Division of Liver Diseases, Department of Medicine, Mount Sinai Medical Center, Mount Sinai School of Medicine, New York, NY, USA.
BACKGROUND & AIMS:
Despite appropriate passive and active immunization, perinatal transmission of hepatitis B virus (HBV) still occurs to 5%-10% of infants born to women with high levels of viremia who test positive for the HB e antigen (HBeAg). We evaluate the effects of caesarean section delivery on perinatal transmission of HBV from women who tested positive for the HB s antigen (HBsAg).
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 caesarean 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.
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=0.593). Infants born by ECS had a significantly lower rate of vertical transmission than those born by non-ECS (1.4% vs 3.6%; P=0.017). 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.
There is a significantly lower rate of vertical transmission of HBV infection to infants delivered by ECS, compared to those delivered vaginally or by UCS. Elective caesarean sections for HBeAg-positive mothers with pre-delivery levels of HBV DNA ≥1,000,000 copies/mL could reduce vertical transmission.