Maternal and Infant Outcomes Associated with Maternity Practices Related to COVID-19: The COVID Mothers Study

Abstract

Background: Maternity care practices such as skin-to-skin care, rooming-in, and direct breastfeeding are recommended, but it is unclear if these practices increase the risk of clinically significant COVID-19 in newborns, and if disruption of these practices adversely affects breastfeeding. Methods: We performed a retrospective cohort study of 357 mothers and their infants <12 months who had confirmed or suspected COVID-19. Subjects came from an anonymous worldwide online survey between May 4 and September 30, 2020, who were recruited through social media, support groups, and health care providers. Using multivariable logistic regression, Fisher's exact test, and summary statistics, we assessed the association of skin-to-skin care, feeding, and rooming-in with SARS-CoV-2 outcomes, breastfeeding outcomes, and maternal distress. Results: Responses came from 31 countries. Among SARS-CoV-2+ mothers whose infection was £3 days of birth, 7.4% of their infants tested positive. We found a nonsignificant decrease in risk of hospitalization among neonates who roomed-in, directly breastfed, or experienced uninterrupted skin-to-skin care (p > 0.2 for each). Infants who did not directly breastfeed, experience skin-to-skin care, or who did not room-in within arms' reach, were significantly less likely to be exclusively breastfed in the first 3 months, adjusting for maternal symptoms (p £ 0.02 for each). Nearly 60% of mothers who experienced separation reported feeling ''very distressed,'' and 29% who tried to breastfeed were unable. Presence of maternal symptoms predicted infant transmission or symptoms (adjusted odds ratio = 4.50, 95% confidence interval = 1.52-13.26, p = 0.006). Conclusion: Disruption of evidence-based quality standards of maternity care is associated with harm and may be unnecessary.

Maternal and Child Symptoms Following COVID-19 Vaccination Among Breastfeeding Mothers

“…In the setting of a COVID-19 infection, symptoms of fatigue, headache, muscle pain, chills, and fever are likely to be more severe and longer in duration. 24,25 Since these symptoms are the same as the adverse effects from the vaccine, which were associated with negative impacts on breastfeeding, the adverse effects may not be clinically relevant to most women at high risk for contracting the virus. This theory may serve as an additional impetus for the vaccine rather than against it.…”

Achieving Breastfeeding Equity and Justice in Black Communities: Past, Present, and Future

“…31 Owing to COVID-19 restrictions, lactation support and maternity care practices supportive of breastfeeding have been significantly impacted. [32][33][34] To mitigate the spread and exposure to COVID-19, many hospitals, clinics, public health programs, and community-based organizations implemented very restrictive visiting policies. These restrictions eliminated critical birth and breastfeeding education, support, and community resources.…”

“…Furthermore, staff were substantially reduced (e.g., essential vs. nonessential), services transitioned to online, virtual or telehealth consultations, or programs completely closed their doors. 31,34 At the height of the pandemic, patients that were identified as being severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive or under investigation were often separated from their infants immediately after birth. 33,34 The separation of maternal-infant dyads potentially impacted bonding, skinto-skin opportunities, and breastfeeding and chestfeeding initiation and may have long-term health consequences for the dyad.…”

“…31,34 At the height of the pandemic, patients that were identified as being severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive or under investigation were often separated from their infants immediately after birth. 33,34 The separation of maternal-infant dyads potentially impacted bonding, skinto-skin opportunities, and breastfeeding and chestfeeding initiation and may have long-term health consequences for the dyad. 33,34 Given that Black, Indigenous, and People of Color (BIPOC) communities have experienced higher rates of COVID-19 infections and deaths and inequitable access to testing and vaccines, the pandemic has only exacerbated preexisting health disparities and inequities impacting Black communities.…”

“…33,34 The separation of maternal-infant dyads potentially impacted bonding, skinto-skin opportunities, and breastfeeding and chestfeeding initiation and may have long-term health consequences for the dyad. 33,34 Given that Black, Indigenous, and People of Color (BIPOC) communities have experienced higher rates of COVID-19 infections and deaths and inequitable access to testing and vaccines, the pandemic has only exacerbated preexisting health disparities and inequities impacting Black communities. [35][36][37] Going forward, we need multiple public health and clinical strategies that center community experiences and expertise and are informed by Community-Based Participatory Research (CBPR) principles.…”