Maternal Transmission of SARS-CoV-2: Safety of Breastfeeding in Infants Born to Infected Mothers

Abstract

Coronavirus disease 2019 (COVID-19) is a recent epidemic disease caused by severe acute respiratory syndrome virus type 2 (SARS-CoV-2). In pregnancy, SARS-Cov-2 infection creates additional alarm due to concerns regarding the potential for transmission from the mother to the baby during both the antenatal and postpartum times. In general, breastfeeding is seldom disallowed because of infection of the mother. However, there are few exceptions with regards to certain infectious organisms with established transmission evidence from mother to infant and the link of infection of a newborn with significant morbidity and mortality. It is confirmed that pregnant women can become infected with SARS-CoV-2, although the debate on the possible vertical transmission of SARS-CoV-2 infection during pregnancy is still open. In this regard, the literature is still poor. On the contrary, the information on the safety of breastfeeding even during infections seems reassuring when the mother takes the necessary precautions. However, there are still answered questions regarding the precautions to be taken during breastfeeding by COVID-19 patients. This paper reviews the existing answers to these and many other questions. This review therefore presents a summary of the present-day understanding of infection with SARS-CoV-2 and discusses the answers around the maternal transmission of COVID-19 and the potential threat of breastfeeding to babies born to infected pregnant mothers. In conclusion, intrauterine transmission of SARS-CoV-2 infection is less likely to occur during pregnancy. Most studies suggest that COVID-19 is not transmitted through breast milk. Correspondingly, COVID-19-infected neonates might acquire the infection via the respiratory route because of the postnatal contact with the mother rather than during the prenatal period. International organizations encourage breastfeeding regardless of the COVID-19 status of the mother or child as long as proper hygienic and safety measures are adhered to so as to minimize the chance of infant infection by droplets and direct contact with the infected mother. Pasteurized donor human milk or infant formula as supplemental feeding can be quite beneficial in the case of mother–infant separation till breastfeeding is safe.

Risks and Preventions for Pregnant Women and Their Preterm Infants in a World with COVID-19: A Narrative Review

“…In a retrospective study by Chen et al including pregnant women with COVID-19, breastmilk samples of all the tested samples were negative for SARS-CoV-2 [ 70 ]. Therefore, most pediatric guidelines do not warn against breastfeeding COVID-19 mothers [ 83 ]. Due to the increasing number of COVID-19 cases every day, a set of regulations has been established to limit the number of parents who reach the NICU to prevent the transmission of infection from parents to newborns, and this limitation influences the psychological and physiological health of both parents and newborns [ 84 , 85 ].…”

The role of neutrophil extracellular traps (NETs) in the immunopathogenesis of severe COVID-19: potential immunotherapeutic strategies regulating NET formation and activity

“…У пациентов с тяжелым течением инфекционного процесса происходит срыв контроля противосвертывающей системы, что приводит к развитию неконтролируемого тромбообразования [44]. Кроме того патологическое тромбообразование приводит, в первую очередь, к повреждению микроциркуляторного русла легких и почек, что сопровождается развитием тяжелой пневмонии и острым повреждением почек [20,32]. Развивающиеся коагулопатии у детей младенческого возраста при легком течение COVID-19 могут повлечь за собой развитие синдрома Кавасаки [16].…”

Pregnancy and COVID-19: high or low risk of vertical transmission

“…Concerning breastfeeding, there have not been any positive RT-PCR findings reported in the breast milk of infected mothers [ 34 ]. Nonetheless, infected mothers are advised to stop breastfeeding until the results of RT-PCR are negative [ 35 ].…”