Abstract
BACKGROUND: Studies on the issue of whether elective cesarean section (ECS) may reduce mother-to-child transmission (MTCT) of HBV in infants of carrier mothers with high viremia (HBV DNA > 2 × 10(5) IU/ml) showed inconsistent results. In addition, whether breastfeeding may cause MTCT of HBV is still a concern. We compared the MTCT rates in infants born to non-antiviral mothers with HBV DNA > 2 × 10(5) IU/ml with different delivery and feeding modes. METHODS: In total, 460 mothers with HBV DNA > 2 × 10(5) IU/ml and their 462 infants (2 twin sets) were included. Hepatitis B surface antigen (HBsAg) and antibodies against HBsAg (anti-HBs) in infants were quantitatively tested at 7-14 month age. Chi-square or Fisher's exact tests was applied to analysis the MTCT rates with different delivery and feeding modes. RESULTS: Of the 462 infants, 214 (46.3%) were delivered by ECS and 178 (38.5%) were exclusively bottle-fed. Overall, 11 (2.4%) of 462 infants were HBsAg positive at 9.9 ± 2.4 month age. The MTCT rate (2.0%, 5/248) in vaginally delivered infants was similar to that (2.8%, 6/214) in infants delivered with ECS (χ(2) = 0.307, p = 0.580), and the rate (3.2%, 9/284) in breastfed infants was also similar to that (1.1%, 2/178) in exclusively bottle-fed infants (χ(2) = 2.190, p = 0.139). Moreover, the MTCT rates in infants with vaginal delivery and breastfed, ECS and breastfed, vaginal delivery and bottle-fed, and ECS and bottle-fed had no statistical significance, with 2.5%, 3.9%, 1.1%, and 1.1%, respectively (χ(2) = 2.090, p = 0.538). CONCLUSIONS: With timely immunoprophylaxis, ECS and bottle-feeding cannot reduce MTCT of HBV in infants born to high viremic mothers without antiviral therapy. ECS or bottle-feeding should not be recommended for the prevention of perinatal HBV infection.