Breastfeeding confers immuno-protective factors to the baby and helps build the baby’s own lifelong immune system.
Breastfeeding is now more important than ever as optimal nutrition for the child on the one hand, and on the other hand because of its important role for the human immune system for lifelong health.
- Breastfeeding and the immune system
- What do parents know?
- Covid-19, breastfeeding and the immune protection
- Antiviral properties
- List of immuno-protective factors transmitted to the infant via breastfeeding
- What’s in Breastmilk – Poster
- Changes in Human Milk during prolonged lactation
- Difference between breastfeeding and feeding with human milk
- Breastfeeding and epigenetics
- Risks of artificial feeding
Breastfeeding and the immune system
New relevant document published by IBFAN with 25 scientific references (Carol Bartle et al.)
What do parents know?
Most parents are aware of the overall beneficial impact of breastfeeding on the health of the baby. Their child’s immune system is immature at birth, and few parents know that breastfeeding not only protects the child through the transfer of immunoglobulins and other immunocompetent factors, but that breast milk helps their baby to strengthen and mature his or her immune system.
Breastfeeding not only strengthens the child’s immune system, but breast milk also contributes to the child’s development. Breastfeeding provides the child with many immuno-protective factors: specific (adapted to the mother’s and child’s environment) and non-specific (those present in the basic composition of breast milk from the beginning, such as IgA, cytokines, human oligosaccharides (about 200), tumour-killing proteins, and many others – the list is long (see below).
Moreover, breastfeeding builds and nourishes the child’s microbiota. Breast milk acts on the intestinal flora and mucous membranes, two important protective filters against pathogens and viruses. As researcher Lars A. Hanson wrote as early as 2004: Breastfeeding protects the baby, and in addition, it nourishes him. “Major components of human milk are not primarily for nutrition, but for host defense” (in Immunobiology of Human Milk – How Breastfeeding protects babies, 2004) .
Covid-19, breastfeeding and the immune protection
A number of studies have shown that a breastfeeding mother transfers to her baby immunoglobulins (IgAs) and antibodies that specifically target the coronavirus SARS-CoV-2. Olearo et al (2022) state: “Breast milk antibodies in all groups showed neutralization capacities against an early pandemic SARS-CoV-2 isolate (HH-1) and moreover, also against the Omicron variant, although with lower antibody titer.” Didikoglu et al (2021) state: “The odds of contracting COVID-19 were 12% lower among respondents who were breastfed when they were babies.”
- Olearo F et al. Anti-SARS-CoV-2 antibodies in breast milk during lactation after infection or vaccination: A cohort study. Sept 2022 https://pubmed.ncbi.nlm.nih.gov/36029724/
- Didikoglu A et al. Early life factors and COVID-19 infection in England: A prospective analysis of UK Biobank participants (Feb 2021) https://doi.org/10.1016/j.earlhumdev.2021.105326
- Pace et al COVID-19 and human milk: SARS-CoV-2, antibodies, and neutralizing capacity in Milk produced by women with Covid-19 (2020, Oct 21)https://journals.asm.org/doi/10.1128/mBio.03192-20#
- Tong et al, Mother’s Milk May Inhibit COVID-19 (2020, Sept 29) https://www.medscape.com/viewarticle/938228?nlid=137631_2046&src=WNL_mdplsnews_201002_mscpedit_peds&uac=104320SJ&spon=9&impID=2599391&faf=1 Mother’s milk could help treat or prevent the coronavirus.
- Van Keulen et al, Breastmilk; a source of SARS-CoV-2 specific IgA antibodieshttps://www.medrxiv.org/content/10.1101/2020.08.18.20176743v1 The research so far seems to back this up. Scientists at Amsterdam University say they have found multiple lines of evidence on the presence of a variety of antibodies that are effective against SARS-CoV-2 in the breastmilk of corona-affected women, with no such antibodies present in the controls.
- Groß R, Conzelmann C, Müller JA, Stenger S, Steinhart K, Kirchhoff F, Münch J. 2020. Detection of SARS-CoV-2 in human breastmilk. Lancet 395:1757–1758. https://pubmed.ncbi.nlm.nih.gov/32446324/
- Buonsenso D, Costa S, Sanguinetti M, Cattani P, Posteraro B, Marchetti S, Carducci B, Lanzone A, Tamburrini E, Vento G, Valentini P. 2020. Neonatal late onset infection with severe acute respiratory syndrome coronavirus 2. Am J Perinatol 37:869–872. https://pubmed.ncbi.nlm.nih.gov/32359227/
- Kirtsman M, Diambomba Y, Poutanen SM, Malinowski AK, Vlachodimitropoulou E, Parks WT, Erdman L, Morris SK, Shah PS. 2020. Probable congenital SARS-CoV-2 infection in a neonate born to a woman with active SARS-CoV-2 infection. CMAJ 192:E647–E650. https://pubmed.ncbi.nlm.nih.gov/32409520/
- Tam PCK, Ly KM, Kernich ML, Spurrier N, Lawrence D, Gordon DL, Tucker EC. 2020. Detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in human breast milk of a mildly symptomatic patient with coronavirus disease 2019 (COVID-19). Clin Infect Dis doi: https://academic.oup.com/cid/article/72/1/128/5848850
- Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, Li J, Zhao D, Xu D, Gong Q, Liao J, Yang H, Hou W, Zhang Y. 2020. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 395:809–815. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30360-3/fulltext
- Fan C, Lei D, Fang C, Li C, Wang M, Liu Y, Bao Y, Sun Y, Huang J, Guo Y, Yu Y, Wang S. 2020. Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry? Clin Infect Dis https://pubmed.ncbi.nlm.nih.gov/32182347/
- Lackey KA, Pace RM, Williams JE, Bode L, Donovan SM, Järvinen KM, Seppo AE, Raiten DJ, Meehan CL, McGuire MA, McGuire MK. 2020. SARS‐CoV‐2 and human milk: what is the evidence? Matern Child Nutr 16:e13032. https://pubmed.ncbi.nlm.nih.gov/32472745/
- Dong Y, Chi X, Hai H, Sun L, Zhang M, Xie W-F, Chen W. 2020. Antibodies in the breast milk of a maternal woman with COVID-19. Emerg Microbes Infect 9:1467–1469. https://pubmed.ncbi.nlm.nih.gov/32552365/
- Fox A, Marino J, Amanat F, Krammer F, Hahn-Holbrook J, Zolla-Pazner S, Powell RL. 2020. Robust and specific secretory IgA against SARS-CoV-2 detected in human milk. iScience 23:101735. https://pubmed.ncbi.nlm.nih.gov/33134887/
- Chambers C, Krogstad P, Bertrand K, Contreras D, Tobin NH, Bode L, Aldrovandi G. 2020. Evaluation for SARS-CoV-2 in breast milk from 18 infected women. JAMA 324:1347–1348. https://pubmed.ncbi.nlm.nih.gov/32822495/
Breastfeeding builds and nourishes the child’s microbiota, and breast milk acts on the intestinal flora and mucous membranes, two important protective filters against pathogens and viruses. As researcher Lars A Hanson wrote as early as 2004: breastfeeding not only protects the baby, but also nourishes it: “The main components of human milk are not primarily for feeding, but for defending the baby. (in Immunobiology of Human Milk – How Breastfeeding protects babies, 2004).
During the first two years of life, the thymus gland of the breastfed child is exceptionally large. It is the “organ” that produces T-lymphocytes or “killer” lymphocytes of infected cells and therefore plays an important role in the fight against immune aggression. In the non-breastfed child, the thymus is only half the size.
The protein-lipid complex HAMLET (human alpha-lactalbumin made lethal to tumor cells) has a broad spectrum of activity against cancer cells of different origin. (Ho et al. 2017)
The act of breastfeeding means more than just the nutritious transfer of human milk. It is a dynamic biological process that requires close contact between mother and baby so that the mother produces protective factors via her breast tissue in response to her environment and her own exposure to infectious agents.
- Morniroli D et al. The antiviral properties of human milk: a multitude of defence tools from mother nature. Nutrients 2021; 13: 694. https://www.mdpi.com/2072-6643/13/2/694
- Wedekind SIS, Shenker NS. Antiviral properties of human milk. Microorganisms 2021; 9: 715. https://www.mdpi.com/2076-2607/9/4/715
Breastfeeding confers antibodies against SARS-CoV-2 virus, see the list above.
List of immuno-protective factors transmitted to the infant via breastfeeding
Chondroitin sulphate (-like)
Free secretory component
Gangliosides GM1-3, GD1a, GT1b, GQ1b
Glycolipid Gb3, Gb
Glycoproteins (sialic acid-containing or terminal galactose)
Lactadherin (mucin-associated glycoprotein)
Lactoperoxidase Lewis antigens
Milk cells (macrophages, neutrophils, B & T lymphocytes)
Mucin (muc-1; milk fat globulin membrane)
Nonimmunoglobulin macromolecules (milk fat, proteins)
Oligosaccharides (about 200 human oligosaccharides are known today)
(Tri to penta) phosphorylated beta-casein
Prostaglandins E1, E2, F2 alpha
Secretory IgA (see above, too)
Secretory leukocyte protease inhibitor (antileukocyte protease; SLPI)
Sialyloligosaccharides on sIgA(Fc)
Soluble bacterial pattern recognition receptor CD14
Soluble intracellular adhesion molecule 1 (ICAM-1)
Soluble vascular cell adhesion molecule 1 (VCAM-1)
Xanthine oxidase (with added hypoxanthine)
What’s in Breastmilk – Poster
The list of immunocompetent factors transmitted from mother to child through breastfeeding is not only considerable in itself but reveals part of the way in which breastfeeding functions: it is not a static assembly of ingredients, but a biological liquid resulting from its continuous and dynamic production during breastfeeding and mother-child skin-to-skin contact.
In other words, the fine-tuned adaptation of breast milk is the result of an ongoing dialogue between the mother’s microbial environment and that of her child. Thus, in addition to the many non-specific immunological factors transmitted to the infant, the mother provides targeted anti-infective agents and immunological factors for her child.
Changes in Human Milk during prolonged lactation
The results of a study by Sinkiewicz-Darol E et al (2021) suggest an adaptive role of human milk to the nutritional needs of newborns and older children. This may support the promotion of long-term breastfeeding, including co-breastfeeding. Tandem Breastfeeding: A Descriptive Analysis of the Nutritional Value of Milk When Feeding a Younger and Older Child https://pubmed.ncbi.nlm.nih.gov/33478010/
Human milk after the 2nd year of lactation contains significantly higher concentrations of protein, SIgA, and IgG. High concentration of immunoglobulins and protein during prolonged lactation is an additional argument to support breastfeeding even after introducing solid foods and should be one of the overarching goals in the protection of children’s health. Therefore, it is important to consider when making recommendations that not even the number of feeds per day but breastfeeding, in general, should be continued for as long as possible that the mother and the baby wish to as supplement and support for the maturing immune system of the baby. Czosnykowska-Łukacka MO et al.(2020) https://doi.org/10.3389/fped.2020.00428
Lactoferrin in breastmilk. The concentration of Lf in human milk is lactation-stage related; colostrum contains more than 5 g/L, which then significantly decreases to 2-3 g/L in mature milk. The milk of mothers who are breastfeeding for more than one year is of a standard value, containing macronutrients in a composition similar to that of human milk at later stages. The aim of this study was to evaluate lactoferrin concentration in prolonged lactation from the first to the 48th month postpartum. The mean value of lactoferrin concentration was the lowest in the group of 1-12 months of lactation (3.39 ± 1.43 g/L), significantly increasing in the 13-18 months group (5.55 ± 4.00 g/L; p < 0.006), and remaining at a comparable level in the groups of 19-24 month and over 24 months (5.02 ± 2.97 and 4.90 ± 3.18 g/L, respectively). Czosnykowska-Łukacka MO et al.(2019) https://pubmed.ncbi.nlm.nih.gov/31581741/
Protein content of human milk is negatively associated to volume of milk production, so the decrease in the milk volume predicted an increase in protein content. While the nutritional content of human milk is variable, on average the milk protein concentration during the later stages of lactation is sensitive to the declining output of milk. Studies dating back several decades have shown an increase in the proportion of immunoglobulins, lactoferrin, and serum albumin during weaning or prolonged breastfeeding. Verd S et al. (2018) https://www.mdpi.com/2072-6643/10/8/1124
The aim of another study was to describe longitudinal changes in human milk macronutrient concentrations during the prolonged lactation of healthy mothers from the 1st to the 48th month. For the macronutrient content of milk of mothers breastfeeding for longer than 18 months, fat and protein increased and carbohydrates decreased significantly, compared with milk expressed by women breastfeeding up to 12 months. Moreover, the concentration of fat, protein and carbohydrates in HM over 2 years of lactation from the 24th to the 48th month remained at a stable level. Czosnykowska-Łukacka MO et al.(2018) https://pubmed.ncbi.nlm.nih.gov/30513944/
Difference between breastfeeding and feeding with human milk
There is a significant difference between
- breastfeeding with skin to skin contact and transfer of the mother’s antibodies and the anti-infective agents in the live cells to her child, and
- the feeding with human milk using expressed (and transformed) breastmilk and delivered through feeding apparatus.
That said, breastmilk in any form (raw human milk, pasteurized human milk, individual donor milk or pooled breastmilk…) will always be superior to “formula” or artificial baby milk which is always at risk for contamination: on the production site (check out here) and through preparation (follow WHO Guidelines for the safe preparation, storage and handling of powdered infant formula)
Breastfeeding and epigenetics
Breastfeeding also provides epigenetic information to the child in the form of maternal stem cells, hormones and miRNA messengers which play an important role in metabolism and protection against non-communicable diseases (NCDs), known as “diseases of civilisation” (obesity, diabetes, cancer, hypertension, cardiovascular diseases…). Lancet Breastfeeding Series 2016
In a research study of 2017, Melnik & Schmitz describe it as follows: “There is accumulating evidence that milk functions as a transmitter or relay between the maternal lactation genome and epigenetic regulation of genes of the milk recipient, who under physiological conditions is the newborn infant […] Because human milk protects against diseases of civilization in later life, the World Health Organization recommends exclusive breastfeeding for up to six months with continuation of breastfeeding for at least the first two years.”
- UNICEF 2023 Emerging research: Epigenetics and the microbiome https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/infant-health-research/epigenetics-microbiome-research/
- Pauwels S et al. The Influence of the Duration of Breastfeeding on the Infant’s Metabolic Epigenome (2019)”Our results support the hypothesis that breastfeeding could induce epigenetic changes in infants.” https://pubmed.ncbi.nlm.nih.gov/31234503/
- Moossavi et al. Composition and Variation of the Human Milk Microbiota Are Influenced by Maternal and Early-Life Factors (2019), Cell Host & Microbe 25, 324–335 February 13, 2019 a 2019 Elsevier Inc. https://doi.org/10.1016/j.chom.2019.01.011
- Santiago Rio J, Epigenetics of Breastfeeding: 4 Diseases and Disorders That Breast Milk Could Protect Against (2018) https://www.whatisepigenetics.com/epigenetics-of-breastfeeding-4-diseases-and-disorders-that-breast-milk-could-protect-against/
- Epigenetics and breastfeeding, ICEA https://icea.org/epigenetics-and-breastfeeding/ (2018) with references
- Melnik and Schmitz, Milk’s Role as an Epigenetic Regulator in Health and Disease, 2017 https://www.ncbi.nlm.nih.gov/pubmed/28933365
- Pires Hartwig F et al. Breastfeeding effects on DNA methylation in the offspring: A systematic literature review (2017) https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0173070
- Indrio F et al. Epigenetic Matters: The Link between Early Nutrition, Microbiome, and Long-term Health Development. Front Pediatr 2017, 5: 178 (14 pages) https://www.ncbi.nlm.nih.gov/pubmed/28879172
- Floris I et al., Roles of MicroRNA across Prenatal and Postnatal Periods. (2016) Review, Int J Mol Sci 2016, 17: 1994 (12 pages) https://www.ncbi.nlm.nih.gov/pubmed/27916805
- Laurel Wilson, UNICEF UK Babyfriendly Hospital Talk 2014 https://www.unicef.org.uk/babyfriendly/epigenetics-and-breastfeeding-laurel-wilson/
- Verduci E et al. Epigenetic effects of human breast milk (2014) Nutrients, doi: 10.3390/nu60417
Risks of artificial feeding
This document by Dr Jack Newman lists research items about the negative impact of articifial feeding as of 1998.