would be observed in more than one third of infants born to HBV-positive mothers in the absence of prophylaxis. Very low and declining rates of perinatal transmission have been documented for infants in case management programs that track and coordinate the delivery of preventive interventions. Screening for HBV infection in pregnancy is standard prenatal care practice in the United States and identifies women and infants eligible for effective case management for effective interventions to prevent perinatal transmission.
Contents
Suggested citation:
Henderson JT, Webber EM, Bean SI. Screening for Hepatitis B Virus Infection in Pregnant Women: An Updated Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 179. AHRQ Publication No. 19-05248-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2019.
This report is based on research conducted by the Kaiser Permanente Research Affiliates Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2015-00007-I, Task Order No. 3). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
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