妊娠期肝炎病毒多重感染对母婴的影响

目的 探讨妊娠期肝炎病毒多重感染对母婴的影响。方法 对1994年1月至1999年12月在我院产前检查,肝功能异常的孕妇行甲、乙、丙、丁、戊等5种肝炎病毒标记物检测,其中确诊为肝炎病毒多重感染者32例（多重感染组）,确诊为肝炎病毒单一感染者32例（单一感染组）,对两组母儿并发症及预后进行观察比较。结果 两组丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、血清总胆红素（TBIL）水平比较,差异无显著性（P＞0．05）。多重感染组乙型肝炎病毒e抗原（HBeAg)阳性率（35．7％）显著低于单一感染组（76．9％,P＜0．05）,而乙型肝炎病毒e抗体（HBeAb)阳性率（57．1％）显著高于单一感染组（15．4％,P＜0．01）。多重感染组孕妇妊娠高血压综合征（妊高征）、产后出血、重症肝炎、死亡的发生率与单一感染组比较,差异无显著性（P＞0．05）。而多重感染组胎膜早破、早产的发生率（28．1％,25．0％）明显高于单一感染组（6．3％、3．1％,P＜0．05）;胎儿宫内窘迫及新生儿窒息的发生率（31．3％,25．0％）显著高于单一感染组（9．4％、0．0％,P＜0．05、P＜0．01）。结论 妊娠期肝炎病毒多重感染对孕妇的影响无明显加重,而对围产儿的影响较为明显;应加强孕期保健,防止胎膜早破及早产的发生。     

Risk factors for intrauterine infection with hepatitis B virus

Objective

To investigate risk factors for hepatitis B virus (HBV) intrauterine infection.

Methods

Peripheral blood samples and clinical data were collected from 174 pregnant women who were positive for hepatitis B surface antigen (HBsAg). Their 176 neonates received an active–passive immunization schedule at 0, 1, and 6 months. Blood samples from the infants, collected before immune prophylaxis administration, were tested for HBV markers and HBV DNA.

Results

The intrauterine infection rate at 6 months after birth was 5.1%. Maternal HBV DNA positivity (OR 11.362; 95% CI, 1.389–92.931), hepatitis B e antigen (HBeAg) positivity (OR 7.278; 95% CI, 1.734–30.538), and thalassemia minor (OR 15.619; 95% CI, 2.239–108.964) were associated with intrauterine infection. The intrauterine infection rate for mothers with 10⁵ copies/mL of serum HBV DNA or more was 18.2%, compared with 0.8% for mothers with less than 10⁵ copies/mL.

Conclusion

A positive HBsAg test at 24 hours and/or 1 month of age followed by a positive test at 6 months is an objective and comprehensive criterion for the diagnosis of HBV intrauterine infection. Maternal HBV DNA positivity (especially 10⁵ copies/mL of HBV DNA or more), HBeAg positivity, and thalassemia minor are risk factors for HBV intrauterine infection.     

Hepatitis C virus infection is associated with a higher incidence of cholestasis of pregnancy

To investigate a possible relationship between hepatitis C virus infection and cholestasis of pregnancy, we identified all cases of cholestasis of pregnancy (145/16,271) and hepatitis C virus infection (63/16,27 1) between January 1992 and December 1997. Serologic screening was performed universally. The rate of cholestasis of pregnancy was greater in women whose hepatitis C virus antibodies were positive rather than negative [15.9% (10/63) vs 0.8% (135/16,208),   P < 0.0011  . Among women with cholestasis of pregnancy, mean (standard deviation) gestational age at onset of symptoms and at delivery was significantly lower among women whose hepatitis C virus antibodies were positive compared with negative women: 28.9 (3.2) vs 34.3 (3–5) weeks,   P < 0.001  and 36–3 (0.9) vs 37.0 (1–6) weeks,   P = 0.03  , respectively. These findings suggest that early Occurrence of cholestasis of pregnancy may be an indication for serologic testing for hepatitis C virus.     

Hepatitis C virus infection is associated with a higher incidence of cholestasis of pregnancy.

To investigate a possible relationship between hepatitis C virus infection and cholestasis of pregnancy, we identified all cases of cholestasis of pregnancy (145/16,271) and hepatitis C virus infection (63/16,271) between January 1992 and December 1997. Serologic screening was performed universally. The rate of cholestasis of pregnancy was greater in women whose hepatitis C virus antibodies were positive rather than negative [15.9% (10/63) vs 0.8% (135/16,208), P < 0.001]. Among women with cholestasis of pregnancy, mean (standard deviation) gestational age at onset of symptoms and at delivery was significantly lower among women whose hepatitis C virus antibodies were positive compared with negative women: 28.9 (3.2) vs 34.3 (3.5) weeks, P < 0.001 and 36.3 (0.9) vs 37.0 (1.6) weeks, P = 0.03, respectively. These findings suggest that early occurrence of cholestasis of pregnancy may be an indication for serologic testing for hepatitis C virus.     

Amniocentesis in mothers who are hepatitis B virus carriers does not expose the infant to an increased risk of hepatitis B virus infection

Sixty-seven pairs of mothers with hepatitis B virus (HBV) surface antigen (HBsAg) and their infants were divided into two study groups to determine the effect of amniocentesis on intrauterine HBV infection. In the first study group (35 pairs), the infant's HBsAg status in cord blood was studied and the results were compared with those obtained in the cord blood from 65 infants born to HBsAg-positive women who did not have an amniocentesis. In the second study group (32 pairs), the HBV status of the infants was studied at the age of three months to five years and compared with the HBV status of 3,454 infants in the National HBV Prevention Program. In the first study group, one sample (2.9%) was weakly positive for HBsAg; while in the first control group, two (3.1%) were positive. In the second study group, three (10%) infants were positive for HBsAg. The failure rates of immunoprophylaxis in the second study and control groups were similar (9.4% vs 11% for HBsAg carrier mothers; 30% vs 14% for HBe antigen-positive carrier mothers). This suggested that genetic amniocentesis did not increase the risk of intrauterine HBV infection.     

The presence of hepatitis B surface antigen and deoxyribonucleic acid in amniotic fluid and cord blood

OBJECTIVE: It is uncertain whether neonatal infection with hepatitis B, despite treatment after delivery with immunoglobulin and vaccine, is the result of prior in utero transmission of the virus or treatment failure. Furthermore, the potential risk of hepatitis B transmission from the mother to the fetus at the time a genetic amniocentesis is performed is also a concern. In an attempt to better elucidate these controversies, amniotic fluid and cord blood specimens obtained from pregnant women positive for hepatitis B surface antigen were analyzed for the presence of hepatitis B surface antigen and hepatitis B deoxyribonucleic acid. STUDY DESIGN: This study was a prospective longitudinal analysis that identified hepatitis B surface antigen-positive patients who presented for amniocentesis. Cord blood was obtained from these patients at the time of delivery. Cord blood was also obtained from a group of hepatitis B surface antigen-positive patients for whom no amniocentesis was performed. All samples were analyzed for the presence of hepatitis B surface antigen and hepatitis B deoxyribonucleic acid. RESULTS: A total of 121 hepatitis B surface antigen-positive pregnant women were identified. In the 72 pregnancies in which amniocentesis was not performed, 18% of the cord blood samples were positive for hepatitis B surface antigen and 4% were positive for hepatitis B deoxyribonucleic acid. Of 47 amniocentesis fluid samples, 32% were positive for hepatitis B surface antigen but all were negative for hepatitis B virus deoxyribonucleic acid. Of 30 cord blood samples from patients who underwent an amniocentesis, 27% were positive for hepatitis B surface antigen, but all were negative for hepatitis B virus deoxyribonucleic acid. CONCLUSIONS: This study found that hepatitis B viral deoxyribonucleic acid is rarely present in cord blood and was not identified in amniotic fluid obtained by amniocentesis. This finding suggests that in utero transmission of the virus is rare prior to the onset of labor. These data further confirm the reports in the current literature that the risk of hepatitis B transmission to the fetus during amniocentesis is low. Because hepatitis B surface antigen can exist as an isolated entity devoid of nuclear material, in some cases this protein may be able to traverse the placental and amniotic membrane barrier in a manner similar to other proteins, such as alpha-fetoprotein. Recommendations for genetic amniocentesis in women positive for hepatitis B surface antigen are discussed.     

1214例急性呼吸道感染住院患儿9种病原体检测分析

目的分析急性呼吸道感染住院患儿病原体的特点,为临床早期病原学诊断和合理用药提供依据。方法 2014年5月至2015年7月宜兴市中医医院儿科收治住院的急性呼吸道感染患儿1 214例,采用间接免疫荧光法检测患儿血清中9种常见病原体IgM抗体,并对上述病原谱、病原流行情况等进行资料汇总分析。结果1 214例急性呼吸道感染患儿中检出病原体IgM抗体阳性371例,阳性率30.5%,其中肺炎支原体阳性率最高,占总样本的16.8%,其次是乙型流感病毒(5.8%)和副流感病毒(2.7%)。205例患儿肺炎支原体混合其他1种或1种以上感染,占总混合感染的55.2%。肺炎支原体春夏季病毒检出率高于秋冬季,差异有统计学意义(P0.008 3)。乙型流感病毒夏季病毒检出率高于秋季,差异有统计学意义(P0.008 3)。1~3岁患儿肺炎支原体感染率均高于1岁和3岁患儿,差异有统计学意义(P0.017);1~3岁患儿乙型流感病毒感染率均高于1岁和3岁患儿,但差异无统计学意义(P0.017);不同年龄段副流感病毒感染率比较差异无统计学意义(P0.05)。结论本院急性呼吸道感染住院患儿主要病原体是肺炎支原体、乙型流感病毒、副流感病毒;肺炎支原体合并其他病原体感染比较普遍;肺炎支原体和乙型流感病毒以夏季感染为主;1~3岁肺炎支原体感染率高。     

Interspousal and intrafamilial transmission of hepatitis C virus: A myth or a concern?

Objective: To investigate intrafamilial and interspousal transmission of hepatitis C virus.Methods: The incidence of anti-hepatitis C virus antibodies in 224 family members of 65 index patients was studied. Sixty-five of the 94 index patients were asymptomatic, apparently healthy parturient Egyptian women, who were detected to be anti-hepatitis C virus positive at routine antenatal screening and whose spouses resided in the United Arab Emirates. The serologic status of family members of seropositive index patients was compared with that of 218 family contacts of 65 matched healthy anti-hepatitis C virus-negative parturient Egyptian women (control group). To determine interspousal transmission, hepatitis C virus genotype was determined in 35 of 36 hepatitis C virus-RNA positive index patient-spouse pairs and 22 of 25 nonrelated RNA positive pairs by polymerase chain reaction. Subsequently nucleotide sequencing of the hepatitis C virus genome was done.Results: In comparison with the control group, a significantly greater number of family members of the index patients were anti-hepatitis C virus positive (five of 218 versus 60 of 224; P < .004). Husbands of index patients had the highest prevalence of anti-hepatitis C virus (74%), with longer duration of marriage being an important risk factor. Of the 35 index patient-spouse pairs analyzed, 33 (94%) had the same hepatitis C virus genotype. On nucleotide sequencing, 30 (91%) couples showed 100% homology, and two had a high (>97%) homology. Among nonspouse pairs, six pairs (27%) had the same hepatitis C virus genotype; however, low nucleotide sequence homologies (less than 88%) were noted.Conclusion: These data suggest that interspousal transmission of hepatitis C virus occurs and that this may be an important route of intrafamilial spread of hepatitis C virus infection.     

Prevalence of hepatitis B and C in the maternity department of a Greek district hospital.

OBJECTIVE: To define the prevalence of infection with hepatitis B virus (HBV) and hepatitis C virus (HBC), and the modifications observed during the last 8 years, amongst parturients who gave birth in our department. DESIGN: This was a retrospective study. PATIENTS: The 5497 parturients who gave birth in our department between October 1994 and September 2002. RESULTS: On average, 3.87% (213) of the pregnant women tested positive for hepatitis B surface antigen; 2.90% amongst pregnant Greek women and 4.67% amongst pregnant immigrant women. Among all pregnant women, 0.80% (44) tested positive for antibodies against HCV; 0.16% amongst Greek women and 1.33% amongst immigrant women. CONCLUSIONS: HBV prevalence in pregnant women did not seem to be affected by the increase of immigrants in our obstetric population over the course of time. HCV prevalence in the pregnant women, however, did seem to follow the increase of immigrants in our obstetric population. Economic and security issues unfortunately deprive some neonates, born to mothers with HBV infection, from the use of hepatitis B immunoglobulin.     

Risk factors for hepatitis C infection among sexually transmitted disease-infected, inner city obstetric patients

OBJECTIVE: To test the hypothesis that our inner city obstetric patients who have been infected with sexually transmitted diseases (STDs) will have a higher prevalence of hepatitis C virus infection than the general population and to identify specific risk factors and high-risk groups. METHODS: All patients in our prenatal clinic (July 1997-April 1999) who tested positive for one or more STDs were asked to return for hepatitis C antibody testing. Medical charts of all patients who returned for hepatitis C testing were reviewed. RESULTS: A total of 106 patients with STDs were tested for hepatitis C. Positive screening tests for anti-hepatitis C antibody were found in 6.6% (7/106) of the patients (95% CI = 2.7-13.1%). This frequency is significantly higher than the hepatitis C prevalence (1.8%) in the general United States population (p = 0.006). Multiple logistic regression analysis confirmed only older age (p = 0.0 16) and positive HIV status (p = 0.023) to be significant predictors of hepatitis C infection. CONCLUSIONS: Inner city STD-infected obstetric patients are at high risk for hepatitis C infection compared with the general population. Increasing age and HIV-positive status are risk factors which are significantly associated with hepatitis C infection.     

Effects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus. European Paediatric Hepatitis C Virus Network

Objective To investigate the effects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus.
Design Pooled retrospective analysis of prospectively collected data.
Sample Data on hepatitis C virus seropositive mothers and their children identified around delivery were sent from 24 centres of the European Paediatric Hepatitis C Virus Network.
Main outcome measures Hepatitis C virus infection status of children born to hepatitis C virus infected women.
Results A total of 1,474 hepatitis C virus infected women were identified, of whom 503 (35%) were co-infected with HIV. Co-infected women were more than twice as likely to transmit hepatitis C virus to their children than women with hepatitis C virus infection alone. Overall 9.2% (136/1474) of children were hepatitis C virus infected. Among the women with hepatitis C virus infection-only, multivariate analyses did not show a significant effect of mode of delivery and breastfeeding: caesarean section vs vaginal delivery OR=1.17, P =0.66; breastfed versus non-breastfed OR=1.07, P =0.83. However, HIV co-infected women delivered by caesarean section were 60% less likely to have an infected child than those delivered vaginally (OR=0.36,   P =0.01  ) and those who breastfed were about four times more likely to infect their children than those who did not (OR=6.41, P =0.03). HIV infected children were three to four times more likely also to be hepatitis C virus infected than children without HIV infection (crude OR=3.76, 95% CI 1.89–7.41).
Conclusions These results do not support a recommendation of elective caesarean section or avoidance of breastfeeding for women with hepatitis C virus infection only, but the case for HIV infected women undergoing caesarean section delivery and avoiding breastfeeding is strengthened if they are also hepatitis C virus infected.     

妊娠合并乙型肝炎病毒感染孕妇胎儿窘迫发病原因分析

目的：探讨妊娠合并乙型肝炎病毒（HBV）感染孕妇胎儿窘迫的病因、预后及治疗方法。方法：对81例妊娠期HBV表面抗原（HBsAg）、HBVe抗原（HBeAg)、HBV核心抗体（HBcAb)和HBV DNA均阳性,肝功能正常的孕妇及其新生儿（研究组）,85例无肝炎病毒感染,肝功能正常的孕妇及新生儿（对照组）的临床资料、血清学检查结果、胎盘病理检查结果和胎儿预后进行分析,并对研究组中76例婴儿在出生后0、1、6月龄时分别注射酵母菌重组乙型肝炎疫苗10μg,24月龄时检测婴儿HBV表面抗体（HBsAb),以评价母婴HBV阻断效果。结果：（1）研究组胎儿窘迫的发生率为38．3％,对照组为16．5％,两组比较差异有显著性（P＜0．05）。（2）HBV感染胎盘可导致绒毛膜血管病。（3胎儿窘迫者,24月龄时母婴阻断率为78．6％,无胎儿窘迫者母婴HBV阻断率为91．7％,两 者比较,差异有显著性（P＜0．05）。结论：妊娠合并HBV感染,可引起胎盘绒毛膜血管病,致使胎盘功能下降,临床表现为胎儿窘迫、进而导致HBV母婴阻断失败。     

Hepatitis C virus infection in pregnancy

Objective To evaluate the clinical aspects of hepatitis C virus (HCV) liver disease in anti-HCV + ve mothers, both during pregnancy and six months after delivery, and to assess the outcome of pregnancy.
Setting Obstetric department for high risk pregnancies of the University of Padova, Italy.
Participants Seventeen hundred consecutive pregnant women were studied.
Methods Each woman underwent the following: 1. serological screening for hepatitis surface antigen (HBsAg), antibodies to HCV (anti-HCV), antibodies to human immunodeficiency virus type 1 (HIVI) within the first trimester of pregnancy; and 2. clinico-biochemical assessment in order to ascertain previous or active liver disease and risk factors for viral infections.
Results Twenty-nine (1.7%) of the 1700 women were found anti-HCV positive. Eight of them had an associated positivity for HIV infection. HCV-RNA was positive in 64.2% of anti-HCV positive women. Liver function tests (included transaminases) were within the normal range in 27 mothers (both during and six months after delivery). Only 2/29 women had a slight increase in AST/ALT; liver biopsy in these cases was compatible with mild chronic active hepatitis. In all women the outcome of pregnancy was favourable (12/29 anti-HCV positive mothers underwent caesarean delivery for causes independent from HCV infection).
Conclusions A substantial proportion of anti-HCV positive pregnant mothers, even if asymptomatic, have circulating HCV-RNA. The pregnancy does not induce a deterioration of liver disease, and vice versa, HCV infection does not increase the risk of obstetric complications.     

丙型庚型肝炎病毒母婴传播研究

目的 研究丙型、庚型肝炎病毒(HCV、HGV)母婴传播及其影响因素。方法 2000年1月至2002年12月应用第三代ELISA法检测HCV—Ab、HGV—Ab，FQ—PCR方法检测HCV—RNA、HGV—RNA。结果 2052例普通孕妇检测抗HCV阳性22例，阳性率1．07％，其中16例HCVRNA阳性母亲所生16例婴儿有3例HCVRNA阳性，母婴传播率为18．75％。318例普通孕妇检测抗HGV阳性8例，阳性率2．52％，其中4例HGVRNA阳性母亲所生4例婴儿1例HGVRNA阳性。结论 阴道分娩过程感染可能是HCV、HGV母婴传播主要途径，孕妇临产时创旧升高是孕妇母婴传播的危险因素。     

乙肝免疫球蛋白联合乙肝疫苗阻断乙肝感染父婴传播的可行性分析

目的观察乙肝疫苗与乙肝免疫球蛋白联合应用对乙肝感染父婴传播阻断的临床效果。方法2012年1月至2015年5月在湛江中心人民医院分娩的产妇及其配偶68对为研究对象,产妇均未感染乙肝病毒,配偶均为乙肝患者,随机分为观察组和对照组各34对。对照组新生儿注射乙肝疫苗,观察组在对照组基础上加用乙肝免疫球蛋白。观察两组新生儿出生体质量、Apgar评分、丙氨酸氨基转移酶(ALT)水平及乙型肝炎病毒(HBV)检测结果。结果两组新生儿出生体质量、Apgar评分以及ALT水平比较差异无统计学意义(P0.05);观察组新生儿HBsAg阳性率为5.88%(2/34),低于对照组23.53%(8/34),差异有统计学意义(P0.05);观察组新生儿HBsAb阳性率为32.35%(11/34),高于对照组11.76%(4/34),差异有统计学意义(P0.05)。结论新生儿应用乙肝疫苗联合乙肝免疫球蛋白,能够对感染乙肝病毒的父婴传播进行有效阻断,明显降低新生儿感染率。     

Prevalence of asymptomatic hepatitis B infection in pregnant Mexican-American women

Recent reports document high rates of asymptomatic hepatitis B virus infection in pregnant Hispanic women of Caribbean and Latin American origin, frequently in the absence of identifiable risk factors. We hypothesized that the prevalence of asymptomatic hepatitis B virus infection in Mexican-American women was much lower and that most belonged to established risk groups. Three thousand seven hundred eight-nine pregnant women, 77% of whom had Hispanic surnames, were screened for hepatitis B surface antigen upon admission in labor to Medical Center Hospital in San Antonio. Twelve women, six of whom had Hispanic surnames, were found to have asymptomatic hepatitis B infections. The prevalence of asymptomatic infections was 3.2 per 1000 (95% confidence interval 1.6-5.5) in the total population, 2.0 per 1000 (95% confidence interval 0.7-4.5) in those with Hispanic surnames, and 7.0 per 1000 (95% confidence interval 2.5-15.0) in those with non-Hispanic surnames. Risk factors, as defined by the Centers for Disease Control, were found in five (42%) of the positive patients overall and in only one (17%) of the positive patients with an Hispanic surname. We conclude that, although asymptomatic hepatitis B infection is uncommon in these pregnant Mexican-American women, the absence of identifiable risk factors in the majority of those infected suggests that routine screening in this population is justified.     

Effects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus

Objective To investigate the effects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus.Design Pooled retrospective analysis of prospectively collected data.Sample Data on hepatitis C virus seropositive mothers and their children identified around delivery were sent from 24 centres of the European Paediatric Hepatitis C Virus Network.Main outcome measures Hepatitis C virus infection status of children born to hepatitis C virus infected women.Results A total of 1,474 hepatitis C virus infected women were identified, of whom 503 (35%) were co-infected with HIV. Co-infected women were more than twice as likely to transmit hepatitis C virus to their children than women with hepatitis C virus infection alone. Overall 9.2% (136/1474) of children were hepatitis C virus infected. Among the women with hepatitis C virus infection-only, multivariate analyses did not show a significant effect of mode of delivery and breastfeeding: caesarean section vs vaginal delivery OR=1.17, P=0.66; breastfed versus non-breastfed OR=1.07, P=0.83. However, HIV co-infected women delivered by caesarean section were 60% less likely to have an infected child than those delivered vaginally (OR=0.36, P=0.01) and those who breastfed were about four times more likely to infect their children than those who did not (OR=6.41, P=0.03). HIV infected children were three to four times more likely also to be hepatitis C virus infected than children without HIV infection (crude OR=3.76, 95% CI 1.89–7.41).Conclusions These results do not support a recommendation of elective caesarean section or avoidance of breastfeeding for women with hepatitis C virus infection only, but the case for HIV infected women undergoing caesarean section delivery and avoiding breastfeeding is strengthened if they are also hepatitis C virus infected.     

Seroprevalence and clinico-epidemiological correlates of hepatitis C viral antibodies at an antenatal booking clinic of a tertiary hospital in Nigeria

Purpose

This was to determine the sero-prevalence of hepatitis C viral (HCV) antibodies in pregnant women attending the first antenatal clinic and assess the epidemiologic correlates of women anti-HCV positive.

Methods

This was a prospective observational study which used in vitro diagnostic test kits to detect anti-HCV antibodies. Women attending their first antenatal clinic were recruited at the antenatal clinic of Irrua Specialist Teaching Hospital, Edo State, Nigeria. Seropositive women had liver enzymes assessed, and screening for hepatitis B surface antigen and Human Immuno-deficiency Virus (HIV) was done.

Results

Eight out of 205 women were anti-HCV positive. The prevalence of hepatitis C infection was 3.9 %. The mean age of the women was 28.9 ± 2.1 years. Most (50 %) anti-HCV positive women had tertiary level education. Though health workers made up 3.5 % of the participants, they constituted 25 % women with anti-HCV antibody. Awareness of HCV infection had no impact on the rate of infection. Multiple sexual partners (P = 0.71), blood transfusion (0.64) and female circumcision (P = 1.00) were not significant risks of infection. 2 (1 %) women had hepatitis B co-infection and 1 (12.5 %) woman had both HCV antibody and HIV co-infection.

Conclusion

Despite the 3.9 % prevalence, routine screening for hepatitis C virus infection in pregnancy is unjustified. Risk-based screening using locally prevailing risk factors with antenatal monitoring and postpartum treatment of women with hepatitis C antibodies is recommended.     

Breastfeeding initiation: is this influenced by maternal hepatitis B infection?

Objective: To elucidate the effect of hepatitis B virus (HBV) infection on breastfeeding uptake in Chinese mothers in an endemic region. Patients and Methods: A retrospective cohort study on 63 885 consecutive pregnant delivered between January 1997 and June 2008, were extracted from computerized database to examine the relationship between breastfeeding uptake and maternal HBV status, adjusted for demographic factors. Results: A total of 6593 (10.3%) women were hepatitis B surface antigen (HBsAg)-positive, with an annual prevalence of around 10%. In the study period, 29 869 (46.8%) practised breastfeeding, and its prevalence ranged from 35.4 to 54.8% with an increasing trend throughout the years (p < 0.001). HBsAg-positive mothers had a significantly lower rate of breastfeeding (39.2 vs. 47.6% p < 0.001). Multiparas had higher incidence of HBV infection (10.9 vs. 9.8%, p < 0.001) and lower breastfeeding rate (42.2% versus 51.0%, p < 0.001) when compared with primiparas. Among those factors, maternal HBV infection had the strongest negative association with breastfeeding (adjusted odd ratio (aOR) = 0.726, 95% confidence interval (CI): 0.689–0.765). Conclusions: Our results suggested maternal HBV infection was one of the factors for the persistently low breastfeeding rate in Hong Kong over the past decades. To promote breastfeeding, it is necessary to generate definitive data on its safety regarding to mother-to-child transmission (MTCT) of HBV in order to allay the fear and anxiety in HBsAg-positive mothers.