Yang M, et al. - This meta-analysis is conducted to elucidate the question of whether cesarean section may reduce the risk of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) as compared to vaginal delivery. A cesarean section could decrease the risk of MTCT of HBV in comparison to vaginal delivery in China. However, owing to several limitations of this meta-analysis, future well-designed randomized controlled trials with adequate statistical power, could be a more appropriate next step.

Methods

• A systematic literature search was performed of the PubMed (Medline), Embase, ISI Web of Science, China Biological Medicine Database, China National Knowledge Infrastructure, and VIP Database for Chinese Technical Periodicals databases for articles written in English or Chinese through July 2015.
• For additional papers, the reference lists of relevant articles were also investigated.
• Randomized controlled trials, cohort studies, or case-control studies examining the impact of delivery mode on MTCT of HBV were incorporated.

Results

• In this investigation, they included 28 articles containing 30 datasets.
• The data encompassed 9906 participants.
• The MTCT rate of HBV was 6.76% (670 of 9906) overall, with individual rates of 4.37% (223 of 5105) for mothers who underwent cesarean section and 9.31% (447 of 4801) for those who underwent vaginal delivery.
• The summary relative risk (RR) was 0.51 (95%CI: 0.44-0.60, P < 0.001), indicating a statistically significant decrease in HBV vertical transmission via cesarean section compared with vaginal delivery.
• The heterogeneity among studies was moderate with an I² of 29.3%.
• Publication bias was not detected by the Egger’s and Begg’s tests, and the funnel plot was symmetric.
• In the subgroup analyses, maternal hepatitis B e antigen status and follow-up time did not influence the importance of the results, but hepatitis B immune globulin (HBIG) administration to mother and infant did.