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To evaluate long-term trends in MTCT rates and associated factors within Korea\u2019s national program.Methods: Population-based cohort study using linked data from the Perinatal Hepatitis B Prevention Program (PHBPP) and National Health Insurance Service in Korea. The study included HBsAg-positive mother-infant pairs with post-vaccination serologic results from 2002 to 2021.Results: Among the 154,478 mother-infant pairs, the overall MTCT rate after prophylaxis was 2.3%. Antiviral use lowered MTCT rates (0.9% vs. 2.4%) particularly in HBeAg-positivity (1.0% vs. 5.9%; adjusted odds ratio [aOR] 0.21; 95% confidence interval [CI] 0.14\u20130.32). Lower MTCT rates were observed for cesarean section vs. vaginal delivery (1.9% vs. 2.6%; aOR 0.78; 95% CI 0.73\u20130.84) and breastfeeding vs. formula feeding (1.8% vs. 2.8%; aOR 0.65; 95% CI 0.56\u20130.76). Annual MTCT rates decreased from 3.6% (2002\u20132005) to 1.3% (2018\u20132021). Antivirals reduced MTCT rates; initiation at 14\u201327 weeks (0.39%), or 28\u201332 weeks (0.44%) vs. \u226533 weeks (1.47%); postpartum continuation (0.55%) vs. antepartum discontinuation (1.44%); use \u226561 days (0.51%) vs. 1\u201360 days (1.67%). Lower MTCT risk was associated with maternal (old age, high income) and infant (female sex, preterm birth) factors.Conclusions: This comprehensive analysis of the PHBPP in Korea demonstrates that the use of antivirals, breastfeeding, and cesarean section, combined with conventional immunoprophylaxis, has significantly reduced MTCT rates. These results are crucial for global HBV elimination and can help to guide HBV MTCT prevention strategies.<\/jats:p>","DOI":"10.3350\/cmh.2025.0214","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T02:50:24Z","timestamp":1750733424000},"page":"1298-1315","update-policy":"https:\/\/doi.org\/10.3350\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Factors associated with hepatitis B mother-to-child transmission in a national prevention 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