Maternal hepatitis B doesn't preclude breastfeeding

Women with hepatitis B can breastfeed their babies safely if they take precautions, a new meta-analysis from Temple University (Philadelphia, Pennsylvania) suggests.

The study examined data from 10 clinical controlled trials performed in China that compared rates of hepatitis B in the babies of more than 1,300 mothers with the virus, about half of whom breastfed their infants. All infants in both the breastfeeding and nonbreastfeeding groups received hepatitis B immunoglobulin and/or hepatitis B vaccine within 24 hours after birth. By 12 months of age, 31 of the 637 breastfed infants tested positive for hepatitis B compared with 33 of the 706 babies who were not breastfed. No complications or adverse events occurred during breastfeeding.

“Our meta-analysis provides strong evidence that [in women] without cracked or bleeding nipples or lesions, breastfeeding did not contribute to MTCT [mother-to-child transmission] of HBV [hepatitis B virus] after proper immunoprophylaxis in the infants and should be recommended as a valuable source of nutrition to infants,” the authors write. They note that women with hepatitis B who have cracked or bleeding nipples or lesions on their breasts shouldn’t breastfeed because doing so could facilitate transmission of the virus to the baby.

This study helps resolve questions about whether HBV can be transmitted through breast milk although the role of blood, amniotic fluid, and vaginal secretions in transmitting the virus from mother to child during pregnancy and delivery are well known. The authors caution that “to more thoroughly evaluate the role of breasfeeding in HBV MTCT, more randomized controlled trials or clinical controlled trials with detailed breast milk HBV marker testing and larger size are needed for further investigations and more convincing results.”

The study was published online May 2 in the Archives of Pediatrics and Adolescent Medicine.