Hepatitis B and Pregnancy: An Underestimated Issue

Maureen M. Jonas


Liver International. 2009;29(s1):133-139. 

In This Article

Breastfeeding by Hepatitis B Virus-infected Women

Decades ago, studies from the Far East demonstrated that HBsAg could be detected in breast milk in a large proportion of HBV-infected women.[48,49] Because many infants became infected before the availability of immunization, there was concern about the additional risk that breastfeeding might confer. However, around the same time, Beasley et al.[50] reported 53% HBV infection in breastfed vs 60% in formula-fed infants. More recently, several studies have documented no difference in rates of perinatal infection between breastfed and formula-fed vaccinated infants, which was between 0 and 5% in both groups, although many of the women in these studies were HBeAg negative.[51,52] These data support the recommendation of the American Academy of Pediatrics that HBV infection not be considered a contraindication to breastfeeding of infants who receive the HBIG and HBV vaccine as advised.[53] In addition, it appears that breastfeeding does not interfere with the immune response to the HBV vaccine. In one group of 230 infants, the rate of anti-HBs at 1 year of age was 80.9% in breastfed compared with 73.2% in formula-fed infants who received the HBV vaccine alone, and 90.9 vs 90.3% in those who received the HBV vaccine and HBIG.[54] It may be prudent, however, to counsel against breastfeeding by women receiving antiviral agents, because the safety of these drugs during lactation has not been demonstrated.