Breastfeeding and COVID-19

Author(s): I. Hoskins , Date: 06 August 2021

Women should continue to breastfeed if they have or suspect they have COVID-19 and they should come forward to be vaccinated while continuing breastfeeding are the twin messages on COVID-19 in World Breastfeeding Week. Lack of support services and misinformation around COVID-19 have dented breastfeeding rates during the pandemic according to WHO and UNICEF. Recent research, however suggests that mRNA vaccines given to breast feeding women are safe for mother and baby and confer additional benefits to infants in the form of protective antibodies.

 

World Breast Feeding Week

The statement from WHO and UNICEF marking World Breastfeeding Week show how far we have come in improving breastfeeding rates over the last 4 decades- there has been a 50% increase in exclusive breast feeding round the world.

The pandemic has however threatened those achievements according to WHO and UNICEF. The enormous pressures on health services have let to a reduction in breastfeeding support services. At the same time baby food manufacturers may be spreading misinformation about COVID transmission to encourage use of manufactured formulas. The joint statement urges proper implementation of the now 40 year old International code of marketing of breastmilk substitutes which aims to protect mothers from aggressive formula marketing to combat these rumours and claims.

WHO Europe marked the Week by releasing a statement supporting breast feeding with COVID infection and after vaccination:

Natasha Azzopardi Muscat, Director of Country Health Policies and Systems at WHO/Europe, said: “As a mother who has breastfed all 3 of my children, I know first-hand that breastmilk is one of the best sources of nutrition for infants, including infants whose mothers have confirmed or suspected COVID-19 infection. As long as an infected mother takes appropriate precautions, she can breastfeed her baby.”

 

What is the evidence about transmission of COVID-19 through breast milk?

A systematic review of transmission of COVID-19 from mother to child while breastfeeding, supported by WHO, concludes that there is no evidence suggesting COVID-19 can be passed to infants through breast milk. WHO guidance to healthcare workers, says that women with COVID-19 should continue to breastfeed as long as they feel well enough to do so. They should wear a mask if possible and wash their hands before feeding their child. WHO says the benefits outweigh possible risks to the child: this age group is at low risk of infection and serious illness from COVID and breast feeding significantly reduces infant deaths from other causes.

 

Breastfeeding and COVID-19 vaccines

There has been a great deal of uncertainty about vaccination of breastfeeding women, not helped by the fact that they were excluded from the vaccine trials. When vaccines were becoming available in December 2020, the Academy of Breast Feeding Medicine recommended that women who get vaccinated should not stop breastfeeding and suggested that an mRNA based vaccine was unlikely to leave the injection site in the arm to reach the breast and be passed to an infant. A small study examining vaccine mRNA in milk of 7 women published last month suggests they were probably correct. In the 48 hours after vaccination, vaccine related mRNA could not be detected in the women’s milk suggesting infants would not ingest any vaccine related material.

Recent studies suggest that vaccination of breastfeeding women is also safe for them and there is an additional benefit in that antibodies can travel through the milk to protect the child (Jakuszko et al., Perl et al. and  Gray et. al. 2021).

 

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