Am J Perinatol
DOI: 10.1055/s-0040-1714277
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Protecting Breastfeeding during the COVID-19 Pandemic

1  Division of Pediatric Infectious Disease, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
,
Elizabeth Partridge
1  Division of Pediatric Infectious Disease, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
,
Laura R. Kair
2  Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
,
Kara M. Kuhn-Riordon
3  Division of Neonatology, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
,
Angelique I. Silva
4  Women's Pavilion and Newborn Nursery, UC Davis Medical Center, Sacramento, California
,
Maria E. Bettinelli
5  Department of Clinical Science and Community Health, University of Milan, Milan, Italy
,
Caroline J. Chantry
6  Division of General Pediatrics, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
,
Mark A. Underwood
3  Division of Neonatology, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
,
Satyan Lakshminrusimha
3  Division of Neonatology, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
,
Dean Blumberg
1  Division of Pediatric Infectious Disease, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
› Author Affiliations
Funding 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.
Further Information

Publication History

05 June 2020

18 June 2020

Publication Date:
21 July 2020 (online)

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.