MacLachlan Jennifer H, Romero Nicole, Allard Nicole, Rowe Stacey L, Cowie Benjamin C
WHO Collaborating Centre for Viral Hepatitis, The Doherty Institute, Melbourne, Victoria, Australia.
Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia.
J Gastroenterol Hepatol. 2024 Nov;39(11):2377-2385. doi: 10.1111/jgh.16711. Epub 2024 Aug 5.
Pregnancy is a key setting for engagement in chronic hepatitis B (CHB) care, due to the implications for transmission to the infant and antenatal diagnosis representing an opportunity for ongoing follow-up. This study aimed to identify the coverage and predictors of clinical care for women with CHB during and after pregnancy in a population-level cohort.
Notified CHB cases in Victoria, Australia, were linked with hospitalizations, medical services, and prescribing data, covering the period 1991-2018. Women with an admission for a live birth were identified and services provided during pregnancy were assessed, including general practitioner (GP) or specialist visits, viral load and serology testing, and antiviral treatment. Viral load and serology testing coverage ware also assessed for the 2-year period following pregnancy. Demographic and clinical predictors of viral load testing during pregnancy were assessed.
A total of 11 015 birth events occurred for 6090 women with CHB. During pregnancy most had a GP consultation (91.6%); however, only 39.5% had viral load testing and 41.4% had a gastroenterology or infectious diseases specialist consultation. Viral load testing and serology testing in the 2 years after pregnancy occurred in approximately half (47.9% and 52.2%, respectively) with increases over time. Viral load testing was more likely in those born overseas, those with more than one previous birth, and those living in Melbourne.
Despite improvements over time, key gaps were identified in the provision of CHB clinical care during and after pregnancy, with implications for ongoing transmission and adverse outcomes.
由于慢性乙型肝炎（CHB）对母婴传播的影响以及产前诊断为持续随访提供了契机，妊娠是参与CHB护理的关键阶段。本研究旨在确定人群队列中CHB女性在孕期及产后临床护理的覆盖情况和预测因素。
将澳大利亚维多利亚州报告的CHB病例与1991年至2018年期间的住院、医疗服务和处方数据相关联。确定有活产住院记录的女性，并评估孕期提供的服务，包括全科医生（GP）或专科医生就诊、病毒载量和血清学检测以及抗病毒治疗。还评估了产后2年的病毒载量和血清学检测覆盖率。评估孕期病毒载量检测的人口统计学和临床预测因素。
6090例CHB女性共发生11015次分娩事件。孕期大多数人进行了全科医生咨询（91.6%）；然而，只有39.5%进行了病毒载量检测，41.4%进行了胃肠病学或传染病专科医生咨询。产后2年约一半的人进行了病毒载量检测和血清学检测（分别为47.9%和52.2%），且随时间增加。出生在海外、有多次既往分娩史以及居住在墨尔本的人更有可能进行病毒载量检测。
尽管随着时间推移有所改善，但在孕期及产后CHB临床护理的提供方面仍存在关键差距，这对持续传播和不良结局有影响。
