(418) Postpartum Gastroenterology Referrals and Follow Up in Pregnant Patients with Viral Hepatitis

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Anthony Chartier, MD (he/him/his)

Resident
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth
Houston, Texas, United States

Coauthor(s)

KS

Kaitlyn Stark, BS

Medical Student
University of Texas Health Science Center at Houston - McGovern Medical School
Houston, Texas, United States
HC

Han-Yang M. Chen, PhD

Associate Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Irene A. Stafford, MD, MS

Associate Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Objective: The objective of this study was to determine rates of appropriate postpartum gastroenterology (GI) referral and follow up in pregnant patients with hepatitis B and C.

Study Design: After institutional review board approval, we performed a retrospective cohort study among 19,974 pregnant patients who delivered at a safety net hospital system between 1/2019 and 12/2022. The primary outcomes were referrals to GI and postpartum follow-up with GI. All baseline demographics and obstetrical variables were collected, including viral hepatitis status. Differences in the baseline characteristics and outcomes were examined using chi-square or Fisher’s exact test for categorical variables. A P value of < 0.05 was considered significant. Multivariable Poisson regression models with robust error variance were used to examine the association, and an adjusted relative risk (aRR) with 95% CIs was calculated.

Results: Out of the 19,974 pregnant patients in this cohort, 82 (0.4%) had hepatitis B and 49 (0.2%) had hepatitis C. Hepatitis B was more prevalent in Black women, limited prenatal care, and lack of substance abuse, p = < 0.001, for each. (Table 1). Patients with hepatitis B were significantly more likely to be referred to GI than hepatitis C patients, with 62 (75.6%) of hepatitis B patients referred and 22 (44.9%) of hepatitis C patients referred (p < 0.001). Furthermore, patients with hepatitis B were significantly more likely to attend a follow-up appointment with GI during the postpartum period. 23 (28.1%) of hepatitis B patients attended a GI appointment postpartum, compared to 5 (10.2%) of hepatitis C patients (p = 0.016). After adjustment, hepatitis B patients were 2.60 times more likely to be referred or seen by GI (CI: 1.54-4.38), compared to hepatitis C patients.

Conclusion: This study demonstrates low rates of indicated GI referrals for pregnant women with viral hepatitis, despite screening recommendations to test all pregnant women to prevent mother-to-child transmission and to link them to care services for treatment. Further studies are needed to evaluate the reasons for these gaps.