Perinatal Hepatitis B Virus (HBV) transmission results in chronic disease in 90% of infected infants. Immunoprophylaxis reduces perinatal HBV infections by 95%. For women with viral loads >200,000 IU/mL, antiviral therapy during pregnancy is recommended to further reduce perinatal transmission. We sought to characterize antiviral therapy use in Hepatitis B-infected pregnant women.
The Centers for Disease Control and Prevention (CDC) provided auxiliary funding for five Perinatal Hepatitis B Prevention Programs. We analyzed data collected retrospectively from Hepatitis B-infected pregnant women in Georgia, Michigan, New York City, Philadelphia, and Wisconsin identified as having live births during April 2016–December 2017. We assessed maternal antiviral therapy use during pregnancy; HBV DNA levels included in our analysis were from the last result available prior to delivery for each woman.
We identified 3,971 pregnant women with HBV infection; of these, 803 (20.2%) had information regarding prescription of antiviral therapy during pregnancy. HBV DNA levels were known for 1,907 women, of whom 9.1% (n=173) had HBV DNA >200,000 IU/mL nearest delivery. Antiviral therapy was prescribed for 26.5% (n=213) of women with information. Antiviral therapy was more commonly prescribed for women aged <30 years vs. ≥30 years (32.0% vs. 23.1%, p=0.0069), Asian/Pacific Island race vs. white or black (42.7% vs. 2.8% and 6.2%, respectively, p<0.0001), and those whose HBV was monitored by a gastroenterologist/hepatologist vs. maternal fetal medicine or infectious disease specialist (55.1% vs. 10.3% and 36.4%, respectively, p<0.0001). Tenofovir was prescribed for 92.9% of women prescribed antiviral therapy; lamivudine was prescribed for 3.8%.
Antiviral therapy was prescribed for one-fourth of Hepatitis B-infected women with information and was more commonly prescribed for women who were younger, Asian/Pacific Island race, and who received Hepatitis B care from a gastroenterologist/hepatologist. Although these are preliminary findings and data collection is ongoing, opportunities may exist to improve guideline-concordant antiviral therapy use among Hepatitis B-infected pregnant women.
NOTE: Prevention of perinatal HBV transmission is an off-label use of antiviral therapy.
J. Lazaroff, None
E. Burkhardt, None
P. Fineis, CDC: Grant Investigator , Grant recipient .
S. Born, None
D. Hinds, None
A. Koneru, None