On July 23, the U.S. Preventive Services Task Force published a final recommendation statement(www.uspreventiveservicestaskforce.org) and final evidence review(www.uspreventiveservicestaskforce.org) on screening for hepatitis B virus infection in pregnant women.
Based on the evidence, the USPSTF recommends all pregnant women be screened for HBV infection at their first prenatal visit to prevent infection in newborns -- an "A" recommendation.(www.uspreventiveservicestaskforce.org)
Screening is intended to prevent perinatal HBV transmission in infants, which can confer as much as a 90% risk of developing chronic HBV infection. Such chronic infection, in turn, can increase long-term morbidity and mortality by predisposing the infected person to cirrhosis of the liver and liver cancer.
And although infants are now routinely vaccinated for HBV shortly after birth, rates of maternal HBV infection have increased by more than 5% each year since 1998.
"Clinicians can help mothers and their babies by screening all pregnant people at their first prenatal visit for hepatitis B," said USPSTF member John Wong, M.D., in a news release.(www.uspreventiveservicestaskforce.org) "Screening helps pregnant people get appropriate care throughout their pregnancy and helps reduce the chances of transmitting the virus to the baby."
- The U.S. Preventive Services Task Force posted a final recommendation statement and final evidence review on July 23 that calls for screening pregnant women for hepatitis B virus infection at the first prenatal visit.
- Because screening for HBV infection in pregnant people is currently a well-established, evidence-based standard of practice in primary care, the USPSTF used a reaffirmation deliberation process to update the recommendation.
- This final recommendation is consistent with the USPSTF's January 2019 draft and 2009 final recommendations on the topic.
This final recommendation is consistent with the USPSTF's January 2019 draft and its 2009 final recommendation on the same topic, which the AAFP supported at that time.
Given the strength of evidence on which the task force based that 2009 final recommendation, the task force used a reaffirmation deliberation process for the current update. The USPSTF uses the reaffirmation process for well-established, evidence-based standards of practice in current primary care practice for which only a very high level of evidence would justify a change in the grade of the recommendation.
Thus, for this latest final recommendation statement, the USPSTF commissioned a targeted review to seek new and substantial evidence on the benefits and harms of screening, ultimately determining that the net benefit of screening for HBV infection in pregnant women continues to be well established and, therefore, reaffirming its recommendation to screen pregnant women for the infection.
The primary screening test to detect maternal HBV infection is serologic identification of hepatitis B surface antigen. Serological immunoassays for detecting HBsAg have a reported sensitivity and specificity greater than 98%.
When the draft version of this final recommendation was released, Jeffrey Quinlan, M.D., of Alexandria, Va., a member of the AAFP's Commission on Health of the Public and Science, told AAFP News that it's already common practice for family physicians to screen pregnant women for HBV during the first trimester.
As for additional screening during the first prenatal visit, that should include screens for gonorrhea, chlamydia, syphilis and HIV -- each of which can increase risks for poor maternal and fetal outcomes, Quinlan said.
"Screening is also often done for cystic fibrosis and muscular dystrophy -- although both are ideally done before conception," he noted. Further testing includes screening for anemia and urinary tract infections/asymptomatic bacteriuria, as well as determining the mother's blood type and rubella immunity status.
Response to Public Comment
Draft versions of this final recommendation statement and evidence review were posted for public comment on the USPSTF website from Jan. 8 to Feb. 4.
Most comments the task force fielded requested more information about treatment with antiviral therapy.
In response, the USPSTF added information in the Clinical Considerations section(www.uspreventiveservicestaskforce.org) about emerging evidence that treating HBV-positive women with antiviral therapy (i.e., tenofovir) -- in combination with HBIG prophylaxis at birth and HBV vaccination -- can significantly reduce the risk of HBsAg seropositivity in infants. Also, in the Other Considerations section,(www.uspreventiveservicestaskforce.org) the task force noted the need for additional studies in this area.
The AAFP's Commission on Health of the Public and Science plans to review the USPSTF's final recommendation statement and evidence review and will determine the Academy's stance on the recommendation.
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