Protecting Breastfeeding during the COVID-19 PandemicFunding L.R.K. was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (grant: UL1 TR001860), and the National Institutes of Health Building Interdisciplinary Research Careers in Women's Health Program (K12HD051958). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health.
05 June 2020
18 June 2020
21 July 2020 (online)
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.
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.
- 1 Ghebreyesus TA. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. Available at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 . Accessed June 26, 2020
- 2 WHO. Breastfeeding advice during the COVID-19 outbreak. Available at: http://www.emro.who.int/nutrition/nutrition-infocus/breastfeeding-advice-during-covid-19-outbreak.html . Accessed April 15, 2020
- 3 Coronavirus (COVID-19) Infection in Pregnancy: Information for healthcare professionals. Available at: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/ . Accessed June 26, 2020
- 4 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; 16 (03) e13010
- 5 CDC. Coronavirus Disease 2019 (COVID-19) Considerations for Inpatient Obstetric Healthcare Settings 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html . Accessed April 15, 2020
- 6 Kumar A. Management of Infants Born to Mothers with COVID-19: Initial Guidance for pediatric hospitals. Available at: https://www.the-hospitalist.org/hospitalist/article/221157/pediatrics/management-infants-born-mothers-covid-19 . Accessed June 26, 2020
- 7 Stuebe A. Should infants be separated from mothers with COVID-19? First, do no harm. Available at: https://www.liebertpub.com/doi/full/10.1089/bfm.2020.29153.ams . Accessed June 26, 2020
- 8 Dunne-Castagna VP, Mills DA, Lönnerdal B. Effects of milk secretory immunoglobulin a on the commensal microbiota. Nestle Nutr Inst Workshop Ser 2020; 94: 158-168
- 9 Yang B, Chuang H, Chen R. Protection from viral infections by human milk oligosaccharides: direct blockade and indirect modulation of intestinal ecology and immune reactions. Open Glycosci 2012; (05) 19-25
- 10 Victora CG, Horta BL, Loret de Mola C. , et al. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. Lancet Glob Health 2015; 3 (04) e199-e205
- 11 Schwartz DA, Graham AL. Potential maternal and infant outcomes from (Wuhan) coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections. Viruses 2020; 12 (02) E194
- 12 Baud D, Greub G, Favre G. , et al. Second-trimester miscarriage in a pregnant woman with SARS-CoV-2 infection. JAMA 2020; (e-pub ahead of print) DOI: 10.1001/jama.2020.7233.
- 13 Schwartz DA. An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: maternal coronavirus infections and pregnancy outcomes. Arch Pathol Lab Med 2020; (e-pub ahead of print) DOI: 10.5858/arpa.2020-0901-SA.
- 14 Zhu H, Wang L, Fang C. , et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 9 (01) 51-60
- 15 Dong L, Tian J, He S. , et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020
- 16 Zeng H, Xu C, Fan J. , et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA 2020
- 17 Kimberlin DW, Stagno S. Can SARS-CoV-2 infection be acquired in utero?: more definitive evidence is needed. JAMA 2020; (e-pub ahead of print) DOI: 10.1001/jama.2020.4868.
- 18 Lackey KA, Pace RM, Williams JE. , et al. SARS-CoV-2 and human milk: what is the evidence?. Maternal and Child Nutrition 2020; DOI: 10.1111/mcn.13032.
- 19 Groß R, Conzelmann C, Müller JA. , et al. Detection of SARS-CoV-2 in human breast milk. Lancet 2020; (e-pub ahead of print) DOI: 10.1016/S0140-6736(20)31181-8.
- 20 Buonsenso D, Costa S, Sanguinetti M. , et al. Neonatal late onset infection with severe acute respiratory syndrome coronavirus 2. Am J Perinatol 2020
- 21 Bai Y, Yao L, Wei T. , et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA 2020
- 22 Molloy EJ, Bearer CF. COVID-19 in children and altered inflammatory responses. Pediatr Res 2020
- 23 CDC COVID-19 Response Team. Coronavirus disease 2019 in children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (14) 422-426
- 24 Expanded Access Remdesivir (RDV; GS-5734). Available at: https://clinicaltrials.gov/ct2/show/NCT04302766 . Accessed June 26, 2020
- 25 Sarilumab COVID-19. Available at: https://clinicaltrials.gov/ct2/show/NCT04327388 . Accessed June 26, 2020
- 26 Dörnemann J, Burzio C, Ronsse A. , et al. First newborn baby to receive experimental therapies survives ebola virus disease. J Infect Dis 2017; 215 (02) 171-174
- 27 Peng W, Liu R, Zhang L, Fu Q, Mei D, Du X. Breast milk concentration of hydroxychloroquine in Chinese lactating women with connective tissue diseases. Eur J Clin Pharmacol 2019; 75 (11) 1547-1553
- 28 Hydroxychloroquine, in Drugs and Lactation Database (LactMed). Available at: https://www.ncbi.nlm.nih.gov/books/NBK501150/ . Accessed June 26, 2020
- 29 Sarilumab, in Drugs and Lactation Database (LactMed). Available at: https://www.ncbi.nlm.nih.gov/sites/books/NBK500915/ . Accessed June 26, 2020
- 30 Chandrasekharan P, Vento M, Trevisanuto D. , et al. Neonatal resuscitation and postresuscitation care of infants born to mothers with suspected or confirmed SARS-CoV-2 infection. Am J Perinatol 2020
- 31 Liu Y, Yan LM, Wan L. , et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis 2020; 20 (06) 656-657