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Mothers with Hepatitis B Can Safely Breastfeed

Women with chronic HBV infection can breastfeed with minimal risk of transmitting the virus to their babies if they use standard prophylactic therapy, according to a recent review.

Hepatitis B virus (HBV) is a blood-borne pathogen can be transmitted from mothers to infants during pregnancy or delivery. Research has shown that use of prophylactic therapy including hepatitis B immune globulin (HBIG) and HBV vaccination can prevent infant infection at birth, but transmission via breastfeeding has been less extensively studied.

As described in the May 2, 2011, advance issue of Archives of Pediatrics and Adolescent Medicine, Zhongjie Shi from Sun Yat-sen University in Guangzhou, China, and colleagues performed a systematic review and meta-analysis of studies looking at the role of breastfeeding in mother-to-child HBV transmission.

The review authors searched medical literature databases including MEDLINE, EMBASE, Cochrane Library, National Science Digital Library, and China Biological Medicine Database for relevant studies published between January 1990 and August 2010; they also interviewed experts in the field.

Shi's team selected prospective, peer-reviewed, controlled clinical trials that examined breastfeeding as a route of HBV exposure. Babies were given HBIG and an initial HBV vaccine dose soon after birth, with follow-up vaccine doses over the next several months.

The researchers collected data on HBV intrauterine infection, maternal blood and breast milk infectiousness, infant immune prophylaxis methods and response, and occurrence of adverse events.


  • The analysis included 10 studies that met the inclusion criteria, all done in China.
  • These studies involved a total of 751 infants in the breastfeeding group and 873 infants in the non-breastfeeding group.
  • By the age of 12 months, 31 infants in the breastfeeding group tested positive for HBV, compared with 33 in the non-breastfeeding group.
  • According to infant blood tests for hepatitis B surface antigen (HBsAg) or HBV DNA positivity at age 6 to 12 months, HBV transmission occurred with similar frequency in the breastfeeding and non-breastfeeding groups (odds ratio 0.86).
  • According to infant blood hepatitis B surface antibody (anti-HBs) positivity at 6 to 12 months, babies in both groups were equally likely to develop surface antibodies (odds ratio 0.98).
  • No adverse events or complications were observed during breastfeeding.

Based on these findings, the study authors concluded, "Breastfeeding after proper immunoprophylaxis did not contribute to mother-to-child transmission of HBV."

Given that the rate of infection was similar in infants in the breastfeeding and non-breastfeeding groups, the investigators suggested that the small number of infections likely occurred during pregnancy or delivery. Breastfeeding should generally be recommended for its nutritional value, they said, but women should avoid it if they have cracked nipples or sores than could expose babies to blood.

Investigator affiliations: Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of General Surgery, Second Affiliated Hospital and Harbin Medical University, Harbin, China; Heilongjiang Academy of Traditional Chinese Medicine, Harbin, China; Department of Chemistry and Health Science Center, Temple University, Philadelphia, PA.


Z Shi, Y Yang, H Wang, et al. Breastfeeding of Newborns by Mothers Carrying Hepatitis B Virus: A Meta-analysis and Systematic Review. Archives of Pediatrics and Adolescent Medicine (abstract). May 2, 2011 (Epub ahead of print).