Breast-Feeding Practices in HBV and HCV Patients

Abstract

Introduction: Chronic hepatitis B (HBV) & C Virus (HCV) infection are important cause of cirrhosis of liver for which effective treatment is available but still significant number of patients require liver transplantation when it reaches end stage liver disease. Breastfeeding is highly recommended for mothers with Hepatitis B (HBV) and Hepatitis C (HCV), provided proper immunoprophylaxis is administered. Breast milk itself does not significantly increase transmission risk, and the nutritional benefits far outweigh the potential for infection. Mothers with high viral loads often receive antiviral medications Tenofovir during the third trimester to reduce the risk of transmission. All infants born to HBsAg-positive mothers must receive the Hepatitis B vaccine and Hepatitis B Immune Globulin (HBIG) within 12-24 hours of birth. With proper vaccination and HBIG, breastfeeding is completely safe and not a contraindication.

Aims and Objectives: To determine hurdles faced and implementation of breast- feeding program in HBV & HCV pregnant patients.

Materials & Methods: It was prospective study conducted at Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, over a period of four years from 1^st June, 2023 to 31^st May, 2026 during which 200 confirmed pregnant patients each of HBV & HCV were enrolled in the study and were enquired about challenges faced regarding breast feeding and following of practice of breast feeding. All these 400 pregnant patients delivered in hospital surroundings. All newborns borne to HBV pregnant patients received mandatory 0.5 ml intravenous hepatitis B immunoglobulin, along with zero dose HBV vaccination, followed by complete source of vaccination. Out of these 200 HBV patients, 60 (30%) received antiviral treatment with tenofovir 300 mg, in view of raised levels of HBV DNA, HbeAg and transaminases, as per scientific guidelines. All 400 HBV and HCV pregnant females were motivated for breast feeding on every follow-up. Hence data pertaining to these total 400 patients was used in final analysis.

Results: Out of the 200 HBV pregnant patients, 196 (98%) breast fed for six months or more, 2 patients (1%) lactation did not occur, and 2 patients (1%) intentionally never breast fed due to pressure of family members due to fear of transmission of HBV infection to new born. Hence, these 4 newborns, out of 200 were given top feed. Out of the 200 HCV pregnant patients, 197 (98.5%) breast fed for six months or more, in 1 patient (0.5%) lactation did not occur, and 2 patients (1%) intentionally never breast fed due to pressure of family members due to fear of transmission of HCV infection to new born. Hence, these 3 newborns, out of 200 were given top feed.

Conclusion: The HBV and HCV patients are already terrified regarding their illness, course & side effects of treatment, familial transmission and social stigma associated with the illness. The pregnant females having HBV and HCV infection are more worried for their newborn, then for themselves. The main worry is transmission to the newborn during pregnancy and after delivery, especially by breast feeding and close contact with mother. The main precipitant are family members, relatives and society at large. Hence, all manoeuvres should be done to break all challenges and myths associated with breastfeeding in HBV and HCV infected mothers.