Cesarean section and nonbreastfeeding tend to reduce the risk of mother-to-child transmission (MTCT) in infants of HBsAg- and HBeAg-positive mothers who were not administered antiviral therapy during pregnancy, suggests a new study published in the Journal of Viral Hepatitis.

Pan et al conducted a cohort study and a meta-analysis to determine whether cesarean section and nonbreastfeeding can prevent MTCT in HBsAg- and HBeAg-positive mothers.

HBsAg- and HBeAg-positive pregnant women who did not receive antiviral treatment during pregnancy were enrolled between August 2009 and June 2015. Infants received active and passive immunity. A systematic literature search was also performed in the PubMed, Embase, Cochrane, China National Knowledge Infrastructure and Wanfang Chinese databases for "HBV" or "hepatitis b" or "hepatitis b virus" and "mother-to-infant transmission" or "vertical transmission". Investigators screened the studies and extracted data. The fixed-effect model helped analyze the studies.

Overall, 852 mothers and 857 newborns were enrolled. At 7 months of age, 41 infants (4.78%) were positive for HBsAg. According to multivariate analysis, mothers with higher HBV DNA levels (>108 IU/mL; RR = 3.03, 95% CI: 1.41-6.52) were found to be associated with an elevated risk of infection. Although not statistically significant, cesarean section (RR = 0.61) and nonbreastfeeding (RR = 0.88) appeared to reduce the risk of infection.

In all, 5726 studies were identified from the literature search. Besides the current study, 13 were included in the analysis of delivery mode, and 12 were included in the analysis of feeding mode. The risk of infection in the cesarean section group was found to be lower compared to that in the vaginal delivery group. Furthermore, in the feeding mode analysis, the risk in the nonbreastfeeding group was significantly lower.

Cesarean section and nonbreastfeeding thus appeared to reduce the risk of MTCT in infants of HBsAg- and HBeAg-positive mothers not given antiviral therapy during pregnancy.

Source: Pan Y-C, Jia Z-F, Wang Y-Q, et al. The Role of Caesarean Section and Nonbreastfeeding 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. J Viral Hepat. 2020 May 3.