Delivery via cesarean section and avoidance of breastfeeding was found to reduce the risk of mother-to-child transmission of hepatitis B virus (HBV) in infants of mothers positive for hepatitis B surface antigen (HBsAg) and hepatitis B e-antigen, according to the results of a study published in the Journal of Viral Hepatitis.

When HBV infection is transmitted from mother to infant during the perinatal period, the rate of chronic infection can be as high as 90%; however, the rate of transmission drops to 25% to 30% during the infant period. As infection in infants is more likely to progress to cirrhosis and hepatocellular carcinoma, prevention of mother-to-child transmission of HBV is needed.

Researchers in China conducted a cohort study and a meta-analysis to assess whether cesarean section and avoidance of breastfeeding can prevent HBV transmission from HBsAg-positive and HBeAg-positive mothers to their offspring. A total of 852 mothers and 857 newborns were enrolled, and at the age of 7 months, 41 infants (4.78%) were found to be positive for HBsAg. Multivariate analysis showed that mothers with higher HBV DNA levels (>108 IU/mL) were associated with increased risk of infection in their infants, and although there was no statistical significance, cesarean section and avoidance of breastfeeding showed a tendency to reduce the risk of infection. The researchers also identified 5726 studies and together with their study, 13 studies were included in an analysis of delivery mode and 12 were included in an analysis of feeding mode. They found that the risk of infection in the cesarean section group was lower than that in the vaginal delivery group, and the risk in the nonbreastfeeding group was significantly lower than that in the breastfeeding group.

“In conclusion, by combining the results of a cohort study and a meta-analysis, we found that cesarean section and non-breastfeeding reduced the risk of HBV immunoprophylaxis failure in infants born to both HBsAg and HBeAg positive mothers who did not receive antiviral therapy during pregnancy,” stated the authors.


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Reference

Pan Y-C, Jia Z-F, Wang Y-Q, et al. The role of cesarean section and non-breastfeeding in preventing mother-to-child transmission of hepatitis B virus in HBsAg and HBeAg positive mothers: results from a prospective cohort study and a meta-analysis [published online May 22, 2020]. J Viral Hepat. doi:10.1111/jvh.13314