USPSTF Reaffirms Need for HBV Screening in All Pregnant Women

By Reuters Staff

July 24, 2019

NEW YORK (Reuters Health) - All pregnant women should continue to be screened for hepatitis B virus (HBV) infection at their first prenatal visit, the U.S. Preventive Services Task Force (USPSTF) said in an updated recommendation statement.

This grade "A" recommendation, in today's JAMA, reaffirms 2009 task force advice.

HBV screening during pregnancy, the standard of care for more than 30 years, identifies women at risk of transmitting the infection to their infants so that effective prophylactic interventions can be started, note Dr. Douglas Owens from Stanford University in California and colleagues.

The USPSTF commissioned a "reaffirmation" evidence update to identify substantial new evidence sufficient enough to change the prior recommendation. The task force uses this 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," they explain.

The updated evidence review found no new substantial evidence that would change its recommendation and, therefore, reaffirmed its recommendation to screen for HBV infection in all pregnant women because the benefits of screening continue to substantially outweigh the harms.

The principal screening test for detecting maternal HBV infection is the serologic identification of hepatitis B surface antigen (HBsAg). Screening should be performed in each pregnancy, regardless of prior HBV vaccination or previous negative HBsAg test results, the task force says.

The USPSTF recommendation is in line with recommendations from several other organizations.

The American College of Obstetricians and Gynecologists recommends HBV screening with serologic testing for HBsAg in every pregnant patient at the earliest prenatal visit. Pregnant women who test positive for HBsAg should then be tested for HBV DNA.

The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices also recommends testing for HBsAg in all pregnant women during an early prenatal visit and HBV DNA testing for pregnant women who test positive for HBsAg. The American Academy of Family Physicians and The American Association for the Study of Liver Diseases also endorse early HBV screening in pregnant women.

In an editorial in JAMA, Dr. Neil Silverman from the David Geffen School of Medicine at University of California, Los Angeles, says the practice of universal screening for HBV infection, as reaffirmed by the USPSTF, "remains an important component of interrupting perinatal HBV transmission. In addition, adherence to these recommendations also allows for discussions and implementation of treatment modalities that have been established since the last statement from the USPSTF on this topic."

"These include maternal HBV-targeted antiviral therapy during pregnancy as an adjunct to neonatal immunoprophylaxis to address the risk of fetal infection in the face of high levels of maternal viremia," he adds, "as well as the ability to refer women for chronic treatment of their HBV disease to forestall or prevent long-term complications of infection."


JAMA 2019.