Dr. Priyanka Samji, Ph.D
COVID-19 and Safe Breastfeeding – Scientific Evidence and Guidelines for Breastfeeding Mothers and Healthcare Providers:
Breastfeeding is one of the crucial stages of a newborn and mother’s life. During this Covid-19 pandemic, scientists came up with few guidelines to have safe breastfeeding for the child.
SARS-CoV-2 specific IgG and IgM antibodies were detected in some of the newborn blood samples (Zeng et al., 2020). IgG, the small size antibody, can passively transfer across the placenta from mother to fetus, however, IgM, due to its large macromolecular structure, cannot be transferred across the placenta and so scientists are predicting, maybe this IgM is transferred via the breast milk. However, there is no direct evidence to suggest that SARS-CoV-2 can be transmitted through breastmilk.
The main risk factor during breastfeeding is the close contact between the infected mother and the child. An infected mother might transmit the virus to the baby through respiratory droplets (Li et al., 2020). Therefore, it is suggested to avoid direct breastfeeding rather than use expressed mother’s milk (Favre et al., 2020).
Initially, in China, some pediatrics supported the use of formula milk for infants born to COVID-19 infected mothers and discouraged the direct breastfeeding due to the possible transmission of the virus from the infected mother to the newborn (Wang et al., 2020). However, discouraging the breastfeeding spoils the mother-infant relationship. Based on the shreds of evidence from SARS‐CoV epidemic in 2002–2003 (Robertson et al., 2004), it can be speculated that specific SARS‐CoV‐2 antibodies might pass from the COVID‐19 mother to the infant via breast milk. If the infection of the mother is severe, in that case, it is recommended to consider expressed mother’s milk as a second choice which might rescue at least the benefits of the nutrition with mother’s milk in the absence of direct breast feeding. This is also recommended by the World Health Organization (WHO), United Nations Children’s Fund, Center for Disease Control and Prevention (CDC), Royal College of Obstetricians and Gynecologists, International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), Italian National Institute of Health and Academy of Breastfeeding Medicine.
Due to limited scientific evidence about the possibility of SARS-CoV-2 transmission through breast milk and the presence of antibodies in the breast milk, it is strongly suggested encouraging breastfeeding by COVID-19 infected mothers but with following the guidelines (Davanzo, 2020; (Davanzo et al., 2020). Mothers should be properly counselled regarding the benefits of breastfeeding. They should practice respiratory hygiene and wear a mask while feeding the baby. They should wash hands before and after touching the baby. If the mother is sick, expressed breast milk should safely be given to the baby. Mayo Clinic recommends, “If you’re pumping breast milk, wash your hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning. If possible, have someone who is well give the baby the expressed breast milk.
Postnatal care and advice to the mother infected with COVID-19 should be as per routine practice. If the woman is isolated from the neonate, she should be offered psychological assessment and support.
According to WHO, “The COVID-19 virus has not been detected in the breast-milk of any mother with confirmed and suspected COVID-19 and there is no evidence so far that the virus is transmitted through breastfeeding.” Further, it is expected that this information and guidance might change in the future due to availability of more information about the COVID‐19 pandemic, it’s perinatal transmission, and clinical characteristics of cases of infants born to SARS‐CoV‐2 infected mothers.
Breastfeeding advice during the COVID-19 outbreak to all mothers with confirmed or suspected COVID-19:
Dr. Roopali Chaudhary, Ph.D
Breast milk provides protection against many illnesses and is the best source of nutrition for most infants.
Can COVID-19 be passed through breastfeeding?
If you have questions and concerns about whether it is safe for mothers with confirmed or suspected COVID-19 to be close to and breastfeed their babies during the pandemic then go through the You Tube link given below.
https://www.bio-services.org/covid-19-breastfeeding-dr-roopali-chaudhary/
Authors:
Dr. Priyanka Samji, Ph.D (Molecular Endocrinology and Reproductive Biology), Indian Institute of Science, Bangalore, India.
Dr. Roopali Chaudhary, Ph.D (Cellular and Molecular Biology), McMaster University, Hamilton, Ontario, Canada.
May 19, 2020
Edited by:
Dr. Abira Ganguly, Ph.D (Scientific editor at Bio-Services). https://www.bio-services.org/dr-abira-ganguly-ph-d/
References:
1. Hui Zeng, Chen Xu, Junli Fan, Yueting Tang, Qiaoling Deng, Wei Zhang, Xinghua Long Antibodies in Infants Born to Mothers With COVID-19 Pneumonia. Published online March 26, 2020. doi:10.1001/jama.2020.48
2. Li F, Feng ZC, Shi Y. Proposal for prevention and control of the 2019 novel coronavirus disease in newborn infants. Arch Dis Child Fetal Neonatal Ed 2020:pii: fetalneonatal-2020-318996.
3. Favre G, Pomar L, Qi X, et al. Guidelines for pregnant women with suspected SARS-CoV-2 infection. Lancet Infect Dis. 2020 March 3rd. doi: 10.1016/S1473-3099(20)30157-2
4. Wang, L., Shi, Y., Xiao, T., Fu, J,. Feng, X., Mu, D., Zhou, W. Working Committee on Perinatal and Neonatal Management for the Prevention and Control of the 2019 Novel Coronavirus Infection. Chinese expert consensus on the perinatal and neonatal management for the prevention and control of the 2019 novel coronavirus infection (First Edition). Annales of Translational Medicine 2020: 8(3):47. https://doi.org/10.21037/atm.2020.02.20
5. Corwin A. Robertson, Sara A. Lowther and Eddy Bresnitz SARS and Pregnancy: A Case Report Emerg Infect Dis. 2004 Feb; 10(2): 345–348. doi: 10.3201/eid1002.030736
6. Davanzo R Breast feeding at the time of COVID-19: do not forget expressed mother’s milk, please. Arch Dis Child Fetal Neonatal Ed.2020 Apr 6. pii: fetalneonatal-2020-319149. doi: 10.1136/archdischild-2020-31914
7. Davanzo R, Moro G, Sandri F, Agosti M, Moretti C, Mosca F Breastfeeding and coronavirus disease-2019: Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Matern Child Nutr. 2020 Apr 3:e13010. doi: 10.1111/mcn.13010