Huang Hongyu, Hu Yali, Dai Yimin, Zhou Yi-Hua
Department of Infection Management, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, 214000, China.
Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, 210008, China.
BMC Pregnancy Childbirth. 2025 Apr 23;25(1):482. doi: 10.1186/s12884-025-07606-z.
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 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 IU/ml with different delivery and feeding modes.
In total, 460 mothers with HBV DNA > 2 × 10 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.
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 = 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 = 2.190, 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 = 2.090, p = 0.538).
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.
关于择期剖宫产（ECS）是否可降低高病毒血症（HBV DNA＞2×10 IU/ml）的携带母亲所生婴儿的母婴传播（MTCT）HBV问题的研究结果不一致。此外，母乳喂养是否会导致HBV的母婴传播仍是一个关注点。我们比较了不同分娩和喂养方式下，HBV DNA＞2×10 IU/ml且未接受抗病毒治疗的母亲所生婴儿的母婴传播率。
共纳入460例HBV DNA＞2×10 IU/ml的母亲及其462例婴儿（2对双胞胎）。在婴儿7至14月龄时定量检测其乙肝表面抗原（HBsAg）和抗HBsAg抗体（抗-HBs）。采用卡方检验或Fisher精确检验分析不同分娩和喂养方式下的母婴传播率。
462例婴儿中，214例（46.3%）通过择期剖宫产分娩，178例（38.5%）完全采用奶瓶喂养。总体而言，462例婴儿中有11例（2.4%）在9.9±2.4月龄时HBsAg呈阳性。阴道分娩婴儿的母婴传播率（2.0%，5/248）与择期剖宫产分娩婴儿的母婴传播率（2.8%，6/214）相似（χ=0.307，p=0.580），母乳喂养婴儿的母婴传播率（3.2%，9/284）与完全奶瓶喂养婴儿的母婴传播率（1.1%，2/178）也相似（χ=2.190，p=0.139）。此外，阴道分娩并母乳喂养、择期剖宫产并母乳喂养、阴道分娩并奶瓶喂养以及择期剖宫产并奶瓶喂养的婴儿的母婴传播率无统计学意义，分别为2.5%、3.9%、1.1%和1.1%（χ=2.090，p=0.538）。
通过及时的免疫预防，在未接受抗病毒治疗的高病毒血症母亲所生婴儿中，择期剖宫产和奶瓶喂养并不能降低HBV的母婴传播。不建议采用择期剖宫产或奶瓶喂养来预防围产期HBV感染。
