Breastfeeding during a Pandemic

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Abstract

Background: The current pandemic and the concerns of vertical transmission of SARS-CoV-2 have contributed to increasing the rate of breastfeeding interruption. This tendency has been associated with negative effects on the well-being of lactating mothers and their infants. The aim of this review is to summarize the evidence on the strategies to support breastfeeding during the COVID-19 pandemic and on the safety of breastfeeding during a SARS-CoV-2 infection or after COVID-19 vaccination. Summary: Available data show that the lack of support of lactating mothers during the pandemic has contributed to breastfeeding cessation worldwide. However, a few strategies have been proposed to overcome this issue. The risk of SARS-CoV-2 transmission from infected mothers to their offspring is extremely low. Furthermore, vaccination of lactating mothers is not associated with side effects in their infants. Key Messages: Increasing effort should be made to support breastfeeding during the COVID-19 pandemic. Mothers who are able to take care of their offspring and to adopt basic hygiene measures should not interrupt breastfeeding during a SARS-CoV-2 infection. Vaccination of lactating mothers might further strengthen the protective effect of breastfeeding against infections.

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Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

Cuiyan Wang, Riyu Pan, Xiaoyang Wan … (2020)

Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.

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Detection of SARS-CoV-2 in human breastmilk

Rüdiger Groß, Carina Conzelmann, Janis A Müller … (2020)

It remains unclear whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be shed into breastmilk and transmitted to a child through breastfeeding. Recent investigations have found no evidence of SARS-CoV-2 in human breastmilk, but sample sizes were small.1, 2, 3 We examined milk from two nursing mothers infected with SARS-CoV-2. Both mothers were informed about the study and gave informed consent. Ethical approval for this case study was waived by the Ethics Committee of Ulm University and all samples were anonymised. Clinical data and the timecourse of infection in the two mothers is shown in figure 1 . After feeding and nipple disinfection, milk was collected with pumps and stored in sterile containers at 4°C or −20°C until further analysis. We determined viral loads using RT-qPCR for SARS-CoV-2 N and ORF1b-nsp14 genes 4 in both whole and skimmed milk (obtained after removal of the lipid fraction). Further details of sample storage and processing are provided in the appendix. Following admission and delivery (day 0), four samples from Mother 1 tested negative (figure 2 ). By contrast, SARS-CoV-2 RNA was detected in milk from Mother 2 at days 10 (left and right breast), 12, and 13. Samples taken subsequently were negative (figure 2). Ct values for SARS-CoV-2 N peaked at 29·8 and 30·4 in whole milk and skimmed milk, respectively, corresponding to 1·32 × 105 copies per mL and 9·48 × 104 copies per mL (mean of both isolations). Since milk components might affect RNA isolation and quantification, viral RNA recovery rates in milk spiked with serial dilutions of a SARS-CoV-2 stock were determined. We observed up to 89·2% reduced recovery rate in whole milk and 51·5% in skimmed milk (appendix), suggesting that the actual viral loads in whole milk of Mother 2 could be even higher than detected. Figure 1 Timecourse of SARS-CoV-2 infection of two mothers with newborn children After delivery, Mother 1 developed mild COVID-19 symptoms and tested positive for SARS-CoV-2. Following spatial isolation of Mother 1 with her newborn (Newborn 1), Newborn 1 subsequently tested positive and developed respiratory problems, but both Mother 1 and Newborn 1 recovered. Mother 2 was admitted to the same hospital and room as Mother 1 and Newborn 1. Upon delivery, Mother 2 and Newborn 2 were brought back to the same room as Mother 1 and Newborn 1, and they stayed in the same room until Mother 1 tested positive for SARS-CoV-2 and isolated. Mother 2 and Newborn 2 were discharged on day 4. Mother 2 developed mild COVID-19 symptoms shortly thereafter and began wearing a surgical mask at all times of the day. Mother 2 tested positive for SARS-CoV-2 on day 8. 3 days later, Newborn 2 tested positive for SARS-CoV-2 and was readmitted to hospital because of newborn icterus and severe breathing problems. The child received ultraviolet therapy and ventilation therapy. Newborn 2 tested positive for RSV and SARS-CoV-2 at later timepoints. Mother 1 tested positive for SARS-CoV-2 again on day 22, 13 days after first being diagnosed. RT-qPCR analysis of breastmilk samples from both mothers revealed SARS-CoV-2 RNA in the milk of Mother 2 on days 10–13 (red bottles), whereas samples from Mother 1 were negative (white bottles). Dark shading indicates time from first SARS-CoV-2 positive oropharyngeal and nasopharyngeal swabs. Brackets indicate duration of COVID-19 symptoms. SARS-CoV-2=severe acute respiratory syndrome coronavirus 2. RSV=respiratory syncytial virus. Figure 2 Detection of SARS-CoV-2 in breastmilk from an infected mother SARS-CoV-2 RNA was isolated from whole and skimmed breastmilk obtained at different timepoints and analysed by RT-qPCR, using primer sets targeting SARS-CoV-2 N and ORF1b genes. Samples and viral RNA standard were run in duplicates, and isolation and RT-qPCR were repeated in two independent assays. RNA in breastmilk from Mother 2 on day 25 was only isolated once and only analysed by RT-qPCR for SARS-CoV-2 N. Symbols at baseline indicate no amplification (or Ct>36·5 and no amplification in one replicate). Blue dashed line denotes quantification threshold for N (160 copies per reaction; Ct 34·2) and red dotted line for ORF1b (32 copies per reaction; Ct 35·9). Values below these lines but above baseline indicate amplification in both replicates, but no reliable quantification. Values shown represent mean (SD) from duplicates. SARS-CoV-2=severe acute respiratory syndrome coronavirus 2. Ct=cycle threshold. We detected SARS-CoV-2 RNA in milk samples from Mother 2 for 4 consecutive days. Detection of viral RNA in milk from Mother 2 coincided with mild COVID-19 symptoms and a SARS-CoV-2 positive diagnostic test of the newborn (Newborn 2). Mother 2 had been wearing a surgical mask since the onset of symptoms and followed safety precautions when handling or feeding the neonate (including proper hand and breast disinfection, strict washing, and sterilisation of milk pumps and tubes). However, whether Newborn 2 was infected by breastfeeding or other modes of transmission remains unclear. Further studies of milk samples from lactating women and possible virus transmission via breastfeeding are needed to develop recommendations on whether mothers with COVID-19 should breastfeed.

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SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women

Sivan Perl, Atara Uzan-Yulzari, Hodaya Klainer … (2021)

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Journal

Journal ID (publisher-id): ANM

Journal ID (nlm-ta): Ann Nutr Metab

Journal ID (doi): 10.1159/issn.0250-6807

Title: Annals of Nutrition and Metabolism

Publisher: S. Karger AG

ISBN:

ISBN: 978-3-318-07044-6

ISSN (Print): 0250-6807

ISSN (Electronic): 1421-9697

Publication date Subscription-year: 2022

Publication date Collection: May 2022

Publication date (Electronic): 17 February 2022

Volume: 78

Issue: Suppl 1

Pages: 17-25

Affiliations

[_a] _aUniversity of Milan, Department of Clinical Science and Community Health, Milan, Italy

[_b] _bFondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Pediatric Unit, Milan, Italy

[_c] _cFondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy

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*Carlo Agostoni, carlo.agostoni@unimi.it

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Gregorio P. Milani https://orcid.org/0000-0003-3829-4254

Maria Lorella Giannì https://orcid.org/0000-0003-3901-9131

Article

Publisher ID: 521349 Other ID: Ann Nutr Metab 2022;78(suppl 1):17–25

DOI: 10.1159/000521349

PubMed ID: 35176736

SO-VID: d6e9b72a-7967-4bd1-89fb-0014b77a5f3d

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 06 October 2021

Date accepted : 05 December 2021

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Figures: 2, Tables: 1, Pages: 9

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Breastfeeding during a Pandemic

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Novel Coronavirus Disease COVID-19

Most cited references 52

Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

Detection of SARS-CoV-2 in human breastmilk

SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women

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