Journal
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
Volume 11, Issue 10, Pages 1349-1355Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.cgh.2013.04.026
Keywords
Mother-to-Child Transmission; Prevention; Immunoprophylaxis; Neonate
Categories
Funding
- National Eleventh Five-Year Key Projects in infectious diseases [2008ZX10002-001]
- National Twelfth Five-Year Key Projects in infectious diseases of the Ministry of Science and Technology of China [2012ZX 10004904-003-001, 2012ZX 10002-001-01]
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BACKGROUND & AIMS: Despite appropriate passive and active immunization, perinatal transmission of hepatitis B virus (HBV) still occurs in 5%-10% of infants born to women with high levels of viremia who test positive for the hepatitis B e antigen (HBeAg). We evaluated the effects of cesarean section delivery on perinatal transmission of HBV from women who tested positive for the hepatitis B surface antigen (HBsAg). METHODS: We analyzed data from 1409 infants born to HBsAg-positive mothers through vaginal delivery (VD) (n = 673), elective caesarean section (ECS) (n = 496), or urgent cesarean section (UCS) (n = 240) who completed appropriate immunization against HBV. The prevention was assumed to have failed for infants who were HBsAg positive when they were 7-12 months old; this information was used to assess transmission rates. RESULTS: HBV infection was transmitted to a smaller percentage of infants born by ECS (1.4%) than by VD (3.4%, P < .032) or UCS (4.2%, P <.020). UCS had no effect on vertical transmission, compared with VD (4.2% vs 3.4%, P = .593). Infants born by ECS had a significantly lower rate of vertical transmission than those born by non-ECS (1.4% vs 3.6%, P = .017). Women with HBV DNA levels < 1,000,000 copies/mL did not transmit the infection to their infants, regardless of method of delivery. There were no differences in maternal or infant morbidity and mortality among the groups. CONCLUSIONS: There is a significantly lower rate of vertical transmission of HBV infection to infants delivered by ECS, compared with those delivered vaginally or by UCS. Elective cesarean sections for HBeAg-positive mothers with pre-delivery levels of HBV DNA 1,000,000 copies/mL could reduce vertical transmission.
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