The study aimed to assess whether
caesarean section and nonbreastfeeding can prevent mother-to-child transmission (MTCT) in
HBsAg- and
HBeAg-positive mothers via a cohort study and a meta-analysis. (1) Pregnant women who were positive for
HBsAg and
HBeAg and did not receive
antiviral treatment during pregnancy were recruited from the First Hospital of Jilin University, Maternal and Child Health Care Center of Jiangsu and Henan from August 2009 to June 2015. Infants received active and passive immunity. (2) In addition, a systematic literature search was performed in the PubMed, Embase, Cochrane, China National Knowledge Infrastructure and Wanfang Chinese databases. The retrieval strategy was [("HBV" or "
hepatitis b" or "hepatitis b virus") and ("mother-to-infant transmission" or "vertical transmission")]. Studies were screened, and data were extracted. The fixed-effect model was used to analyse the studies. A total of 852 mothers and 857 newborns were enrolled. At the age of 7 months, 41 infants (4.78%) were positive for
HBsAg. Multivariate analysis showed that mothers with higher HBV
DNA levels (>108 IU/mL; RR = 3.03, 95% CI: 1.41-6.52) were associated with an increased risk of
infection. Although there was no statistical significance,
caesarean section (RR = 0.61) and nonbreastfeeding (RR = 0.88) showed a tendency to reduce the risk of
infection. (2) A total of 5726 studies were identified. Together with our study, 13 were included in the analysis of delivery mode, and 12 were included in the analysis of feeding mode. The risk of
infection in the
caesarean section group was lower than that in the vaginal delivery group (RR = 0.58, 95% CI: 0.46-0.74). In the analysis of feeding mode, the risk in the nonbreastfeeding group was significantly lower (RR = 0.74, 95% CI: 0.56-0.98). In conclusion,
caesarean section and nonbreastfeeding reduced the risk of MTCT in infants of
HBsAg- and
HBeAg-positive mothers who did not receive
antiviral therapy during pregnancy.