{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:35:51Z","timestamp":1782970551719,"version":"3.54.5"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"\n Purpose<\/jats:title>\n To explore the factors contributing to breastfeeding failure among mothers infected with the hepatitis B virus (HBV) from the perspectives of stress and decision-making, with a specific focus on psychological factors.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A qualitative, descriptive design using semi-structured interviews.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Purposive sampling recruited 21 HBV-positive mothers at Shanghai First Maternity and Infant Hospital between February 1 and May 10, 2023. Data collection continued until thematic saturation. Interviews were audio-recorded, transcribed verbatim, and analyzed via thematic analysis with NVivo 12.6.1 software. Measures to ensure data trustworthiness included member checking, peer debriefing, and investigator triangulation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Three participants withdrew before completion, resulting in 18 final interviews. Mean maternal age was 32.28\u202f\u00b1\u202f4.80\u202fyears; 56% delivered by cesarean section, 67% had female infants. Five mothers were HBsAg-positive only, 13 were both HBsAg- and HBeAg-positive. Four mothers used partial breastfeeding, 13 formula feeding, only one practiced exclusive breastfeeding during hospitalization. Four core themes emerged: \u201cInadequate Knowledge of HBV Transmission Routes, Breastfeeding Benefits, and Resultant Decision-Making Uncertainty\u201d (Cognitive Knowledge Deficits); Persistent Fear of Getting An Infant Infected With HBV, Despite Reassurance and Medical Information From Healthcare Providers (Emotional\/psychological concerns); Practical Technical Difficulties in Breastfeeding, and Lactation-related Complications Compromising Feeding Sustainability (Persistent physiological and technical breastfeeding barriers); Family Members\u2019 Opposition to Breastfeeding that Increases Above the Maternal Feeding Intent and Directly Affects Infant Feeding Outcome (Family opposition and maternal intent deviate from infant feeding outcomes).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Breastfeeding among HBV-positive mothers is influenced by multiple factors including knowledge gaps, psychological concerns, physical challenges, and social pressures. Interventions should focus on improving knowledge, reducing psychological stress, enhancing technical support and engaging family members to promote breastfeeding continuation.<\/jats:p>\n <\/jats:sec>\n \n Impact<\/jats:title>\n The study identifies HBV-positive mothers\u2019 breastfeeding barriers. It offers evidence for healthcare institutions\u2019 targeted strategies and helps improve breastfeeding rates and infant health.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fnut.2026.1839059","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:23:39Z","timestamp":1782966219000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors influencing breastfeeding failure in mothers with hepatitis B infection: a qualitative study"],"prefix":"10.3389","volume":"13","author":[{"given":"Xin","family":"Jiang","sequence":"first","affiliation":[{"name":"Nursing Department, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Jiang","sequence":"additional","affiliation":[{"name":"Nursing Department, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Huang","sequence":"additional","affiliation":[{"name":"Nursing Department, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1097\/ID9.0000000000000128","article-title":"Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection (text extract): executive summary","volume":"4","year":"2024","journal-title":"Infect Dis Immun"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1038\/s41575-023-00760-9","article-title":"Global burden of hepatitis B virus: current status, missed opportunities and a call for action","volume":"20","author":"Hsu","year":"2023","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1016\/S2468-1253(23)00197-8","article-title":"Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study","volume":"8","year":"2026","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1546","DOI":"10.1016\/S0140-6736(15)61412-X","article-title":"Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013","volume":"386","author":"Schweitzer","year":"2015","journal-title":"Lancet"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1016\/S1473-3099(15)00158-9","article-title":"Global elimination of mother-to-child transmission of hepatitis B: revisiting the current strategy","volume":"15","author":"Thio","year":"2015","journal-title":"Lancet Infect Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"S7","DOI":"10.1093\/jpids\/piu064","article-title":"Prevention of perinatal hepatitis B virus transmission","volume":"3","author":"Nelson","year":"2014","journal-title":"J Pediatric Infect Dis Soc"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/S1473-3099(20)30593-4","article-title":"Accuracy of HBeAg to identify pregnant women at risk of transmitting hepatitis B virus to their neonates: a systematic review and meta-analysis","volume":"21","author":"Boucheron","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1561","DOI":"10.3390\/nu14081561","article-title":"Inhibition of in vitro infection of hepatitis B virus by human breastmilk","volume":"14","author":"Luo","year":"2022","journal-title":"Nutrients"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1186\/1471-2458-11-502","article-title":"Should chronic hepatitis B mothers breastfeed? A meta analysis","volume":"11","author":"Zheng","year":"2011","journal-title":"BMC Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1819","DOI":"10.2147\/IJGM.S289804","article-title":"Breast-feeding is not a risk factor of mother-to-child transmission of hepatitis B virus","volume":"14","author":"Zhou","year":"2021","journal-title":"Int J Gen Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"101542","DOI":"10.1016\/j.clinre.2020.08.017","article-title":"Influence of different delivery modes and HBV DNA titers on mother-to-child transmission of hepatitis B","volume":"45","author":"Deng","year":"2021","journal-title":"Clin Res Hepatol Gastroenterol"},{"key":"ref12","first-page":"154","article-title":"A review of antiviral use for the treatment of chronic hepatitis B virus infection in pregnant women","volume":"13","author":"Jaffe","year":"2017","journal-title":"Gastroenterol Hepatol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"7370","DOI":"10.26355\/eurrev_202308_33309","article-title":"The transmission of hepatitis B virus (HBV) infection from mother-to-infant (MTI) and the susceptibility of offspring to hepatitis B under intrauterine exposure to HBsAg","volume":"27","author":"Zhang","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1186\/s12884-024-06735-1","article-title":"Breastfeeding experiences of women with perinatal mental health problems: a systematic review and thematic synthesis","volume":"24","author":"Billings","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"29","DOI":"10.12688\/wellcomeopenres.14273.2","article-title":"A blind spot? Confronting the stigma of hepatitis B virus (HBV) infection - a systematic review","volume":"3","author":"Mokaya","year":"2018","journal-title":"Wellcome Open Res"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1177\/0890334417707957","article-title":"Interventions to improve breastfeeding self-efficacy and resultant breastfeeding rates: a systematic review and Meta-analysis","volume":"33","author":"Brockway","year":"2017","journal-title":"J Hum Lact"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.3350\/cmh.2025.0214","article-title":"Factors associated with hepatitis B mother-to-child transmission in a national prevention program","volume":"31","author":"Ki","year":"2025","journal-title":"Clin Mol Hepatol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e17822","DOI":"10.1097\/MD.0000000000017822","article-title":"Individualized intervention to improve rates of exclusive breastfeeding: a randomised controlled trial","volume":"98","author":"Huang","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1186\/s12884-026-08814-x","article-title":"Breastfeeding practices among hepatitis b-infected mothers: a prospective cohort study","volume":"26","author":"L\u00fc","year":"2026","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1111\/j.1742-1241.2003.tb10435.x","article-title":"Breastfeeding does not pose any additional risk of immunoprophylaxis failure on infants of HBV carrier mothers","volume":"57","author":"Wang","year":"2003","journal-title":"Int J Clin Pract"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e0315269","DOI":"10.1371\/journal.pone.0315269","article-title":"A qualitative study on the perspectives of prenatal breastfeeding educational classes in Ireland: implications for maternal breastfeeding decisions","volume":"19","author":"Kehinde","year":"2024","journal-title":"PLoS One"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1823","DOI":"10.1016\/j.ijnurstu.2008.04.008","article-title":"Research methodologies to investigate the experience of breastfeeding: a discussion paper","volume":"45","author":"Spencer","year":"2008","journal-title":"Int J Nurs Stud"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e000057","DOI":"10.1136\/fmch-2018-000057","article-title":"Semistructured interviewing in primary care research: a balance of relationship and rigour","volume":"7","author":"DeJonckheere","year":"2019","journal-title":"Fam Med Community Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"668","DOI":"10.3761\/j.issn.0254-1769.2019.05.006","article-title":"Investigation on the current status of breastfeeding in puerpera with hepatitis B","volume":"54","author":"Yue","year":"2019","journal-title":"Chin J Nurs"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1186\/s12875-023-02157-8","article-title":"Barriers to hepatitis B virus screening of pregnant women in primary healthcare centers in Nigeria: health workers' perspective","volume":"24","author":"Olakunde","year":"2023","journal-title":"BMC Prim Care"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1007\/s12072-021-10240-4","article-title":"Health-related quality of life improves after entecavir treatment in patients with compensated HBV cirrhosis","volume":"15","author":"Wu","year":"2021","journal-title":"Hepatol Int"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.3390\/jpm13121689","article-title":"Bidirectional relationship between HIV\/HBV infection and comorbid depression and\/or anxiety: a systematic review on shared biological mechanisms","volume":"13","author":"Fabrazzo","year":"2023","journal-title":"J Pers Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"200271","DOI":"10.1016\/j.tvr.2023.200271","article-title":"Construction of a diagnostic model for hepatitis B-related hepatocellular carcinoma using machine learning and artificial neural networks and revealing the correlation by immunoassay","volume":"16","author":"Zhang","year":"2023","journal-title":"Tumour Virus Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1186\/s12884-019-2421-5","article-title":"Management of hepatitis B infected pregnant women: a cross-sectional study of obstetricians","volume":"19","author":"Chao","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1111\/jvh.13952","article-title":"Peer support for people living with hepatitis B virus-a foundation for treatment expansion","volume":"31","author":"Downs","year":"2024","journal-title":"J Viral Hepat"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1186\/s12889-021-12025-8","article-title":"Exclusive breastfeeding in rural Western China: does father's co-residence matter?","volume":"21","author":"Nie","year":"2021","journal-title":"BMC Public Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1159\/000542999","article-title":"Comprehensive interventions in HBV care: nursing-sensitive approach","volume":"90","author":"Zhang","year":"2025","journal-title":"Gynecol Obstet Investig"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1839059\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:23:41Z","timestamp":1782966221000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1839059\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":32,"alternative-id":["10.3389\/fnut.2026.1839059"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1839059","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]},"article-number":"1839059"}}