This article is more than 5 years old. Information may no longer be current.

Mother-to-child HBV transmission less common with cesarean section delivery

Infants born to mothers with hepatitis B were less likely to contract the infection when delivered via cesarean section in a recent study.

Researchers performed a retrospective analysis of data collected from 673 infants born by vaginal delivery (VD), 496 through elective cesarean section (ECS) and 240 through urgent cesarean section (UCS) to 1,401 hepatitis B surface antigen-positive (HBsAg) mothers. All infants received HBV immunization and were tested for HBsAg when aged 7 to 12 months. Among the mothers, 54.5% also were hepatitis B e antigen-positive (HBeAg) and 61.5% had detectable HBV DNA.

The mother-to-child transmission (MTCT) rate for chronic HBV across the entire cohort was 2.8%. No maternal or infant mortality occurred during the study.

All infants who developed infection were born to mothers who tested positive for HBsAg and HBeAg, and had HBV DNA levels of 6 log₁₀ copies/mL before delivery.

Fewer infants in the ECS group (1.4%) developed HBV than in the VD (3.4%; P<.032 for comparison) or UCS groups (4.2%; P<.02). When the VD and UCS groups were combined for analysis, they displayed a greater rate of HBV than the ECS group (3.6% vs. 1.4%; P=.017).

Multivariate analysis indicated that delivery via VD or UCS was independently associated with increased MTCT risk (OR=4.29; 95% CI, 1.87-9.84). Subanalysis of infants born to HBeAg-positive mothers (n=365, VD group; n=273, ECS group; n=131, UCS group) also yielded a lower MTCT rate for infants born via ECS (2.6%) than those in the VD (6.3%, P=.027) or UCS groups (7.6%, P=.018), or in the non-ECS groups combined (6.7%; P=.015).

“Our study demonstrated that a significantly lower MTCT rate was observed in infants delivered by ECS when compared with the group of those delivered vaginally or by UCS,” the researchers wrote. “Compared with VD, ECS did not seem to have a higher rate of mortality or major complications during 1-year follow-up in both mothers and infants. We concluded that performing ECS only in highly viremic mothers with pre-delivery HBV DNA levels ≥1,000,000 copies/mL may be advisable.”

Disclosure: The researchers report no relevant financial disclosures.