HBV information to their patients (Zola et al., 1997). In a more recent California study of obstetrical practices in 2008, only 62% referred patients who had new diagnoses of HBV to internists or specialists for followup of their chronic HBV infection (Chao et al., 2009b).

Hepatitis B services for foreign-born pregnant women are in need of improved resources that are more culturally and linguistically appropriate. Some 73% of HBsAg-positive pregnant women in the United States were born in East Asia or Southeast Asia (Din, 2009). Among them, Asian and Pacific Islanders, who account for only 5.7% of all births in the United States (CDC, 2009b), account for over two-thirds of births to mothers who have chronic HBV infection. CDC-funded perinatal HBV prevention coordinators are responsible for educating HBsAg-positive mothers and for referring them for appropriate medical management. The coordinators are restricted in their ability to fulfill that responsibility in culturally relevant ways, because of inadequate training and resources (Chao et al., 2009a). To strengthen the capacity and capabilities of the perinatal-HBV coordinators, the committee offers the following recommendation:

Recommendation 5-6. The Centers for Disease Control and Prevention should provide additional resources and guidance to perinatal hepatitis B prevention program coordinators to expand and enhance the capacity to identify chronically infected pregnant women and provide case-management services, including referral for appropriate medical management.

Preventing Perinatal Transmission

Practice guidelines and additional recommendations focused on vaccination to prevent perinatal transmission are detailed in Chapter 4. There is a need to fund research to guide the effective use of antiviral medications late in pregnancy to prevent maternofetal HBV transmission, particularly by high-risk pregnant women who are positive for HBeAg or who have high HBV loads. Results of a few small studies have suggested that the use of lamivudine in the last trimester of pregnancy reduces the rate of perinatal transmission from mothers with high HBV DNA (Li et al., 2003; van Nunen et al., 2000; van Zonneveld et al., 2003). Xu et al. (2009) reported the results of a small randomized, double-blind, placebo-controlled trial involving 155 participants divided into treatment groups; the purpose of the trial was to see whether lamivudine given during late pregnancy could reduce perinatal transmission of HBV. Results suggested that lamivudine in late pregnancy was safe and could reduce HBV transmission from mothers who had high viral loads to their infants who also received HBIG passive immunization. However, the study was small, and large randomized,



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