Breastfeeding Safety for Hepatitis B Positive Mothers
Yes, mothers infected with hepatitis B virus can safely breastfeed their infants when the infant receives proper immunoprophylaxis (hepatitis B vaccine and HBIG within 12 hours of birth), regardless of maternal viral load or antiviral therapy status. 1, 2
Evidence-Based Recommendations
Core Safety Principle
- Breastfeeding should not be discouraged in HBsAg-positive mothers, as current evidence demonstrates it does not increase the risk of HBV transmission to infants when appropriate immunoprophylaxis is provided. 1, 2
- The 2023 EASL guidelines state with 100% consensus that breastfeeding of infants born to HBV-infected mothers is safe and should not be discouraged. 1
- There is no need to delay initiation of breastfeeding until after the infant is immunized—mothers can begin immediately after birth. 2
Required Infant Immunoprophylaxis
- All infants born to HBV-infected mothers must receive both hepatitis B vaccine and HBIG within 12 hours of birth at different injection sites. 3
- For infants ≥2,000 grams, the birth dose counts as the first dose of the vaccine series. 3
- For infants <2,000 grams, the birth dose does NOT count toward the series; these infants require 4 total doses (birth dose plus 3 additional doses starting at age 1 month). 3
Safety with Antiviral Therapy
- Breastfeeding of infants born to mothers treated with tenofovir is safe and should not be discouraged. 1, 2
- The EASL guidelines specifically endorse tenofovir safety during breastfeeding with 100% consensus. 1
- For entecavir, the FDA label states that a decision should be made to discontinue nursing or discontinue entecavir, considering the importance of continued hepatitis B therapy to the mother and the known benefits of breastfeeding. 4
Supporting Research Evidence
- A 2013 study of 546 children found that breastfeeding was not associated with HBV infection in children after adjusting for maternal HBeAg status (HBsAg prevalence: 1.5% breastfed vs. 4.7% formula-fed, P=0.063). 5
- A 2003 study of 230 infants showed no significant differences in immunoprophylaxis failure rates between breastfed and bottle-fed babies (anti-HBs rate at 1 year: 80.9% breastfed vs. 73.2% bottle-fed with vaccine alone). 6
- A 2021 study confirmed that breast-feeding did not increase risks of HBV infection for infants who received active and passive immunization, even in mothers with high viral load. 7
Clinical Monitoring Considerations
- Monitor for and treat any breast conditions (such as cracked or bleeding nipples) that could theoretically increase exposure to maternal blood. 2
- Ensure post-vaccination serologic testing at age 9-12 months for both HBsAg and anti-HBs to confirm protection. 3
Benefits Outweigh Minimal Risk
- The nutritional, immunological, and developmental benefits of breastfeeding far outweigh the minimal risk of HBV transmission when proper immunoprophylaxis is provided. 2
- HBV DNA can be detected in breast milk, but multiple studies confirm this does not translate to increased transmission risk with appropriate infant immunization. 8, 9