Authors (including presenting author) :
Hui PW(1); Ng C(1); Cheung KW(1); Lai CL(2)
Affiliation :
(1)Department of Obstetrics & Gynaecology, Queen Mary Hospital (2)Department of Medicine, The University of Hong Kong
Introduction :
A new service model for women who were screened positive for hepatitis B surface antigen (HBsAg) in pregnancy was set up at Queen Mary Hospital on 15 May 2017. All the women were offered blood test for Hepatitis B virus (HBV) DNA level at HK$400 under Department of Medicine, The University of Hong Kong, during the first antenatal visit at Tsan Yuk Hospital. The laboratory result was reviewed by hepatologists. Women with HBV DNA of or over 200,000 IU/ml were seen by the hepatologists in the antenatal period to counsel for the option of commencement of Tenofovir disopoxil fumarate 300 mg daily from the third trimester onwards. They were followed up by hepatologists for drug compliance and monitored for HBV DNA level. All other women would also be given an elective review by hepatologists.
Objectives :
The objectives of this retrospective analysis is to review the proportion of women with high viral load, triage of patients, attendance of hepatological review, acceptance of anti-viral treatment and impact on HBV DNA level in pregnant Hepatitis B carriers.
Methodology :
All women attending the antenatal clinic who were diagnosed positive HBsAg and had HBV DNA tests over a 30 months period from 15 May 2017 to 30 October 2019 were identified. The HBV DNA level was retrieved and case notes were reviewed.
Result & Outcome :
Results HBV viral load was performed for 213 pregnant women. 49 (23%) women had viral load of or over 200,000 IU/ml and the highest viral load was 688,000,000 IU/ml. 61/213 (28.6%) women were given hepatology appointment before expected date of confinement and this provided 100% coverage for all 49 women with high viral load. Apart from one patient who defaulted follow up, the remaining 48 (98%) women with high viral load received tenofovir disopoxil fumarate before delivery with a median gestation of 25.5 weeks (range 20 to 39 weeks). 38/48 (79.2%) women received tenofovir disopoxil fumarate at or before 28 weeks. For the remaining 10 women, 4 had deferred blood test for viral load, 4 had late antenatal booking beyond 20 weeks, 1 defaulted the initial appointment at 28 weeks and one was seen at 33 weeks of gestation. Outcome With the joint effort of obstetricians and hepatologists, Queen Mary Hospital is the first public hospital initiating the enhanced management of Hepatitis B pregnant carrier. The proportion of women with high viral load was compatible with previous findings. The present review indicated the usefulness of HBV DNA test in pregnant women and high acceptance of antenatal anti-viral treatment. Triage of women by HBV DNA level could be achieved to allow early review and commencement of anti-viral medication, reduce the viral load at time of delivery and consequentially minimise the risk of vertical transmission. This service model has now been adopted as a framework to implementation of the enhancement program of antenatal service in preventing mother-to-child-transmission of hepatitis B virus in public maternity units commencing 1 January 2020.
