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

Xiangru Chen,Xiangru Chen,Shu Zhang,Shu Zhang,Jie Chen,Jie Chen,Yi-Hua Zhou,Yi-Hua Zhou,Chenyu Xu,Chenyu Xu,Yali Hu,Yali Hu,Yali Hu,Jian Wen,James Fung

doi:10.1371/journal.pone.0055303

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.

Highlights

Hepatitis B virus (HBV) infection is a global health problem because of its severe sequelae, such as liver cirrhosis and hepatocellular carcinoma
Children’s ages, gender ratios, and hepatitis B vaccine coverage and administration of hepatitis B immune globulin (HBIG) were comparable between the two groups
The hepatitis B virus (HBV) infection rates were comparable in breastfed and formula-fed children of HBV-infected mothers after currently recommended immunoprophylaxis against hepatitis B, indicating that breastfeeding in high-risk children does not add any risk for mother-to-child transmission of HBV

Summary

Introduction

Hepatitis B virus (HBV) infection is a global health problem because of its severe sequelae, such as liver cirrhosis and hepatocellular carcinoma. World Health Organization and US Advisory Committee on Immunization Practices postulate that chronic HBV infection of the mother could not be an argument against breastfeeding [2,3], many clinicians do not encourage HBV carrier mothers to breastfeed their babies [4,5], since HBV DNA can be detected in breast milk [6] and breast lesions such as cracked or bleeding nipples may increase exposure of infants to HBV. Many 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

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Methods

Results

Conclusion