Even as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus continues to cause thousands of cases every day, with many deaths, life continues to move on regardless. Births occur as usual, and in many countries, mothers prefer to breastfeed their babies, at least for the first few months of life.
However, is it safe for a mother who had COVID-19 towards the end of her pregnancy, and during childbirth, to breastfeed her baby? Is it possible that she is passing on the infection to her child? A new Chinese study published on the online preprint server medRxiv* in May 2020 reports that this fear is unfounded, and new mothers can safely feed their children breastmilk.
Earlier studies have shown no direct proof that the virus is transmitted from the mother to the infant during pregnancy or birth. However, the question of vertical transmission via breastfeeding was unresolved. This is an essential issue since intimate skin-to-skin contact, physical closeness and sharing of the airstream between the mother and the baby, and the possibility of coughing and sneezing into each other’s vicinity, is very high.
The existing guidelines for breastfeeding in this subgroup of women are not yet well established. At present, they suggest that babies be kept away from mothers and not breastfed until there is no viral shedding, to prevent possible infection of the baby via this route. On the other hand, the Royal College of Obstetricians & Gynaecologists (RCOG) does recommend breastfeeding in this situation, believing the risk-benefit ratio to be too small to advise avoiding breastfeeding.
Some of the obvious benefits of breastfeeding include the suitability of breast milk composition for infant needs such as growth and development, the passage of protective antibodies from the mother to the baby against common infectious agents, and the nutritional adequacy of this natural food. Moreover, many studies have looked at the risk of mother-to-child transmission and concluded that it is very low or negligible even with hepatitis B virus or HIV.
The current study is aimed at helping resolve this debate. Though it is admittedly small, it involves 23 pregnant and newly delivered mothers with COVID-19 who were followed up from the time of diagnosis to one month after birth. Of these, 14 had PCR-confirmed infection, while 9 had suspected COVID-19 based on their chest CT findings but a negative test result.
The researchers looked for the presence of the virus, SARS-CoV-2, in breast milk, maternal blood, and infant blood after birth.
The presence of antibodies, both IgM and IgG, indicating acute phase and past history of infection, respectively, was also assessed in the same set of specimens. The type of feeding was also recorded, whether breast milk or formula feeds.
Most of the pregnancies were terminated by Cesarean section, with a mean birth weight of about 3 kg and no neonatal asphyxia. All babies had a throat swab test for SARS-CoV-2 detection.
The study shows that no babies showed evidence of the presence of the virus. All the babies were in good health until the end of follow-up. Six of the babies were being fed entirely or partly with breast milk.
Breast milk samples were uniformly negative for the virus as well. IgM to SARS-CoV-2 was present in breast milk but was due to its passage from the mother’s blood. This could protect the infant from this virus strain.
IgG was not found in any breast milk sample. However, in several cases, the milk samples were collected after the throat swab became negative for the virus, and in two cases diagnosed postpartum, on the 12th and 15th day from delivery.
Neonatal blood was tested for antibodies to SARS-CoV-2 after a month from birth, in 8 of the babies. All were negative.
Earlier coronavirus outbreaks, namely, the SARS and MERS epidemics, showed that pregnant women were at very high risk for mechanical ventilation and ICU care, and death, during this period, with many cases of multi-organ dysfunction as well as neonatal asphyxia being reported. In contrast, COVID-19 outcomes in pregnancy are favorable, without any maternal or fetal deaths being reported, and the stable progress of pregnancy and puerperium in all cases.
Simple measures like wearing a mask properly, washing one’s hands frequently, and turning the head away from the baby when coughing or sneezing during a feed. Expressed breast milk is another alternative. Antivirals may be given as required if the mother is suspected or confirmed to have the infection but wants to breastfeed.
The study concludes, “Findings from this small number of cases suggest that there is currently no evidence for mother-to-child transmission via breastfeeding in women with COVID-19 in the third trimester and puerperium.” However, more research should be carried out to prove that breastfeeding is safe in this population.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.