Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Stanford University, Stanford, California.
JAMA. 2019 Jul 23;322(4):349-354. doi: 10.1001/jama.2019.9365.
Screening for hepatitis B virus (HBV) infection during pregnancy identifies women whose infants are at risk of perinatal transmission. Data from a nationally representative sample showed a prevalence of maternal HBV infection of 85.8 cases per 100 000 deliveries from 1998 to 2011 (0.09% of live-born singleton deliveries in the United States). Although there are guidelines for universal infant HBV vaccination, rates of maternal HBV infection have increased annually by 5.5% since 1998. Children infected with HBV during infancy or childhood are more likely to develop chronic infection. Chronic HBV infection increases long-term morbidity and mortality by predisposing infected persons to cirrhosis of the liver and liver cancer.
To update the 2009 US Preventive Services Task Force (USPSTF) recommendation on screening for HBV infection in pregnant women.
The USPSTF commissioned a reaffirmation evidence update to identify substantial new evidence sufficient enough to change the prior recommendation. The USPSTF targeted its evidence review on the effectiveness and potential harms of screening and the effectiveness and harms of case management to prevent perinatal transmission.
The USPSTF previously found adequate evidence that serologic testing for hepatitis B surface antigen accurately identifies HBV infection. Interventions are effective for preventing perinatal transmission, based on foundational evidence and observational studies of US case management programs. In addition, there is evidence that over time, perinatal transmission has decreased among women and infants enrolled in case management, providing an overall substantial health benefit. Therefore, the USPSTF reaffirms its previous conclusion that there is convincing evidence that screening for HBV infection in pregnant women provides substantial benefit.
The USPSTF recommends screening for HBV infection in pregnant women at their first prenatal visit. (A recommendation).
在怀孕期间筛查乙型肝炎病毒 (HBV) 感染可识别出其婴儿有围产期传播风险的女性。来自全国代表性样本的数据显示，1998 年至 2011 年期间，每 100,000 例分娩中就有 85.8 例（美国活产单胎分娩的 0.09%）存在母体 HBV 感染。尽管有针对婴儿普遍进行乙型肝炎病毒疫苗接种的指南，但自 1998 年以来，母体 HBV 感染率每年增加 5.5%。在婴儿期或儿童期感染 HBV 的儿童更有可能发展为慢性感染。慢性 HBV 感染使感染者易患肝硬化和肝癌，从而增加了长期发病和死亡的风险。
更新 2009 年美国预防服务工作组（USPSTF）关于孕妇乙型肝炎病毒感染筛查的建议。
USPSTF委托进行了重新确认证据更新，以确定足够充分的新证据来改变先前的建议。USPSTF 将其证据审查重点放在筛查的有效性和潜在危害以及病例管理的有效性和危害上，以预防围产期传播。
USPSTF 之前发现有足够的证据表明，乙型肝炎表面抗原的血清学检测可准确识别 HBV 感染。基于基础证据和美国病例管理计划的观察性研究，干预措施可有效预防围产期传播。此外，有证据表明，随着时间的推移，参加病例管理的女性和婴儿的围产期传播率有所下降，从而带来了整体的重大健康益处。因此，USPSTF 再次确认其先前的结论，即有令人信服的证据表明，对孕妇进行乙型肝炎病毒感染筛查可带来实质性益处。
USPSTF 建议在孕妇的第一次产前就诊时筛查 HBV 感染。（推荐）
