Last update Nov. 11, 2023

Maternal Hepatitis B Infection

Compatible

Safe product and/or breastfeeding is the best option.

In 1975, before there was universal neonatal immunization against Hepatitis B (HB), vertical transmission frequency (mother to child) of 53% in breastfed infants and 60% in non-breastfed infants was recorded (Beasley 1975), suggesting that breastfeeding did not play an important role in the vertical transmission of HB.

In 369 children of mothers with chronic HB who were vaccinated at birth, there was no case of HB transmission among the 101 who were breastfed and there were 9 cases (3%) of transmission among the 268 fed artificial formula. (Hill 2002)

Although the surface antigen of the hepatitis B virus (HBsAg) is detected in breastmilk, there is no difference in the frequency of transmission from mothers with HBsAg to their breastfed children compared to those who do not breastfeed. (Red Book 2021-24, Zhou 2021)

There is widespread agreement among medical associations and expert consensus that maternal hepatitis B is not transmitted to the infant through breastmilk and therefore does not contraindicate breastfeeding. (Red Book 2021-24, Zhou 2021, Mammas 2017, Fouquet 2016, Visvanathan 2016, Dionne 2016, Sogni 2015, Dunkelberg 2014, NIHCE-UK 2013, SFP 2013, Bzowej 2012, Borgia 2012, CDC 2010, Bzowej 2010, Fiore 2010, Larke 1977)

Prior to neonatal vaccination, vertical transmission through breastfeeding was never proven (Castillo 2017) and neither was it after adequate neonatal immunoprophylaxis with the administration of anti-HB vaccine and HB-immunoglobulin to the newborn of an HBsAg+ mother (Xiao 2017, Yi 2016, SMFM 2016, García 2015, Lamberth 2015, Zhang 2014 y 2014, Geeta 2013, Tran 2012, Shi 2011, Pol 2011, Zheng 2011, Sookoian 2006, Pronczuk 2002, CDC 1990, de Martino 1985), even in mothers with high infectivity. (Kumar 2012, Zheng 2011)

Several antiviral drugs used to treat hepatitis B do not contraindicate breastfeeding (Wong 2018, Chamroonkul 2017, Marcellin 2016, NIHCE-UK 2013, Pandhi 2104, Hirnschall 2013, Pol 2011), although some authors recommend stopping treatment while breastfeeding. (SMFM2016, Lamberth 2015, Bzowej 2012, Kumar 2012)

It is recommended to talk in each case with the mother due to the ethical and legal problem that is the frequent contraindication of breastfeeding in the technical data sheets of medicines. (Rosenthal 2015)

The acceptance among professionals of the compatibility of Hepatitis B and its antiviral treatment with breastfeeding has been gradually gaining ground over recent years. (Ahn 2010)

Despite this overwhelming consensus in favor of compatibility, which is also supported by the WHO (Pronczuk 2002) even in cases of non-vaccination (Indian Ped 1997), some countries, such as China, have very low breastfeeding rates among HBsAg+ mothers. (Qiu 2010)


See below the information of these related products:

  • Adefovir Dipivoxil (Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.)
  • Entecavir (Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.)
  • Hepatitis B Vaccines (Safe product and/or breastfeeding is the best option.)
  • Hepatitis B immunoglobulin (Safe product and/or breastfeeding is the best option.)
  • Interferon Alfa (IFN-α) (Safe product and/or breastfeeding is the best option.)
  • Lamivudine (3TC) (Safe product and/or breastfeeding is the best option.)
  • Peginterferon alfa (Safe product and/or breastfeeding is the best option.)
  • Tenofovir (TAF / TDF) (Safe product and/or breastfeeding is the best option.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.
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References

  1. (Red Book). AAP. Kimberlin DW, Barnett ED, , Lynfield R, Sawyer MH eds. Red Book: 2021-2024. Report of the Committee on Infectious Diseases. 32th ed. Elk Grove Village, - 2021
  2. Van de Perre P, Molès JP, Nagot N, Tuaillon E, Ceccaldi PE, Goga A, Prendergast AJ, Rollins N. Revisiting Koch's postulate to determine the plausibility of viral transmission by human milk. Pediatr Allergy Immunol. 2021 Jul;32(5):835-842. Abstract Full text (link to original source)
  3. Zhou M, Li L, Han L, Sun F, Yi N. Breast-Feeding is Not a Risk Factor of Mother-to-Child Transmission of Hepatitis B Virus. Int J Gen Med. 2021 May 11;14:1819-1827. Abstract Full text (link to original source)
  4. Wong GL, Seto WK, Wong VW, Yuen MF, Chan HL. Review article: long-term safety of oral anti-viral treatment for chronic hepatitis B. Aliment Pharmacol Ther. 2018 Abstract
  5. Mammas IN, Spandidos DA. The innovation of the subspecialty of Paediatric Virology: An interview with Research Professor of Molecular Virology Anna Kramvis. Exp Ther Med. 2017 Abstract Full text (link to original source) Full text (in our servers)
  6. Xiao F, Lan A, Mo W. Breastfeeding from mothers carrying HBV would not increase the risk of HBV infection in infants after proper immunoprophylaxis. Minerva Pediatr. 2017 Abstract
  7. Chamroonkul N, Piratvisuth T. Hepatitis B During Pregnancy in Endemic Areas: Screening, Treatment, and Prevention of Mother-to-Child Transmission. Paediatr Drugs. 2017 Abstract
  8. Castillo E, Murphy K, van Schalkwyk J. No. 342-Hepatitis B and Pregnancy. J Obstet Gynaecol Can. 2017 Abstract Full text (link to original source)
  9. Castillo E, Murphy K, van Schalkwyk J. N° 342-L'hépatite B et la grossesse. J Obstet Gynaecol Can. 2017 Abstract Full text (link to original source)
  10. Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MM, Murad MH; American Association for the Study of Liver Diseases.. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016 Jan;63(1):261-83. Abstract Full text (link to original source)
  11. Marcellin P, Zoulim F, Hézode C, Causse X, Roche B, Truchi R, Pauwels A, Ouzan D, Dumortier J, Pageaux GP, Bourlière M, Riachi G, Zarski JP, Cadranel JF, Tilliet V, Stern C, Pétour P, Libert O, Consoli SM, Larrey D. Effectiveness and Safety of Tenofovir Disoproxil Fumarate in Chronic Hepatitis B: A 3-Year, Prospective, Real-World Study in France. Dig Dis Sci. 2016 Abstract Full text (link to original source) Full text (in our servers)
  12. Yi P, Chen R, Huang Y, Zhou RR, Fan XG. Management of mother-to-child transmission of hepatitis B virus: Propositions and challenges. J Clin Virol. 2016 Abstract Full text (link to original source) Full text (in our servers)
  13. Visvanathan K, Dusheiko G, Giles M, Wong ML, Phung N, Walker S, Le S, Lim SG, Gane E, Ngu M, Hardikar W, Cowie B, Bowden S, Strasser S, Levy M, Sasaduesz J. Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow-up: position paper produced by Australian, UK and New Zealand key opinion leaders. Gut. 2016 Feb;65(2):340-50. Abstract
  14. Society for Maternal-Fetal Medicine (SMFM)., Dionne-Odom J, Tita AT, Silverman NS. #38: Hepatitis B in pregnancy screening, treatment, and prevention of vertical transmission. Am J Obstet Gynecol. 2016 Jan;214(1):6-14. Abstract Full text (link to original source) Full text (in our servers)
  15. Lawrence RA, Lawrence RM. Breastfeeding. A guide for the medical profession. Eighth Edition. Philadelphia: Elsevier; 2016
  16. Rosenthal P. Editorial commentary: the conundrum of Lamivudine and tenofovir disoproxil fumarate for hepatitis B: fetus versus infant. Clin Infect Dis. 2015 Abstract Full text (link to original source) Full text (in our servers)
  17. Garcia-Loygorri MC, De Luis D, Torreblanca B, March GA, Bachiller MR, Eiros JM. La leche materna como vehículo de transmisión de virus. [Beast Milk as vehicle of transmission of virus]. Nutr Hosp. 2015 Abstract Full text (link to original source) Full text (in our servers)
  18. Sogni P. [Pregnancy and viral hepatitis B and C]. Presse Med. 2015 Abstract
  19. Ehrhardt S, Xie C, Guo N, Nelson K, Thio CL. Breastfeeding while taking lamivudine or tenofovir disoproxil fumarate: a review of the evidence. Clin Infect Dis. 2015 Abstract Full text (link to original source) Full text (in our servers)
  20. Lamberth JR, Reddy SC, Pan JJ, Dasher KJ. Chronic hepatitis B infection in pregnancy. World J Hepatol. 2015 Abstract
  21. Dunkelberg JC, Berkley EM, Thiel KW, Leslie KK. Hepatitis B and C in pregnancy: a review and recommendations for care. J Perinatol. 2014 Abstract Full text (link to original source) Full text (in our servers)
  22. Pandhi D, Ailawadi P. Initiation of antiretroviral therapy. Indian J Sex Transm Dis. 2014 Abstract Full text (link to original source) Full text (in our servers)
  23. Zhang L, Gui X, Wang B, Ji H, Yisilafu R, Li F, Zhou Y, Zhang L, Zhang H, Liu X. A study of immunoprophylaxis failure and risk factors of hepatitis B virus mother-to-infant transmission. Eur J Pediatr. 2014 Abstract
  24. Zhang L, Gui X, Fan J, Wang B, Ji H, Yisilafu R, Li F, Zhou Y, Tong Y, Kong X, Ye P, Zong L. Breast feeding and immunoprophylaxis efficacy of mother-to-child transmission of hepatitis B virus. J Matern Fetal Neonatal Med. 2014 Abstract
  25. Hirnschall G, Harries AD, Easterbrook PJ, Doherty MC, Ball A. The next generation of the World Health Organization's global antiretroviral guidance. J Int AIDS Soc. 2013 Abstract Full text (link to original source) Full text (in our servers)
  26. Chen X, Chen J, Wen J, Xu C, Zhang S, Zhou YH, Hu Y. Breastfeeding is not a risk factor for mother-to-child transmission of hepatitis B virus. PLoS One. 2013 Abstract
  27. NIHCE (UK). National Clinical Guideline Centre. Hepatitis B (Chronic): Diagnosis and Management of Chronic Hepatitis B in Children, Young People and Adults. London: National Institute for Health and Care Excellence (UK). 2013 Abstract Full text (link to original source) Full text (in our servers)
  28. Geeta MG, Riyaz A. Prevention of mother to child transmission of hepatitis B infection. Indian Pediatr. 2013 Abstract Full text (link to original source) Full text (in our servers)
  29. SFP- Comité de nutrition de la Société française de pédiatrie., Turck D, Vidailhet M, Bocquet A, Bresson JL, Briend A, Chouraqui JP, Darmaun D, Dupont C, Frelut ML, Girardet JP, Goulet O, Hankard R, Rieu D, Simeoni U. [Breastfeeding: health benefits for child and mother]. Arch Pediatr. 2013 Abstract
  30. Borgia G, Carleo MA, Gaeta GB, Gentile I. Hepatitis B in pregnancy. World J Gastroenterol. 2012 Abstract Full text (link to original source) Full text (in our servers)
  31. Bzowej NH. Optimal Management of the Hepatitis B Patient Who Desires Pregnancy or Is Pregnant. Curr Hepat Rep. 2012 Abstract Full text (link to original source) Full text (in our servers)
  32. Kumar M, Singh T, Sinha S. Chronic hepatitis B virus infection and pregnancy. J Clin Exp Hepatol. 2012 Abstract Full text (link to original source) Full text (in our servers)
  33. Tran TT. Breastfeeding by mothers infected with hepatitis B carries no increased risk of transmission to infants who receive proper immunoprophylaxis: a meta-analysis. Evid Based Med. 2012 Abstract
  34. Zheng Y, Lu Y, Ye Q, Xia Y, Zhou Y, Yao Q, Wei S. Should chronic hepatitis B mothers breastfeed? a meta analysis. BMC Public Health. 2011 Abstract Full text (link to original source) Full text (in our servers)
  35. Shi Z, Yang Y, Wang H, Ma L, Schreiber A, Li X, Sun W, Zhao X, Yang X, Zhang L, Lu W, Teng J, An Y. Breastfeeding of newborns by mothers carrying hepatitis B virus: a meta-analysis and systematic review. Arch Pediatr Adolesc Med. 2011 Abstract Full text (link to original source)
  36. Pol S, Corouge M, Fontaine H. Hepatitis B virus infection and pregnancy. Clin Res Hepatol Gastroenterol. 2011 Abstract
  37. Bzowej NH. Hepatitis B Therapy in Pregnancy. Curr Hepat Rep. 2010 Abstract Full text (link to original source) Full text (in our servers)
  38. Qiu L, Binns CW, Zhao Y, Zhang K, Xie X. Hepatitis B and breastfeeding in Hangzhou, Zhejiang Province, People's Republic of China. Breastfeed Med. 2010 Abstract
  39. CDC - Workowski KA, Berman S; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Abstract Full text (link to original source) Full text (in our servers)
  40. Petrova M, Kamburov V. Breastfeeding and chronic HBV infection: clinical and social implications. World J Gastroenterol. 2010 Abstract Full text (link to original source) Full text (in our servers)
  41. Ahn J, Salem SB, Cohen SM. Evaluation and management of hepatitis B in pregnancy: a survey of current practices. Gastroenterol Hepatol (N Y). 2010 Abstract Full text (link to original source) Full text (in our servers)
  42. Fiore S, Savasi V. Treatment of viral hepatitis in pregnancy. Expert Opin Pharmacother. 2009 Abstract
  43. Sookoian S. Liver disease during pregnancy: acute viral hepatitis. Ann Hepatol. 2006 Abstract
  44. Pronczuk J, Akre J, Moy G, Vallenas C. Global perspectives in breast milk contamination: infectious and toxic hazards. Environ Health Perspect. 2002 Abstract Full text (link to original source) Full text (in our servers)
  45. Hill JB, Sheffield JS, Kim MJ, Alexander JM, Sercely B, Wendel GD. Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers. Obstet Gynecol. 2002 Abstract
  46. [No authors listed] Hepatitis B and breastfeeding. Indian Pediatr. 1997 Abstract
  47. CDC-ACIP. Protection Against Viral Hepatitis Recommendations of the Immunization Practices Advisory Committee (ACIP). Recommendations and Reports. 1990 Full text (link to original source) Full text (in our servers)
  48. de Martino M, Appendino C, Resti M, Rossi ME, Muccioli AT, Vierucci A. Should hepatitis B surface antigen positive mothers breast feed? Arch Dis Child. 1985 Abstract Full text (link to original source) Full text (in our servers)
  49. Larke RP, Haworth JC, Read JH. Breast-feeding by mothers positive for HBsAG. Can Med Assoc J. 1977 Abstract Full text (link to original source) Full text (in our servers)
  50. Beasley RP, Stevens CE, Shiao IS, Meng HC. Evidence against breast-feeding as a mechanism for vertical transmission of hepatitis B. Lancet. 1975 Abstract

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