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

Abstract

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.

Keywords::

• Breastfeeding
• hepatitis B infection
• maternal age
• mother-to-child transmission
• parity

Acknowledgements

We gratefully acknowledge the tremendous work in entering the data provided by all the midwives of the Department of Obstetrics and Gynaecology. No funding has been provided.

Author contributions

We certify that we have each made a substantial contribution so as to qualify for authorship and that we have approved the contents. S.S.H.S., V.K.T.L., T.T.L. and O.K.C. planned the study. D.S.S. retrieved the data from hospital OBSCIS system, V.K.T.L. and S.S.H.S. managed the data and preformed the statistical analyses. V.K.T.L. and S.S.H.S. interpreted results and wrote the paper with T.T.L. O.K.C., T.K.L., T.Y.L., and D.S.S. preformed the internal review.

Declaration of Interest: The authors declared no conflicts of interest.