Mother-to-child transmission of hepatitis B virus, its associated risk factors, and the adoption of maternal antiviral therapy in eastern China: a retrospective cohort study

Background Hepatitis B virus (HBV) mother-to-child transmission (MTCT) remains a major global public health challenge. While the World Health Organization has set ambitious targets for elimination of MTCT, achieving these goals in high-burden countries like China requires robust, real-world evaluation of preventive strategies. Our study aims to analyze the effectiveness of preventing MTCT of HBV and the associated risk factors. Methods This retrospective cohort study comprised 16,223 pairs of hepatitis B surface antigen-positive mothers and infants from 2021 to 2023 in geographical regions replete with coverage by preventive measures. We calculated MTCT rates of HBV in different maternal-infant groups and analyzed the risk factors associated with MTCT of HBV. Results The mother-infant pairs in our study exhibited a 99.46% compliance rate for hepatitis B immunoglobulin and 98.87% for the birth-dose vaccine. The overall HBV MTCT rate was 0.60% (97/16,223). When hepatitis B viral protein (HBeAg)-positive women received timely antiviral intervention, MTCT rates were reduced to 0.48%. Multivariate analysis confirmed that HBeAg-positive (adjusted odds ratio [aOR], 132.03 [95% confidence interval {CI}, 18.26–954.41]) and HBV DNA viral load ≥ 2 × 105 IU/ml (aOR, 2.05 [95% CI, 1.30–3.22]) were associated with an increased risk for MTCT. Maternal antiviral therapy (aOR, 0.17 [95% CI, 0.10–0.28]) and infants receiving three doses of hepatitis B vaccine (aOR, 0.07 [95% CI, 0.01–0.76]) were found to be the protective factors. Conclusions This study provides important insights into the factors contributing to HBV MTCT. However, gaps remain with respect to adherence to antiviral therapy, the timeliness of the full-three-dose vaccination series in high-risk infants, and the standardization of treatment protocols. Clinical trial number Not applicable.