Breastfeeding Is Not a Risk Factor for Mother-to-Child Transmission of Hepatitis B Virus

Abstract

BackgroundMany clinicians do not encourage breastfeeding in hepatitis B virus (HBV) carriers, since HBV DNA can be detected in breast milk and breast lesions may increase exposure of infants to HBV. The aim of this study was to determine whether breastfeeding may add risk for perinatal HBV transmission.Methodology/Principal FindingsTotally 546 children (1–7-year-old) of 544 HBV-infected mothers were investigated, with 397 breastfed and 149 formula-fed; 137 were born to HBeAg-positive mothers. All children had been vaccinated against hepatitis B but only 53.3% received hepatitis B immune globulin (HBIG). The overall prevalence of HBsAg+, HBsAg−/anti-HBc+, and anti-HBs (≥10 mIU/ml) in children was 2.4%, 3.1%, and 71.6% respectively. The HBsAg prevalence in breast- and formula-fed children was 1.5% and 4.7% respectively (P = 0.063); the difference was likely due to the higher mothers' HBeAg-positive rate in formula-fed group (formula-fed 49.0% vs. breastfed 15.9%, P<0.001). Further logistic regression analyses showed that breastfeeding was not associated with the HBV infection in the children, adjusting for the effect of maternal HBeAg status and other factors different between the two groups.Conclusions/SignificanceUnder the recommended prophylaxis, breastfeeding is not a risk factor for mother-to-child transmission of HBV. Therefore, clinicians should encourage HBV-infected mothers to breastfeed their infants.

Management of HBV in Pregnancy

“…Of note, HBV transmission is rare from breastfeeding alone [61] and therefore should not factor into the decision of whether or not to breastfeed. Lastly, an important and often overlooked issue is that patients diagnosed with hepatitis B during pregnancy require ongoing follow-up for this chronic disease.…”

Antiviral Treatment During Breastfeeding in Hepatitis B

“…Although the World Health Organization (WHO) recommends breastfeeding in chronic hepatitis B (CHB), unfortunately, 25-50% medical professionals (most of whom are hepatologists) do not encourage these mothers to breastfeed their babies (6,7). Even though HBV DNA is detected in breast milk (8), many studies suggest that breastfeeding is not a risk for mother-to-child transmission if the newborn is adequately managed for hepatitis B prevention at birth (9,10). Moreover, the majority of the mother-to-child transmission happens before deciding on infants' feeding modes (11).…”

Discrepancy in impact of maternal milk on vertical transmission between Hepatitis B virus and Human cytomegalovirus

“…8 However, studies present a discrepancy between HBV vertical transmission via breast milk and that of HCMV. [9][10][11][12][13] On the one hand, Breast-feeding has a major impact on cytomegaloviral infections in early life. [11][12][13] HCMV can be reactivated in latently infected mothers and is shed within the breast milk.…”

“…12 On the other hand, even though the HBV antigen has been detected in breast milk, there is no evidence that breast-feeding increases the risk of mother-to-child transmission. 9,10 The World Health Organization postulates that chronic HBV infection of the mother could not be an argument against breastfeeding. 8,9 However, some researchers and clinicians disapprove it based on the results of some studies that have investigated the content of viral markers in human milk.…”

“…9,10 The World Health Organization postulates that chronic HBV infection of the mother could not be an argument against breastfeeding. 8,9 However, some researchers and clinicians disapprove it based on the results of some studies that have investigated the content of viral markers in human milk. 9,13 To confirm or dispute the discrepancy and to reveal the reason(s) why the difference, if any, exists between HBV transmission to infants via maternal milk and that of HCMV, this study is the first, to our best of knowledge, to compare the HBV and HCMV infection rates for breast-fed babies born to seropositive mothers with both HBV and HCMV.…”