How do grades differ for HBV screening in pregnant women versus at-risk adults?

• A. Pregnant women: Grade A; at-risk adults: Grade B.
• B. Pregnant women: Grade B; at-risk adults: Grade A.
• C. Pregnant women: Grade A; at-risk adults: Grade A.
• D. Pregnant women: Grade B; at-risk adults: Grade B.

Answer: (A)

USPSTF grades reflect how sure we are about the net benefit of a screening test and how large that benefit is. A grade means there is high certainty that the net benefit is substantial, while a B grade means there is moderate certainty of a moderate net benefit.

For hepatitis B screening in pregnant women, the benefit is very clear and substantial because identifying HBV in mothers allows immediate actions to prevent newborn infection (neonatal vaccination and hepatitis B immune globulin at birth, plus potential antepartum management). That strong, consistent benefit leads to the highest grade.

For adults at risk, screening still provides meaningful benefit by preventing spread and disease, but the certainty and magnitude of benefit are not as strong across all at‑risk groups, resulting in a somewhat lower grade.

So the best pairing is a high-grade recommendation for pregnant women and a somewhat lower-grade recommendation for at‑risk adults.