Advertisement

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.

Comment

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.

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

Citation(s):

Reader Comments (1)

HAKIMAH MAIMUNAH Resident, Pediatric Subspecialty, Dr Soetomo hospital

good study

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

Advertisement
Advertisement
Advertisement