Hospital-based evaluation of programs to prevent perinatal hepatitis B virus transmission
H. R. Yusuf, F. J. Mahoney, C. N. Shapiro, E. E. Mast and L. Polish
Cardiovascular Health Studies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
OBJECTIVE: To evaluate the frequency of hepatitis B surface antigen (HBsAg)
screening of pregnant women in the United States and factors associated
with the lack of screening. DESIGN: A random sample of 200 hospitals with
100 or more births per year was surveyed with regard to policy and
practices. Each hospital was also asked to provide maternal screening and
infant follow-up data for the first 25 infants who were born on or after
March 1, 1993. RESULTS: Of 183 participating hospitals, 137 (75%) had
maternal HBsAg screening policies, and 102 (56%) had standing orders for
HBsAg testing of pregnant women who were admitted without prior screening.
Hospitals that were located in states with laws that required maternal
HBsAg screening were more likely to have a written screening policy
(prevalence ratio [PR], 1.7; 95% confidence interval [CI], 1.2-2.4) and a
standing order (PR, 1.7; 95% CI, 1.4-2.2). A lack of screening was related
to delivery in hospitals without screening policies (PR, 3.4; 95% CI,
1.3-8.9) or standing orders (PR, 2.8; 95% CI, 1.2-6.2), and to the infant's
provider being a family practitioner (PR, 1.7; 95% CI, 1.1-2.7). Among the
3982 infants for whom data were available, 3342 (84%) were born to mothers
who had undergone screening for HBsAg. CONCLUSIONS: These findings suggest
that hospitals should develop specific policies for HBsAg screening, states
should enact laws that require maternal screening, and additional education
of health care providers is needed with regard to the screening of all
pregnant women for HBsAg.
