Covid-19 rarely transmits via breastfeeding

Mothers with Covid-19 infection rarely transmit the virus to their newborns when basic infection-control practices are followed, according to a new study published recently in JAMA Pediatrics. The findings – the most detailed data available on the risk of Covid-19 transmission between mothers and their newborns – suggest that more extensive measures like separating Covid-19 positive mothers from their newborns and avoiding direct breastfeeding may not be warranted.

The researchers at Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children’s Hospital said that the findings should reassure expectant mothers with Covid-19. 

“Basic infection-control measures during and after childbirth – such as wearing a mask and engaging in breast and hand hygiene when holding or breastfeeding a baby – protected newborns from infection in this series,” said Cynthia Gyamfi-Bannerman, professor of women’s health at Columbia University Vagelos College of Physicians and Surgeons and senior author of the paper. 

The researchers examined outcomes in the first 101 newborns born to Covid-19 -positive mothers at New York-Presbyterian Morgan Stanley Children’s Hospital or New York-Presbyterian Allen Hospital from March 13 to April 24, 2020. 

To reduce the risk of transmitting Covid-19 to newborns after delivery, hospital staff practised social distancing, wore masks and placed Covid-positive moms in private rooms. The hospitals provided the mothers with educational materials about Covid-19 and shortened hospital stays for all mothers without complications from delivery. 

Most of the newborns roomed with their mothers, including during the first postpartum checkup. Some were admitted to the newborn intensive care unit for non-Covid-related health reasons.

Infants who roomed with their mothers were placed in protective cribs six feet away from their mothers’ beds when resting. Direct breastfeeding and skin-to-skin contact with babies were strongly encouraged, provided the mothers wore masks and washed hands and breasts with soap and water.

“During the pandemic, we continued to do what we normally do to promote bonding and development in healthy newborns, while taking a few extra precautions to minimise the risk of exposure to the virus,” said Prof Gyamfi-Bannerman.

Only two of the newborns tested positive for Covid-19 but had no clinical evidence of illness. The researchers were unable to pinpoint how the babies became infected. Physicians followed up with about half of the infants, including the two who tested positive for the virus, during the first two weeks of life, and all remained well.

In the early part of the pandemic, a number of paediatric and health organisations had released interim guidelines for pregnant women with Covid-19, recommending the separation of mothers and newborns during their hospital stay, no direct breastfeeding, and bathing newborns as soon as possible. Normally, delayed bathing of newborns is advised as it can interfere with bonding and breastfeeding and can increase the risk of low temperatures and blood sugars. 

“These recommendations were made in the absence of data on rates of mother-to-newborn SARS-CoV-2 transmission and are based on experience with mother- newborn transmission of other infectious diseases,” said lead author Dani Dumitriu, assistant professor of paediatrics in psychiatry at Columbia University Vagelos College of Physicians and Surgeons

“But some of the recommendations conflict with what we know about the developmental benefits of early breastfeeding and skin-to-skin contact. Our study offers further evidence that these measures may not be necessary for healthy newborns with SARS-CoV-2-positive moms,” she added.

Since then, the American Academy of Pediatrics has updated its guidance on rooming-in for mothers with suspected or confirmed Covid-19 .

“We think it’s particularly important that mothers with SARS-CoV-2 have the opportunity to directly breastfeed their newborns,” said Prof Gyamfi-Bannerman. “Breastmilk is known to protect newborns against numerous pathogens, and it may help protect newborns against infection with the virus. Most studies have not found SARS-CoV-2 in breastmilk, and breastmilk has been found to contain antibodies against the virus.”

DOI:10.1001/jamapediatrics.2020.4298