22/04/2024
Breastfeeding and protection against SARS-CoV-2La lactancia materna en el contexto COVID-19 es posible y debe fomentarse para proporcionar factores de inmunidad al lactante virus
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.”
Breastfeeding your baby offers an advantage against the SARS-CoV-2 virus, even later in life.
- 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/
Measures and Guidelines 2021
Swiss Ministery of Health considers that vaccination Covid-19 is possible for pregnant and breastfeeding women as of May 28, 2021.
Johns Hopkins monthly update – Specific repository (bibliography) only on COVID-19, Breastfeeding, Infant Feeding, and Breast Milk with regular updates (last update : 2021 June 10). PDF can be downloaded here Johns Hopkins – Center for Humanitarian Health.
Breastfeeding and Covid-19 vaccine – https://pubmed.ncbi.nlm.nih.gov/33419782/ Rimmer et al, BMJ study from January 8, 2021. Covid-19: Breastfeeding women can have vaccine after guidance turnaround
GIFA document (June 29, 2020) research of SARS-CoV-2 virus in breast-milk
Information in English
No transmission by breastmilk
Transmission of active COVID-19 (virus that can cause infection) through breast milk and breastfeeding has not been detected to date. There is no reason to avoid or stop breastfeeding.
Recommendations on May 28, 2020 are to initiate or maintain breastfeeding and, if mother-baby separation is necessary, to give pumped breast milk.
At present, the data do not show any risk of transmission of the active SARS-CoV-2 virus via breast milk. Maternal infection with Covid-19 is not a contraindication to breast-feeding. Breastfeeding is possible and encouraged in view of its generally beneficial effects on the health of both mother and child, according to the recommendations of numerous international and national experts and learned societies (WHO, UNICEF, CDC, SSP, OFSP/Swissnoso/PIGS, SGGG).
Difference between SARS-CoV-2 and COVID-19
1) SARS-CoV-2 = name of the virus. The virus was named by the International Committee on Taxonomy of Viruses (ICTV) as “Severe Acute Respiratory Syndrome Coronavirus 2,” abbreviated as SARS-CoV-2.
2) COVID-19 = name of the disease. The SARS-CoV-2 virus causes “Coronavirus Disease 2019,” which was named by the World Health Organization and abbreviated as COVID-19.
WHO Film on Breastfeeding and Covid-19
How to breastfeed if mother is Covid-19 positive?
- WHO Q & A on COVID-19, pregnancy, childbirth and breastfeeding
- La Leche League International (en français et 10 autres langues) https://www.llli.org/coronavirus10/
- Royal College of Obstetricians & Gynaecologists (UK, April 3, 2020) Information for pregnant women and their families
WHO Frequently asked Questions: Breastfeeding and Covid-19 (April 28, 2020) 5 pages for Health care workers
May 8, 2020 : Salvatori et al on two mother-baby dyads show no transmission through breastfeeding. “We confirm that SARS-CoV-2 seems to spare breast milk and horizontal transmission from mother to neonate could occur through respiratory droplets rather than through milk.” May 8, 2020 Managing COVID-19-Positive Maternal–Infant Dyads: An Italian Experience https://doi.org/10.1089/bfm.2020.0095
Baby Milk Action Network – List on Covid-19 and Breastfeeding News http://www.babymilkaction.org/archives/24184
WHO Position paper (8 avril 2020) “Breastmilk is the best source of nutrition for infants, including infants whose mothers have confirmed or suspected coronavirus infection. As long as an infected mother takes appropriate precautions—outlined in this paper—she can breastfeed her baby. Breastmilk contains antibodies and other immunological benefits that can help protect against respiratory diseases. A growing body of evidence supports the importance of breastfeeding for a child’s growth, development, and health, as well as for helping them avoid obesity and noncommunicable diseases later in life.”
UNICEF (IYCF 30 mars 2020) Infant & Young Child Feeding in the context of Covid-19 (9 pages)
WHO Interim guidance (13 mars 2020) (21 pages) – see pages 13-14 https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
Royal College of Obstetricians & Gynaecologists (UK, April 9, 2020) https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/
CHUV Lausanne At present, the data, although limited, do not show any risk of transmission of the active SARS- CoV-2/Covid-19 virus via breast milk. Maternal infection with Covid-19 is not a contraindication to breast-feeding, which is possible and encouraged in view of its generally beneficial effects on the health of both mother and child, according to the recommendations of numerous international and national experts and learned societies (WHO, UNICEF, CDC, SSP, OFSP/Swissnoso/PIGS, SGGG). General information : https://www.chuv.ch/fr/dfme/dfme-home/femme-mere/grossesse-accouchement/suivi-de-grossesse-et-covid-19/
Information in other languages
Informations en français
voir ici Covid-19 et allaitement
OMS Lignes directrices provisoires (13 mars 2020) (21 pages) see pages 13-14 https://www.who.int/fr/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
SSGO Société Suisse de Gynécologie et d’Obstétrique (14 avril 2020) https://www.sggg.ch/fr/nouvelles/detail/1/infection-a-coronavirus-covid-19-et-grossesse/
Informaciones en español
Grupo de Trabajo Internacional Voluntario de Expertos en Lactancia Materna https://paso10.org/
IBFAN Latin America has a Breastfeeding and Covid-19 Facebook group with important guidelines and tools, country policies, IBFAN statements, lessons sharing. You can join and invite others: https://www.facebook.com/groups/2681030788691515/?ref=share
Informationen auf deutsch
ELACTA European Lactation Consultant Association gibt gute Information zur Studie von Gross et al. (Lancet, 21. Mai 2020): ZITAT Ein am 21. Mai 2020 im Lancet veröffentlichter → Fallbericht über zwei Frauen, die an an einer Klinik in Baden-Württemberg* entbunden hatten und das Zimmer teilten, hat internationale Aufmerksamkeit erregt. Beide Mütter und Kinder hatten sich infiziert, jedoch wurden nur bei einer der beiden Frauen RNA-Bruchstücke von SARS-CoV2 in ihrer Muttermilch gefunden.
Dieser Nachweis alleine ist jedoch kein Grund, die derzeit bestehenden Empfehlungen zu verändern:
– RNA-Bruchstücke sind nicht gleichbedeutend mit vollständig aktiven Viren
– Es ist nicht vollständig auszuschließen, dass diese Bruchstücke durch Verunreinigung in die Muttermilchproben gelangten
– Es ist nicht nachgewiesen, dass der betroffene Säugling sich über die Muttermilch infizierte und nicht stattdessen über Tröpfchen-/ Schmierinfektion durch die eigene Mutter oder die im gleichen Raum liegende infektiöse andere Mutter
– Beim betroffenen Säugling, der Symptome entwickelte, wurde neben der COVID-19-Infektion auch eine RSV-Infektion festgestellt
– Der Verlauf der Erkrankung war bei bei beiden beteiligten Müttern und einem Kind leicht. Das zweite Kind, das auch von der RSV-Infektion betroffen war und bei dessen Mutter die Muttermilch positiv getestet wurde, musste zeitweise beatmet werden.
Sicher wird die Wissenschaft in den kommenden Monaten weitere Erkenntnisse zur besonderen Situation von Schwangeren und Stillenden gewinnen. Dies wird bei Bedarf zu einer Anpassung der geltenden Empfehlungen führen. Derzeit sind die untenstehenden Empfehlungen unverändert. ENDE ZITAT
SGGG Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe (14 avril 2020) https://www.sggg.ch/news/detail/1/coronavirusinfektion-covid-19-und-schwangerschaft/
DGGG Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, German Society for Gynecology and Obstetrics Webseite
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