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Open Access Research article

Effect of elective cesarean section on the risk of mother-to-child transmission of hepatitis B virus

Yali Hu15, Jie Chen1, Jian Wen2, Chenyu Xu2, Shu Zhang1, Biyun Xu3 and Yi-Hua Zhou45*

Author Affiliations

1 Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, China

2 Department of Obstetrics and Gynecology, Zhenjiang Fourth People's Hospital, Zhenjiang, China

3 Department of Biostatistics, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, China

4 Departments of Laboratory Medicine and Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, China

5 Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China

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BMC Pregnancy and Childbirth 2013, 13:119  doi:10.1186/1471-2393-13-119

Published: 24 May 2013

Abstract

Background

Many clinicians and hepatitis B virus (HBV)-infected pregnant women prefer elective caesarean section (ECS) to prevent mother-to-child transmission of HBV, since some studies found higher transmission of HBV in infants born by vaginal delivery (VD) than by cesarean section. However, other studies showed that ECS does not reduce the risk of being infected with HBV in infants. In this study, we aimed to clarify whether ECS may reduce the risk of mother-to-child transmission of HBV.

Methods

Totally 546 children (1–7-year-old) born to 544 HBsAg-positive mothers from 15 cities and rural areas across Jiangsu Province, China, were enrolled. Of these children, 137 (2 pairs of twins) were born to HBeAg-positive mothers; 285 were delivered by ECS and 261 others by VD (one pair of twin in each group). HBV serologic markers were tested by enzyme or microparticle immunoassay.

Results

The maternal and gestational ages, maternal HBeAg-positive rates, and children’s ages, gender ratios, hepatitis B vaccine coverage and administrations of HBIG were comparable between ECS and VD groups (all p >0.05). The overall prevalence of HBsAg in the 546 children was 2.4%, with 2.5% (7/285) and 2.3% (6/261) in those born by ECS and VD respectively (p = 0.904). Further comparison of chronic HBV infection in the 137 children of HBeAg-positive mothers showed that the HBsAg-positive rates in ECS and VD groups were 10.3% (7/68) and 8.7% (6/69) respectively (p = 0.750), while the mothers had similar HBV DNA levels (2.38 × 106 vs. 2.35 × 106 IU/ml, p = 0.586). Additionally, the overall rate of anti-HBs ≥10 mIU/ml in the children was 71.6%, with 72.3% and 70.9% in those born by ECS and VD respectively (p = 0.717).

Conclusions

With the recommended immunoprophylaxis against hepatitis B, ECS does not reduce the risk of mother-to-child transmission of HBV. Therefore, ECS should not be used in HBsAg-positive pregnant women to prevent mother-to-child transmission of HBV.

Keywords:
Hepatitis B virus; Mother-to-child transmission; Vaginal delivery; Caesarean section