Hospital-based evaluation of programs to prevent perinatal hepatitis B virus transmission

Objective: To evaluate the frequency of hepatitis B surface antigen (HBsAg) screening of pregnant women in the United States and factors associated with the lack of screening. Design: A random sample of 200 hospitals with 100 or more births per year was surveyed with regard to policy and practices. Each hospital was also asked to provide maternal screening and infant follow-up data for the first 25 infants who were born on or after March 1, 1993. Results: Of 183 participating hospitals, 137 (75%) had maternal HBsAg screening policies, and 102 (56%) had standing orders for HBsAg testing of pregnant women who were admitted without prior screening. Hospitals that were located in states with laws that required maternal HBsAg screening were more likely to have a written screening policy (prevalence ratio [PR], 1.7; 95% confidence interval [CI], 1.2-2.4) and a standing order (PR, 1.7; 95% CI, 1.4-2.2). A lack of screening was related to delivery in hospitals without screening policies (PR, 3.4; 95% CI, 1.3-8.9) or standing orders (PR, 2.8; 95% CI, 1.2-6.2), and to the infant's provider being a family practitioner (PR, 1.7; 95% CI, 1.1-2.7). Among the 3982 infants for whom data were available, 3342 (84%) were born to mothers who had undergone screening for HBsAg. Conclusions: These findings suggest that hospitals should develop specific policies for HBsAg screening, states should enact laws that require maternal screening, and additional education of health care providers is needed with regard to the screening of all pregnant women for HBsAg.