Breastfeeding practices among hepatitis b-infected mothers: a prospective cohort study

Mother-to-child transmission (MTCT) remains a primary route of Hepatitis B virus (HBV) infection in China. Despite World Health Organisation (WHO) recommendations supporting the safety of breastfeeding under timely immunoprophylaxis, rates among HBV-infected mothers in China remain low. To investigate breastfeeding practices, maternal perceptions, and factors influencing feeding decisions among HBV-infected mothers whose infants received standard immunoprophylaxis. Between April 2016 and June 2020, 1,308 infants born to HBsAg-positive mothers were screened. After predefined exclusions, 192 mothers and their infants (n = 194) receiving active–passive immunoprophylaxis (hepatitis B immunoglobulin and a three-dose HBV vaccine) were prospectively followed until 20–30 months postpartum. Infant HBV serology (HBsAg and anti-HBs) was assessed at 7–12 and 20–30 months. Breastfeeding practices, maternal perceptions, and associated factors were analysed using SPSS 22.0. Of the screened infants, 194 (14.8%) were included in the final cohort. The overall breastfeeding rate was 81.8%, with 45.8% exclusively breastfed. Physician counselling (56.7%), obstetricians (43.0%), and online media (24.8%) were the main information sources. Fear of transmission was the primary reason for not breastfeeding (60.0%). No infant tested positive for HBsAg. Anti‑HBs positivity was 99.5% at 7–12 months and 94.3% at 20–30 months. Physician counselling (aOR = 3.2, 95% CI: 1.7–5.8) and maternity school attendance (aOR = 2.1, 95% CI: 1.1–3.6) independently predicted breastfeeding initiation. Breastfeeding is safe with infant immunoprophylaxis and maternal antiviral therapy, yet fear remains a key barrier, highlighting the need for enhanced counseling and support.