Coronavirus and Breastfeeding Evidence-Based Statements

PDF Version - Updated 3/26/2020

Coronavirus and breastfeeding: statement for researchers and scientists

Human milk researchers around the world are developing plans to improve our knowledge of how the novel coronavirus (SARS-CoV-2) and the disease it causes (COVID-19) affect human milk and breastfeeding. In one small study from China, milk from 6 women infected in late pregnancy was tested for SARS-CoV-2, and no virus was detected. Several additional small-scale studies collectively tested 8 milk samples, and none found evidence of this coronavirus in human milk. However, there is much remaining to discover. For example, most of the milk tested to date was produced by women infected during pregnancy, not women who acquired the infection during lactation. In addition, nothing is known about how the milk samples were collected and if the analytical methods used were optimized for milk – which is notoriously difficult to analyze due to its complex composition. At the current time, we also do not know anything about viability of the virus in milk, when and how the mother begins producing antibodies to the virus, when these antibodies are eventually passed to the baby via breastmilk, and whether components of the infant’s saliva influence the virus. We also know very little about the effects of refrigeration and freezing (which are common when milk is pumped and stored) on the virus. For all these and many more reasons, researchers from around the world are working together to answer these important questions.

For clinical guidance, the United Nations Children’s Fund (UNICEF), World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and the American College of Obstetrics and Gynecology (ACOG) have interim clinical recommendations for parents and providers with questions about breastfeeding during the coronavirus pandemic.

UNICEF: Is it safe for a mother to breastfeed if she is infected with coronavirus?

WHO: Clinical management of severe acute respiratory infection when novel coronavirus infection is suspected

CDC: Coronavirus Disease (COVID-19) and Breastfeeding

CDC: Interim Considerations for Infection Prevention and Control of COVID-19 in Inpatient Obstetric Settings

ACOG: Novel Coronavirus 2019 (COVID-19)

Published studies:
Chen et al., The Lancet. 2020; 395:809-815. doi.org/10.1016/S1473-3099(20)30192-4
Liu et al., Preprints. 2020; 2020020373.
Kam et al., Clinical Infectious Diseases. 2020;ciaa201. doi:10.1093/cid/ciaa201.
Fan et al., Clinical Infectious Diseases. 2020;ciaa226. doi:10.1093/cid/ciaa226.
Cui et al. Journal of Infectious Diseases. 2020;jiaa113. doi:10.1093/infdis/jiaa113.
Wang et al. Clinical Infectious Diseases. 2020;ciaa225. doi:10.1093/cid/ciaa225.
Li et al. Emerging Infectious Diseases. 2020;26(6):10.3201/eid2606.200287. doi:10.3201/eid2606.200287.
Dong et al. JAMA. doi:10.1001/jama.2020.4621

Coronavirus and breastfeeding: statement for the public

Human milk researchers around the world are working diligently to find out more about how the novel coronavirus affects (or does not affect) breastfeeding, mothers, and infants. While we have little scientific information right now, what we do know is that there have been some milk samples tested which were collected from mothers with the novel coronavirus, and they have all been negative. It’s important to note, however, that these samples were collected from very few mothers (14 total), and some of the women were initially infected with the virus during late pregnancy – not while breastfeeding. Clearly there is still a lot more to learn. For instance, scientists are working hard to make sure that the tests typically used to find this virus work for milk – which is notoriously difficult to analyze. It is also important to know that breastmilk passes antibodies to babies (which may provide protection), but scientists don’t know when this happens for coronavirus. Researchers from around the world are working together to answer these and other important questions related to COVID-19 and breastfeeding.

Are you worried about breastfeeding during coronavirus? The United Nations Children’s Fund (UNICEF), World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and the American College of Obstetrics and Gynecology (ACOG) have clinical guidance for parents and providers with questions about breastfeeding during the coronavirus pandemic. Importantly, at this time none of these recommendations include stopping breastfeeding. If you are concerned about breastfeeding your baby during this pandemic, your physician, lactation consultant, or baby’s pediatrician are excellent resources.

References

Chen et al., The Lancet. 2020; 395:809-815. doi.org/10.1016/S1473-3099(20)30192-4

UNICEF: Is it safe for a mother to breastfeed if she is infected with coronavirus?

WHO: Clinical management of severe acute respiratory infection when novel coronavirus infection is suspected

CDC: Coronavirus Disease (COVID-19) and Breastfeeding

ACOG: Novel Coronavirus 2019 (COVID-19)

Coronavirus and breastfeeding: short statements

  1. To date, only 8 published studies have tested whether SARS-CoV-2 can be detected in breastmilk of mothers who were infected. None of the 14 milk samples tested were positive for the virus. However, we know very little about how the milk samples were collected or analyzed.1
  2. To date, there is no evidence that any infant has been infected with this virus via breastfeeding. However, studies looking at this topic are sparse.
  3. Very little is known about COVID-19 and breastfeeding. It is possible that the virus could be in milk itself, but there is no scientific evidence that this is true. What we do know is that an infected mother might transmit the virus to her infant via coughing or sneezing. As such, the CDC recommends that infected women wishing to breastfeed thoroughly wash their hands and wear a mask if possible.2 Precautions to avoid spreading the virus can be found at https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html.
  4. Even during this COVID-19 pandemic, breastmilk continues to be the best source of nutrition for most infants.2
  5. Mothers with confirmed COVID-19 and those who have symptoms should take all possible precautions to avoid spreading the virus to their infants, including washing hands before touching their infants and wearing a face mask, if possible, while feeding at the breast. All surrounding surfaces should also be cleaned and disinfected.2,3 Precautions to avoid spreading the virus can be found at https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html.
  6. If a mother wishes to pump her milk, she should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning every time the pump is used.2 The CDC’s recommendations for proper pump cleaning can be found at https://www.cdc.gov/healthywater/hygiene/healthychildcare/infantfeeding/breastpump.html.
  7. The US Centers for Disease Control and Prevention (CDC) has no specific guidance for breastfeeding during infection with viruses that are similar to the one that causes COVID-19, like Severe Acute Respiratory Syndrome (SARS-CoV) or Middle Eastern Respiratory Syndrome (MERS-CoV).2 There is much to learn about whether COVID-19 impacts breastfeeding.
  8. The United Nation Children’s Fund (UNICEF) states that “Considering the benefits of breastfeeding and the insignificant role of breastmilk in the transmission of other respiratory viruses, the mother can continue breastfeeding, while applying all the necessary precautions.”3
  9. The United Nation Children’s Fund (UNICEF) suggests that symptomatic mothers who are well enough to breastfeed should wear a mask when near their child (including during feeding), wash their hands before and after contact with their child (including feeding), and clean/disinfect surrounding surfaces – as should be done in all cases where anyone with confirmed or suspected COVID-19 interacts with others, including children.3
  10. If an infected mother is too ill to breastfeed, UNICEF recommends that she pump milk and give it to her child via a clean cup and/or spoon – all while following measures to decrease infection.3 Precautions to avoid spreading the virus can be found at https://www.cdc.gov/coronavirus/2019- ncov/hcp/guidance-prevent-spread.html. The CDC’s recommendations for proper pump cleaning can be found at https://www.cdc.gov/healthywater/hygiene/healthychildcare/infantfeeding/breastpump.html.  
  11. From the American College of Obstetricians and Gynecologists: “Currently, the primary concern is not whether the virus can be transmitted through breastmilk, but rather whether an infected mother can transmit the virus through respiratory droplets during the period of breastfeeding. A mother with confirmed COVID-19 or who is a symptomatic person under investigation should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while breastfeeding.”4 Precautions to avoid spreading the virus can be found at https://www.cdc.gov/coronavirus/2019- ncov/hcp/guidance-prevent-spread.html. The CDC’s recommendations for proper pump cleaning can be found at https://www.cdc.gov/healthywater/hygiene/healthychildcare/infantfeeding/breastpump.html.
  12. If a new mother has been diagnosed with COVID-19 or is suspected of having this disease, the CDC recommends that her newborn be kept at least 6 feet from the mother, and a screen used for further protection. In this case, mothers should express milk and have another healthy adult feed the infant.5 The CDC’s recommendations for proper pump cleaning can be found at https://www.cdc.gov/healthywater/hygiene/healthychildcare/infantfeeding/breastpump.html.

 

References:

1Published studies as of March 26, 2020:
Chen et al., The Lancet. 2020; 395:809-815.
doi.org/10.1016/S1473-3099(20)30192-4
Liu et al., Preprints. 2020; 2020020373.
Kam et al., Clinical Infectious Diseases. 2020;ciaa201. doi:10.1093/cid/ciaa201.
Fan et al., Clinical Infectious Diseases. 2020;ciaa226. doi:10.1093/cid/ciaa226.
Cui et al. Journal of Infectious Diseases. 2020;jiaa113. doi:10.1093/infdis/jiaa113.
Wang et al. Clinical Infectious Diseases. 2020;ciaa225. doi:10.1093/cid/ciaa225.
Li et al. Emerging Infectious Diseases. 2020;26(6):10.3201/eid2606.200287. doi:10.3201/eid2606.200287.
Dong et al. JAMA. doi:10.1001/jama.2020.4621

2US Centers for Disease Control and Prevention. Coronavirus Disease (COVID-19) and Breastfeeding, March 18, 2020.

3UNICEF. Coronavirus disease (COVID-19): What parents should know.

4American College of Obstetricians and Gynecologists. Novel Coronavirus 2019 (COVID-19) Practice Advisory, March 13, 2020.

5US Centers for Disease Control and Prevention. Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings, February 18, 2020.