Effect of elective cesarean section on the risk of mother-to-child transmission of hepatitis B virus

Abstract

BackgroundMany clinicians and hepatitis B virus (HBV)-infected pregnant women prefer elective caesarean section (ECS) to prevent mother-to-child transmission of HBV, since some studies found higher transmission of HBV in infants born by vaginal delivery (VD) than by cesarean section. However, other studies showed that ECS does not reduce the risk of being infected with HBV in infants. In this study, we aimed to clarify whether ECS may reduce the risk of mother-to-child transmission of HBV.MethodsTotally 546 children (1–7-year-old) born to 544 HBsAg-positive mothers from 15 cities and rural areas across Jiangsu Province, China, were enrolled. Of these children, 137 (2 pairs of twins) were born to HBeAg-positive mothers; 285 were delivered by ECS and 261 others by VD (one pair of twin in each group). HBV serologic markers were tested by enzyme or microparticle immunoassay.ResultsThe maternal and gestational ages, maternal HBeAg-positive rates, and children’s ages, gender ratios, hepatitis B vaccine coverage and administrations of HBIG were comparable between ECS and VD groups (all p >0.05). The overall prevalence of HBsAg in the 546 children was 2.4%, with 2.5% (7/285) and 2.3% (6/261) in those born by ECS and VD respectively (p = 0.904). Further comparison of chronic HBV infection in the 137 children of HBeAg-positive mothers showed that the HBsAg-positive rates in ECS and VD groups were 10.3% (7/68) and 8.7% (6/69) respectively (p = 0.750), while the mothers had similar HBV DNA levels (2.38 × 106 vs. 2.35 × 106 IU/ml, p = 0.586). Additionally, the overall rate of anti-HBs ≥10 mIU/ml in the children was 71.6%, with 72.3% and 70.9% in those born by ECS and VD respectively (p = 0.717).ConclusionsWith the recommended immunoprophylaxis against hepatitis B, ECS does not reduce the risk of mother-to-child transmission of HBV. Therefore, ECS should not be used in HBsAg-positive pregnant women to prevent mother-to-child transmission of HBV.

ACG Clinical Guideline: Liver Disease and Pregnancy

“…However, other studies report no benefi t to elective cesarean section ( 106 ). Data from Beijing of 1,409 infants born to HBsAg-positive mothers from 2007 to 2011, all of whom received appropriate immunoprophylaxis at birth, reported MTCT rates of 1.4% with elective cesarean section compared with 3.4% with vaginal delivery and 4.2% with urgent cesarean section ( P <0.05) ( 107 ). When mothers in this study were stratifi ed according to HBV DNA, in those with low HBV DNA (<1,000,000 copies/ml or 2×10 5 IU/ml), delivery modality did not impact MTCT.…”

“…Expert opinion has suggested that there were insuffi cient data to recommend changes in the mode of delivery for HBV-infected women ( 104,105 ). Some more recent data support reconsideration of elective cesarean section to reduce MTCT including a metaanalysis that suggested a 17.5% absolute risk reduction compared with immunoprophylaxis alone.…”

“…Th is suggests a potential role for elective cesarean section among women with HBV DNA >1,000,000 copies/ml (2×10 5 IU/ml). However, before defi nitive recommendations can be made, validation studies are needed to determine the relative safety and effi cacy of elective cesarean section and immunoprophylaxis vs. immunoprophylaxis alone in reducing MTCT without compromising fetal outcomes ( 107,108 ).…”

The Follow-up of HBsAg Carrier Pregnant Women and Their Infants: Evaluation of the Clinical Results of a “Patient follow-up and Treatment Algorithm”

“…Pek çok çalışmada immünopro-filaksi başarısızlığı için en önemli risk faktörleri, annenin HBeAg pozitifliği ve yüksek HBV DNA düzeyi olarak bulunmuştur (4,12,13,15,(17)(18)(19)21,26,31) . Wang ve ark.…”

“…Ayrıca zor da olsa annenin meme başının etrafındaki çatlakların bulaş açısından risk yaratabileceği de bildirilmektedir (18) . Ancak çalışmalar, yeterli immünoprofilaksi uygulanmış çocuklarda emzirme ile beslenmenin mama ile beslenmeye göre daha yüksek risk oluşturmadığını göstermektedir (3,14,15,18,21,33) . Çin'de yapılan iki çalışmanın birinde doğum sonrası HBIG ve hepatit B aşılaması tamamlanmış 170 çocuktan emzirme ile beslenenlerde % 7, mama ile beslenenlerde % 6 oranında bulaş saptanmış.…”