Can a breastfeeding mother with hepatitis B (HBV) continue breastfeeding safely?

Breastfeeding is Safe for Mothers with Hepatitis B

Mothers with hepatitis B (HBV) infection should be encouraged to breastfeed their infants as breastfeeding does not increase the risk of mother-to-child transmission when appropriate immunoprophylaxis is provided to the infant. 1

Safety of Breastfeeding with HBV

• Breastfeeding should not be discouraged in mothers who are HBsAg-positive, as current evidence shows it does not increase the risk of HBV transmission to infants 1
• The European Association for the Study of the Liver (EASL) guidelines specifically state that breastfeeding of infants born to HBsAg-positive mothers should not be discouraged 1
• The only exception is when mothers with detectable HBV DNA have cracked nipples and/or the infant has oral ulcers, which may increase exposure to the virus 1

Immunoprophylaxis Requirements

• All infants born to HBV-infected mothers should receive:
  • Hepatitis B vaccine within 12 hours of birth 1
  • Hepatitis B immune globulin (HBIG) within 12 hours of birth 1
• There is no need to delay initiation of breastfeeding until after the infant is immunized 1
• With appropriate immunoprophylaxis, studies show no significant difference in HBV infection rates between breastfed and formula-fed infants 2, 3

Antiviral Therapy and Breastfeeding

• For mothers on tenofovir treatment for HBV:
  • Breastfeeding is considered safe and should not be discouraged 1
  • The EASL guidelines specifically state that "breastfeeding of infants born to mothers treated with tenofovir is safe" 1
• For mothers on other antiviral medications:
  • Consult drug-specific guidelines, as some medications may not be compatible with breastfeeding 4

Scientific Evidence Supporting Breastfeeding

• Research demonstrates that breastfeeding does not increase HBV transmission risk when infants receive proper immunoprophylaxis 2, 3
• A study of 546 children of HBV-infected mothers found no increased risk of HBV infection in breastfed infants compared to formula-fed infants 2
• Another study of 369 infants showed that none of the 101 breastfed infants became HBV-infected after appropriate immunoprophylaxis, compared to 3% of formula-fed infants 3
• Human breastmilk may actually contain protective factors:
  • Recent research identified that lactoferrin in human milk can bind to HBsAg and inhibit HBV infectivity in vitro 5
  • This may explain why breastfeeding doesn't increase transmission risk despite the potential presence of HBV in breastmilk 5

Common Concerns and Misconceptions

• Despite evidence supporting breastfeeding safety, many HBV-infected mothers remain concerned:
  • Studies show that lack of knowledge about medication safety is a key factor in choosing not to breastfeed 6
  • Healthcare providers should provide clear education about the safety of breastfeeding with HBV 6
• The benefits of breastfeeding (nutritional, immunological, and developmental) far outweigh the minimal risk of HBV transmission when proper immunoprophylaxis is provided 1

Key Points for Clinical Practice

• Encourage HBV-infected mothers to breastfeed their infants 1, 2
• Ensure all infants receive proper immunoprophylaxis (HBV vaccine and HBIG) within 12 hours of birth 1
• Provide education about the safety of breastfeeding with HBV to address misconceptions 6
• Monitor for and treat any breast conditions (such as cracked nipples) that could increase exposure to the virus 1
• Continue appropriate antiviral therapy as needed during breastfeeding, particularly tenofovir which is considered safe 1

By following these guidelines, mothers with HBV can safely breastfeed their infants, providing all the benefits of breastmilk while minimizing any risk of viral transmission.