Can Mothers with Hepatitis B Breastfeed? Key Considerations for Newborns

Can a mother with dual-positive hepatitis B breastfeed?

Hello Dr.
Yang,
I am a carrier of hepatitis B and have been regularly checking my liver function every six months.
My liver function tests, which were originally over 300, have now decreased to around 30 to 40.
However, they have increased again due to my pregnancy.
Could this be due to metabolic issues? Additionally, since I am positive for the hepatitis B e-antigen, my condition is more severe than that of the general population.

If my baby receives immunoglobulin after birth, can I breastfeed? The doctor advised against it, but I really hope to breastfeed.
If the newborn contracts hepatitis B, what kind of harm could it cause? I am currently 33 weeks pregnant; should I continue monitoring my condition? I stopped testing after becoming pregnant—could this have any implications?
Thank you for your response.

Judy, 20~29 year old female. Ask Date: 2000/12/04

Dr. Yang Guojun reply Internal Medicine

You have active hepatitis that can lead to cirrhosis, and there are medications available for treatment.
Please seek treatment at our outpatient clinic as soon as possible.
1.
You can breastfeed.
2.
If your child becomes infected, they may become a carrier and develop liver disease like you.
3.
Please schedule a follow-up appointment with a gastroenterologist after your pregnancy is completed.

Reply Date: 2000/12/04

More Info

Breastfeeding for mothers with Hepatitis B is a complex issue that requires careful consideration of both the mother's health and the potential risks to the newborn. Hepatitis B is a viral infection that can be transmitted through blood and bodily fluids, and it poses a risk of vertical transmission from mother to child during childbirth. However, the transmission of the virus through breast milk is considered to be very low.

Key Considerations for Breastfeeding with Hepatitis B
1. Vaccination and Immunoglobulin Administration: The most critical step in preventing Hepatitis B transmission to the newborn is the timely administration of the Hepatitis B vaccine and Hepatitis B immunoglobulin (HBIG) within 12 hours of birth. This combination significantly reduces the risk of the baby contracting the virus, even if the mother is a carrier.

2. Breastfeeding Safety: Current guidelines from health organizations, including the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), indicate that mothers with Hepatitis B can breastfeed their infants. The risk of transmission through breast milk is minimal, especially if the baby has received the appropriate vaccinations. However, it is essential to ensure that the mother does not have cracked or bleeding nipples, as this could increase the risk of transmission if blood is present.

3. Monitoring Maternal Health: For mothers who are Hepatitis B carriers, regular monitoring of liver function and viral load is crucial. Elevated liver enzymes or a high viral load may necessitate treatment and could influence decisions regarding breastfeeding. If the mother's liver function is stable and the viral load is low, breastfeeding is generally considered safe.

4. Potential Risks of Infection: If a newborn does contract Hepatitis B, the consequences can be severe, including the risk of chronic infection, liver disease, and even liver cancer later in life. Therefore, ensuring that the newborn receives the vaccine and HBIG is paramount.

5. Continued Medical Follow-Up: It is essential for pregnant women with Hepatitis B to continue regular medical check-ups throughout their pregnancy and postpartum. Stopping regular monitoring could lead to undetected changes in liver function or viral load, which could impact both the mother's and baby's health.

6. Consulting Healthcare Providers: It is vital for mothers to have open discussions with their healthcare providers about their specific situation. Each case may vary based on the mother's health status, the presence of any complications, and the overall risk factors involved.

Conclusion
In summary, mothers with Hepatitis B can breastfeed, provided that their newborn receives the appropriate vaccinations and immunoglobulin shortly after birth. The risk of transmission through breast milk is low, especially when the mother’s health is monitored and managed appropriately. It is crucial for mothers to maintain regular check-ups and communicate with their healthcare providers to ensure the best outcomes for both themselves and their infants. If there are any concerns about breastfeeding or the health of the newborn, these should be addressed promptly with a medical professional.

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