Background: A meta-analysis (MA) of natural vs. cesarean births in HBV infected mothers was performed to assess which delivery methods could minimize the mother-to-child transmission (MTCT) of Hepatitis B virus (HBV).
Methods: Electrical databases PubMed, Embase and Cochrane Library were searched for the English papers about the HBV MTCT up to 19 August 2019. STATA 11.0 software was used for all analysis. Odds ratio (OR) and 95% confidence interval (CI) were used to present the effect size for MTCT at birth and MTCT more than 6 months. Heterogeneity was evaluated using the chi-squared Q and I2 test to determine the use of random effects model or fixed effects model.
Results: A total of 19 articles involving 11,144 HBV-positive pregnant women (5251 underwent natural delivery and 5893 received a cesarean section) were included in the study. The pooled OR for MTCT at birth was 0.42, 95% CI: 0.23-0.76 based on random effect model (I2 = 69.9%, p = .019). Meanwhile, in fixed effect model (I2 = 0.0%, p = .470), the pooled OR for MTCT more than 6 months was 0.62, 95% CI: 0.48-0.81. The results indicated that HBV infection in cesarean births significantly lower than that of vaginal delivery. Subgroup analysis of MTCT more than 6 months was clearly, and the results indicated that cesarean section significantly reduced the risk of MTCT (OR = 0.62, 95% CI: 0.48-0.81, p < .001).
Conclusions: Cesarean section can reduce the risk of HBV MTCT and should be employed as a preventive measure. Due to the limitations of this study, further multi-center, large-sample randomized controlled trials must be performed to confirm these findings.
Keywords: Hepatitis B virus; cesarean; childbirth; meta-analysis; mother to child transmission.