TY - JOUR
T1 - Caesarean section to prevent transmission of hepatitis B
T2 - A meta-analysis
AU - Chang, Matthew S.
AU - Gavini, Sravanya
AU - Andrade, Priscila C.
AU - McNabb-Baltar, Julia
N1 - Publisher Copyright:
©2014 Pulsus Group Inc. All rights reserved.
PY - 2014/9/1
Y1 - 2014/9/1
N2 - BACKGROUND: Vertical transmission of hepatitis B virus (HBV) occurs in up to 10% to 20% of births. OBJECTIVE: To assess whether Caesarean section, compared with vaginal delivery, prevents HBV transmission. METHODS: A systematic review and meta-analysis was conducted. Two investigators independently searched PubMed, EMBASE and other databases for relevant studies published between 1988 and 2013. A manual search of relevant topics and major conferences for abstracts was also conducted. Randomized trials, cohort and case-control studies assessing the effect of delivery mode on vertical transmission of HBV were included. Studies assessing antiviral therapy and patients with coinfection were excluded. The primary outcome was HBV transmission rates according to delivery method. RESULTS: Of the 430 studies identified, 10 were included. Caesarean section decreased the odds of HBV transmission by 38% compared with vaginal delivery (OR 0.62 [95% CI 0.40 to 0.98]; P=0.04) based on a random-effects model. Significant heterogeneity among studies was found (I2=63%; P=0.003), which was largely explained by variation in hepatitis B immune globulin (HBIG) administration. Meta-regression showed a significant linear association between the percentage of infants receiving HBIG per study and the log OR (P=0.005), with the least benefit observed in studies with 100% HBIG administration. Subgroup analysis of hepatitis B e-antigen-positive women who underwent Caesarean section did not show a significant reduction in vertical transmission. DISCUSSION: Caesarean section may protect against HBV transmission; however, convincing benefit could not be demonstrated due to significant study heterogeneity from variable HBIG administration, highlighting the importance of HBIG in HBV prevention. CONCLUSION: More high-quality studies are needed before any recommendations can be made.
AB - BACKGROUND: Vertical transmission of hepatitis B virus (HBV) occurs in up to 10% to 20% of births. OBJECTIVE: To assess whether Caesarean section, compared with vaginal delivery, prevents HBV transmission. METHODS: A systematic review and meta-analysis was conducted. Two investigators independently searched PubMed, EMBASE and other databases for relevant studies published between 1988 and 2013. A manual search of relevant topics and major conferences for abstracts was also conducted. Randomized trials, cohort and case-control studies assessing the effect of delivery mode on vertical transmission of HBV were included. Studies assessing antiviral therapy and patients with coinfection were excluded. The primary outcome was HBV transmission rates according to delivery method. RESULTS: Of the 430 studies identified, 10 were included. Caesarean section decreased the odds of HBV transmission by 38% compared with vaginal delivery (OR 0.62 [95% CI 0.40 to 0.98]; P=0.04) based on a random-effects model. Significant heterogeneity among studies was found (I2=63%; P=0.003), which was largely explained by variation in hepatitis B immune globulin (HBIG) administration. Meta-regression showed a significant linear association between the percentage of infants receiving HBIG per study and the log OR (P=0.005), with the least benefit observed in studies with 100% HBIG administration. Subgroup analysis of hepatitis B e-antigen-positive women who underwent Caesarean section did not show a significant reduction in vertical transmission. DISCUSSION: Caesarean section may protect against HBV transmission; however, convincing benefit could not be demonstrated due to significant study heterogeneity from variable HBIG administration, highlighting the importance of HBIG in HBV prevention. CONCLUSION: More high-quality studies are needed before any recommendations can be made.
KW - Hepatitis
KW - Hepatitis B immune globulin
KW - Prophylaxis
KW - Vaccination
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U2 - 10.1155/2014/350179
DO - 10.1155/2014/350179
M3 - Review article
C2 - 25229465
AN - SCOPUS:84907912204
SN - 2291-2789
VL - 28
SP - 439
EP - 444
JO - Canadian Journal of Gastroenterology and Hepatology
JF - Canadian Journal of Gastroenterology and Hepatology
IS - 8
ER -