Breastfeeding Rates During the COVID-19 Pandemic in Germany: Data from the CRONOS Registry

Abstract

SARS-CoV-2 infection and COVID-19 disease are thought to have an impact on breastfeeding rate – besides other known peripartal issues. Data of the national CRONOS registry regarding breastfeeding behavior in 6,746 women was analyzed regarding the time window between maternal SARS-CoV-2 infection and time of delivery. In addition, other influencing factors like the predominant viral variant, maternal disease severity, and gestational age at delivery were taken into account. Our data suggest that within the variables analyzed, in the case of acute maternal infection (<14 days before birth), breastfeeding behavior improved with increasing gestational age at birth (p<0.0001), with less severe maternal illness (p<0.0001) and as the pandemic progressed with less virulent viral variants (p=0.01). When adjusting for COVID-19-associated and non-associated factors, rooming-in remains the most important factor positively influencing breastfeeding behavior. With regards to the benefits for mother and infants from breastfeeding, a separation of mother and child even in case of infectious settings should be avoided.

Zusammenfassung

Neben anderen peripartalen Faktoren, wird davon ausgegangen, dass SARS-CoV-2 und eine COVID-19-Erkrankung einen Einfluss auf die Stillrate haben. Daten des nationalen CRONOS-Registers zum Stillverhalten von 6.746 in der Schwangerschaft mit SARS-CoV-2 infizierten Frauen wurden im Hinblick auf das Zeitfenster zwischen mütterlicher Infektion und dem Zeitpunkt der Entbindung analysiert. Außerdem wurden weitere Einflussfaktoren wie die vorherrschende Virusvariante, der mütterliche Krankheitsschweregrad und das Gestationsalter bei der Geburt berücksichtigt. Unsere Daten deuten darauf hin, dass sich innerhalb der analysierten Variablen das Stillverhalten im Falle einer akuten mütterlichen Infektion (<14 Tage vor der Geburt) mit zunehmendem Gestationsalter bei der Geburt (p <0,0001), mit einer weniger schweren mütterlichen Erkrankung (p <0,0001) und mit dem Fortschreiten der Pandemie mit weniger virulenten Virusvarianten (p=0,01) verbessert. Wenn man die mit COVID-19 assoziierten und nicht assoziierten Faktoren berücksichtigt, bleibt das Rooming-in der wichtigste Faktor, der das Stillverhalten positiv beeinflusst. Im Hinblick auf die Vorteile des Stillens für Mutter und Kind sollte eine Trennung von Mutter und Kind auch im Falle einer Infektion möglichst vermieden werden.

Key words

breastfeeding - COVID-19 - SARS-CoV-2 - CRONOS - neonate

Schlüsselwörter

Stillen - COVID-19 - SARS-CoV-2 - CRONOS - Neonat

Publication History

Received: 30 July 2023

Accepted: 23 November 2023

Article published online:
08 February 2024

• References

• 1 Hale T, Angrist N, Goldszmidt R. et al. A global panel database of pandemic policies (Oxford COVID-19 Government Response Tracker). Nat Hum Behav 2021; 5: 529-538 DOI: 10.1038/s41562-021-01079-8.
• 2 Longardt AC, Winkler VP, Pecks U. [SARS-CoV-2 and Perinatal Aspects]. Z Geburtshilfe Neonatol 2020; 224: 181-186 DOI: 10.1055/a-1192-7437.
• 3 Zollkau J, Heimann Y, Hagenbeck C. et al. Breastfeeding behavior within the COVID-19-Related Obstetric and Neonatal Outcome Study (CRONOS). J Hum Lact 2023; 8903344231190623 DOI: 10.1177/08903344231190623.
• 4 Gross R, Conzelmann C, Muller JA. et al. Detection of SARS-CoV-2 in human breastmilk. Lancet 2020; 395: 1757-1758 DOI: 10.1016/S0140-6736(20)31181-8.
• 5 Wu Y, Liu C, Dong L. et al Viral shedding of Covid-19 in pregnant women. In: SSRN 2020. Available from: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3562059
• 6 Fewtrell M, Bronsky J, Campoy C. et al. Complementary feeding: A position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr 2017; 64: 119-132 DOI: 10.1097/MPG.0000000000001454.
• 7 World Health Organization. Breastfeeding. WHO Website. Available from: https://www.who.int/health-topics/breastfeeding#tab=tab_1 Accessed June 25, 2023
• 8 American Academy of Pediatrics. Where we stand: Breastfeeding. 2023
• 9 Nationale Stillkommission. 2023. Available from: https://www.mri.bund.de/de/themen/nationale-stillkommission
• 10 Briana DD, Malamitsi-Puchner A. Breastfeeding provides a protective hug and the benefits have outweighed the risks during the COVID-19 pandemic. Acta Paediatr 2023; 112: 1177-1181 DOI: 10.1111/apa.16769.
• 11 Zollkau J, Hagenbeck C, Hecher K. et al. [Update on Recommendations for SARS-CoV-2/COVID-19 During Pregnancy, Birth and Childbed]. Z Geburtshilfe Neonatol 2020; 224: 217-222 DOI: 10.1055/a-1199-6404.
• 12 Zollkau J, Hagenbeck C, Hecher K. et al. [Recommendations for SARS-CoV-2/COVID-19 during Pregnancy, Birth and Childbed – Update November 2021 (Short Version)]. Z Geburtshilfe Neonatol 2022; 226: 16-24 DOI: 10.1055/a-1687-2233.
• 13 Zollkau J, Hagenbeck C, Hecher K. et al. [Recommendations for SARS-CoV-2/COVID-19 during Pregnancy, Birth and Childbed – Update November 2021 (Long Version)]. Z Geburtshilfe Neonatol 2022; 226: e1-e35 DOI: 10.1055/a-1688-9398.
• 14 Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. Überblick über die Empfehlungen für Schwangere und Stillende (DGGG e.V.). 2023. Available from: https://www.dggg.de/presse/pressemitteilungen-und-nachrichten/covid-19-kreisssaalempfehlungen-der-dggg-faq-fuer-schwangere-und-weitere-informationen
• 15 Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. SARS-CoV-2 und Schwangerschaft/Stillen. 2023. Available from: https://www.dggg.de/fileadmin/data/Stellungnahmen/DGGG/2021/PM_Update_November_2021_finalV2.pdf
• 16 Ganho-Avila A, Guiomar R, Sobral M. et al. The impact of COVID-19 on breastfeeding rates: An international cross-sectional study. Midwifery 2023; 120: 103631 DOI: 10.1016/j.midw.2023.103631.
• 17 Lapillonne A, Pichon C, Renaudin B. et al. Breastfeeding success and newborn health before and during the covid-19 pandemic: A single-centre comparative study. Neonatology 2023; 1-8 DOI: 10.1159/000530080.
• 18 Cinquetti M, Marchiotto C, Fingerle M. et al. Breastfeeding rates fell in an Italian baby friendly hospital during the 2020 COVID-19 pandemic year and difficulties increased. Acta Paediatr 2023; 112: 770-775 DOI: 10.1111/apa.16674.
• 19 Aabakke AJM, Petersen TG, Wojdemann K. et al. Risk factors for and pregnancy outcomes after SARS-CoV-2 in pregnancy according to disease severity: A nationwide cohort study with validation of the SARS-CoV-2 diagnosis. Acta Obstet Gynecol Scand 2023; 102: 282-293 DOI: 10.1111/aogs.14512.
• 20 Iannaccone A, Mand N, Schmidt B. et al. Is the risk of still and preterm birth affected by the timing of symptomatic SARS-CoV-2 infection during pregnancy? Data from the COVID-19 Related Obstetrics and Neonatal Outcome Study Network, Germany. Am J Obstet Gynecol 2023; 228: 351-352 e352 DOI: 10.1016/j.ajog.2022.11.1301.
• 21 Piekos SN, Roper RT, Hwang YM. et al. The effect of maternal SARS-CoV-2 infection timing on birth outcomes: a retrospective multicentre cohort study. Lancet Digit Health 2022; 4: e95-e104 DOI: 10.1016/S2589-7500(21)00250-8.
• 22 Pecks U, Mand N, Kolben T. et al. SARS-CoV-2 Infection During Pregnancy. Dtsch Arztebl Int 2022; 119: 588-594 DOI: 10.3238/arztebl.m2022.0266.
• 23 Robert Koch Institut. Dritte Aktualisierung der „Retrospektiven Phaseneinteilung der COVID-19-Pandemie in Deutschland“. Epidemiologisches Bulletin – Ausgabe 38/22. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2022/Ausgaben/38_22.pdf?__blob=publicationFile
• 24 Enengl S, Pecks U, Oppelt P. et al. Antibody response and maternofetal antibody transfer in SARS-CoV-2-positive pregnant women: A multicenter observational study. Geburtshilfe Frauenheilkd 2022; 82: 501-509 DOI: 10.1055/a-1768-0415.
• 25 DeYoreo M, Kapinos K, Lawrence R. et al. Changes in breastfeeding and lactation support experiences during COVID. J Womens Health (Larchmt) 2023; 32: 150-160 DOI: 10.1089/jwh.2022.0146.
• 26 Matyas M, Valeanu M, Hasmasanu M. et al. The effect of maternal SARS-CoV-2 infection on neonatal outcome. Children (Basel) 2023; 10: 771 DOI: 10.3390/children10050771.
• 27 Mufdlilah M, Kusuma NI, Suryaningsih EK. Mother’s experience with COVID-19 in breastfeeding: A phenomenological study. SAGE Open Nurs 2023; 9 23779608231172360 DOI: 10.1177/23779608231172360.
• 28 Koc E, Dilli D. How does COVID-19 affect maternal and neonatal outcomes?. J Perinat Med 2023; 51: 277-283 DOI: 10.1515/jpm-2022-0509.
• 29 Dowse G, Perkins EJ, Stein HM. et al. Born into an isolating world: family-centred care for babies born to mothers with COVID-19. EClinicalMedicine 2023; 56: 101822 DOI: 10.1016/j.eclinm.2022.101822.
• 30 Vik ES, Kongslien S, Nedberg IH. et al. Women’s experiences and views on early breastfeeding during the COVID-19 pandemic in Norway: quantitative and qualitative findings from the IMAgiNE EURO study. Int Breastfeed J 2023; 18: 15 DOI: 10.1186/s13006-023-00553-5.
• 31 Magnazi MB, Sartena G, Goldberg M. et al. Impact of the COVID-19 pandemic on breastfeeding in Israel: a cross-sectional, observational survey. Int Breastfeed J 2022; 17: 61 DOI: 10.1186/s13006-022-00505-5.