title: Cesarean section reduces perinatal transmission of hepatitis B virus infection from hepatitis B surface antigen-positive women to their infants.
abstract: OBJECTIVE
  Despite appropriate passive and active immunization, perinatal transmission of hepatitis B virus (HBV) still occurs in 5%-10% of infants born to women with high levels of viremia who test positive for the hepatitis B e antigen (HBeAg). We evaluated the effects of cesarean section delivery on perinatal transmission of HBV from women who tested positive for the hepatitis B surface antigen (HBsAg).
  
  
  METHODS
  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 cesarean 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.
  
  
  RESULTS
  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 = .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 = .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.
  
  
  CONCLUSIONS
  There is a significantly lower rate of vertical transmission of HBV infection to infants delivered by ECS, compared with those delivered vaginally or by UCS. Elective cesarean sections for HBeAg-positive mothers with pre-delivery levels of HBV DNA ≥1,000,000 copies/mL could reduce vertical transmission.
authors: Division of Liver Diseases, Department of Medicine, Mount Sinai Medical Center, Mount Sinai School of Medicine, New York, New York.
authors: Calvin Q
authors: CQ
authors: Pan
authors: Huai-Bin
authors: HB
authors: Zou
authors: Yu
authors: Y
authors: Chen
authors: Xiaohui
authors: X
authors: Zhang
authors: Hua
authors: H
authors: Zhang
authors: Jie
authors: J
authors: Li
authors: Zhongping
authors: Z
authors: Duan
mesh_terms: D000328:Adult; D002585:Cesarean Section; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006514:Hepatitis B Surface Antigens
keywords: ALT; CHB; ECS; HBIg; HBV; HBeAg; HBsAg; Immunoprophylaxis; MTCT; Mother-to-Child Transmission; Neonate; Prevention; UCS; ULN; VD; alanine aminotransferase; chronic hepatitis B; elective cesarean section; hepatitis B e antigen; hepatitis B immunoglobulin; hepatitis B virus; hepatitis B surface antigen; mother-to-child transmission; upper limit of normal; urgent cesarean section; vaginal delivery