Could Elective Cesarean Delivery Reduce Vertical Transmission of HBV?

Summary and Comment |
October 31, 2013

Could Elective Cesarean Delivery Reduce Vertical Transmission of HBV?

  1. Atif Zaman, MD, MPH

Apparently, yes, but it should be considered only as a complement to immunoprophylaxis of infants and among women at high risk for transmitting HBV.

  1. Atif Zaman, MD, MPH

Effective methods for preventing vertical transmission of hepatitis B virus (HBV) from women positive for hepatitis B surface antigen (HBsAg) include immunoprophylaxis in infants (NEJM JW Gastroenterol May 9 2006) and administration of oral antivirals to highly viremic women during the third trimester of pregnancy. Whether mode of delivery affects risk for HBV transmission has been studied, but results are conflicting. A new study from China is the largest to date.

Investigators retrospectively examined the association between mode of delivery and HBsAg positivity at 7 to 12 months in 1409 infants born to HBsAg-positive mothers at a single hospital in Beijing, China. Nearly half of infants (48%) were delivered by vaginal birth, followed by elective cesarean section (35%), and urgent c-section (17%). All infants received appropriate immunization with HBV immune globulin and HBV vaccine series.

Forty infants (2.8%) failed immunoprophylaxis. All were born to mothers with HBV DNA ≥1,000,000 copies/mL (200,000 IU/mL). Vertical HBV transmission was lower with elective c-section (1.4%) compared with vaginal delivery (3.4%; P=0.03) and urgent c-section (4.2%; P=0.02). In multivariate analysis, mode of delivery other than elective c-section (i.e., urgent c-section or vaginal delivery) was associated with a higher likelihood of vertical HBV transmission (odds ratio, 4.29; 95% confidence interval, 1.87–9.84). No maternal or infant deaths occurred in the cohort.


Key findings were the low overall risk for vertical transmission (<3%) and no transmission among women with hepatitis B virus DNA levels <200,000 IU/mL. Elective cesarean section seems to be the delivery mode with the lowest risk for vertical transmission in infants born to highly viremic mothers. These data suggest that mothers who either do not wish to take oral HBV antivirals or do not have access to them should be advised to consider elective c-section as a complement to appropriate immunoprophylaxis.

Editor Disclosures at Time of Publication

  • Disclosures for Atif Zaman, MD, MPH at time of publication Speaker’s bureau Bristol-Myers Squibb; Genentech; Gilead; Kadmon; Merck; Salix; Vertex


Reader Comments (1)

HAKIMAH MAIMUNAH Resident, Pediatric Subspecialty, Dr Soetomo hospital

good study

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