Protecting Breastfeeding during the COVID-19 Pandemic

Ritu Cheema; Elizabeth Partridge; Laura R. Kair; Kara M. Kuhn-Riordon; Angelique I. Silva; Maria E. Bettinelli; Caroline J. Chantry; Mark A. Underwood; Satyan Lakshminrusimha; Dean Blumberg

doi:10.1055/s-0040-1714277

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(03): 260-266
DOI: 10.1055/s-0040-1714277

Review Article

Protecting Breastfeeding during the COVID-19 Pandemic

Authors

Ritu Cheema

¹Division of Pediatric Infectious Disease, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
Elizabeth Partridge

¹Division of Pediatric Infectious Disease, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
Laura R. Kair

²Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
Kara M. Kuhn-Riordon

³Division of Neonatology, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
Angelique I. Silva

⁴Women's Pavilion and Newborn Nursery, UC Davis Medical Center, Sacramento, California
Maria E. Bettinelli

⁵Department of Clinical Science and Community Health, University of Milan, Milan, Italy
Caroline J. Chantry

⁶Division of General Pediatrics, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
Mark A. Underwood

³Division of Neonatology, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
Satyan Lakshminrusimha

³Division of Neonatology, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
Dean Blumberg

¹Division of Pediatric Infectious Disease, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California

Abstract

The severe acute respiratory syndrome–coronavirus-2 (SARS-CoV-2) pandemic has impacted all patient populations including pregnant mothers. There is an incomplete understanding of SARS-CoV-2 pathogenesis and transmission potential at this time and the resultant anxiety has led to variable breastfeeding recommendations for suspected or confirmed mothers with novel coronavirus disease 2019 (COVID-19). Due to the potential concern for transmission of infection from maternal respiratory secretions to the newborn, temporary separation of the maternal-baby dyad, allowing for expressed breast milk to be fed to the infant, was initially recommended but later revised to include breastfeeding by the American Academy of Pediatrics in contrast to international societies, which recommend direct breastfeeding. This separation can have negative health and emotional implications for both mother and baby. Only two publications have reported SARS-CoV-2 in human breast milk but the role of breast milk as a vehicle of transmission of COVID-19 to the newborns still remains unclear and may indeed be providing protective antibodies against SARS-CoV-2 infection even in infected neonates. Other modes of transmission of infection to neonates from infected mothers or any care providers cannot be overemphasized. Symptomatic mothers on hydroxychloroquine can safely breastfeed and no adverse effects were reported in a baby treated with remdesivir in another drug trial. The excretion of sarilumab in human breast milk is unknown at this time. Hence, given the overall safety of breast milk and both short-term and long-term nutritional, immunological, and developmental advantages of breast milk to newborn, breast milk should not be withheld from baby. The setting of maternal care, severity of maternal infection and availability of resources can impact the decision of breastfeeding, the role of shared decision making on breastfeeding between mother and physician needs to be emphasized. We strongly recommend direct breastfeeding with appropriate hygiene precautions unless the maternal or neonatal health condition warrants separation of this dyad.

Key Points

Breastmilk does not appear to play a significant role in transmission of SARS-CoV-2.
Mother–baby separation has negative health and emotional consequences.
Mothers with suspected or confirmed COVID-19 can directly breastfeed with appropriate precautions.

Keywords

SARS-CoV-2 - COVID-19 - breastfeeding - breast milk - maternal–baby separation

Full Text

References

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