Breastfeeding Safety for Mothers with Hepatitis B

Introduction to Breastfeeding Safety

The European Association for the Study of the Liver (EASL) guidelines state that breastfeeding of infants born to HBsAg-positive mothers should not be discouraged, as current evidence shows it does not increase the risk of HBV transmission to infants when appropriate immunoprophylaxis is provided 1, 2, 3
Breastfeeding should not be discouraged in mothers who are HBsAg-positive, as it does not increase the risk of HBV transmission to infants when proper immunoprophylaxis is given 2

All infants born to HBV-infected mothers should receive Hepatitis B vaccine within 12 hours of birth, and Hepatitis B immune globulin (HBIG) within 12 hours of birth, according to the American Academy of Pediatrics guidelines 4
There is no need to delay initiation of breastfeeding until after the infant is immunized, as the risk of HBV transmission is minimal with proper immunoprophylaxis 4

For mothers on tenofovir treatment for HBV, breastfeeding is considered safe and should not be discouraged, as stated by the EASL guidelines 3, 5
The EASL guidelines specifically state that "breastfeeding of infants born to mothers treated with tenofovir is safe" 3

The benefits of breastfeeding (nutritional, immunological, and developmental) far outweigh the minimal risk of HBV transmission when proper immunoprophylaxis is provided, according to the European Association for the Study of the Liver 6

Encourage HBV-infected mothers to breastfeed their infants, as recommended by the European Association for the Study of the Liver 1, 2
Ensure all infants receive proper immunoprophylaxis (HBV vaccine and HBIG) within 12 hours of birth, as recommended by the American Academy of Pediatrics 4
Monitor for and treat any breast conditions (such as cracked nipples) that could increase exposure to the virus, as recommended by the European Association for the Study of the Liver 2
Continue appropriate antiviral therapy as needed during breastfeeding, particularly tenofovir which is considered safe by the European Association for the Study of the Liver 3