Transmission of SARS‐CoV‐2 through breast milk and breastfeeding: a living systematic review

Centeno‐Tablante, Elizabeth; Medina‐Rivera, Melisa; Finkelstein, Julia L.; Rayco‐Solon, Pura; Garcı́a-Casal, Marı́a Nieves; Rogers, Lisa M.; Ghezzi‐Kopel, Kate; Ridwan, Pratiwi; Peña‐Rosas, Juan Pablo; Mehta, Saurabh

doi:10.1111/nyas.14477

Cited by 148 publications

(155 citation statements)

References 302 publications

(296 reference statements)

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“…To ensure that current evidence and updated information are available to the research communities and final users, a living systematic review will be conducted using rapidly emerging and new research evidence generated through a continual literature search approach as previously described elsewhere 25 . Standard method of reporting living systematic reviews 26 were used and will be used every time when the new COVID‐19 research evidence become available.…”

Section: Methodsmentioning

confidence: 99%

Possible vertical transmission and antibodies against SARS‐CoV‐2 among infants born to mothers with COVID‐19: A living systematic review

Bwire

Njiro

Mwakawanga

et al. 2020

Journal of Medical Virology

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Current evidence suggests that coronavirus disease 2019 (COVID‐19), caused by severe respiratory syndrome coronavirus 2 (SARS‐CoV‐2), is predominantly transmitted from human‐to‐human. However, evidence on vertical transmission and natural passive immunity among the newborns exposed to COVID‐19 is scanty and varies. This poses a challenge on preventive interventions for the newborns. We conducted a systematic review to first, determine the likelihood of vertical transmission among COVID‐19 exposed infants and second, determine whether antibodies against SARS‐CoV‐2 were generated among COVID‐19 vertically exposed but negative infants. This review registered in PROSPERO searched evidence from PubMed/MEDLINE and Google Scholar, among others. About 517 studies were pooled, where 33 articles (5.8%) met the inclusion criteria such as infection prevention and control measures at birth. A total of 205 infants born to COVID‐19 positive mothers were studied. Overall, 6.3% (13/205; 95% CI: 3.0%–9.7%) of the infants tested positive for COVID‐19 virus at birth. Of 33 eligible studies, six studies (18.8%) reported about immunoglobulin G/M (IgG/IgM) against SARS‐CoV‐2. IgG/IgM were detected in 90% infants (10/11; 95% CI: 73.9%–107.9%) who tested negative for COVID‐19 virus. The median antibody levels detected were 75.49 AU/ml (range, 7.25–140.32 AU/ml) and 3.79 AU/ml (range, 0.16–45.83 AU/ml), p = .0041 for IgG and IgM, respectively. In conclusion, the current evidence revealed a low possibility of vertical transmission of COVID‐19 and antibodies against SARS‐CoV‐2 were detected among vertically exposed but negative infants. Further studies on transplacental transmission and the magnitude of natural passive immunity in infants born to mothers with COVID‐19 are warranted.

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Section: Methodsmentioning

confidence: 99%

Possible vertical transmission and antibodies against SARS‐CoV‐2 among infants born to mothers with COVID‐19: A living systematic review

Bwire

Njiro

Mwakawanga

et al. 2020

Journal of Medical Virology

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“…[6][7][8][9] While in utero vertical transmission remains unproven, 7 8 10 there may be some indication of transplacental passage of the virus. 11 Currently there is no evidence of viable, infective SARS-Co-V-2 in human milk, [12][13][14] while there are increasing reports of SARS-Co-V-2 specific immunoglobulin in infected mother's milk. [14][15][16] Isolating infants from their mothers with COVID-19 and prohibiting breastfeeding has not been associated with less postpartum transmission of the virus than where mothers are permitted to breastfeed while using appropriate infection prevention and control (IPC) measures (masks, handwashing, World Health Organization, pp 42-43).…”

Section: Introductionmentioning

confidence: 99%

Misalignment of global COVID-19 breastfeeding and newborn care guidelines with World Health Organization recommendations

Hoang¹,

Cashin

Gribble

et al. 2020

BMJNPH

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IntroductionRecommendations for the clinical management of new mothers with suspected or confirmed COVID-19 and their infants are required. Guidance must weigh the risk posed by transmission of SARS-CoV-2 against the protection that maternal proximity and breastfeeding provide infants. Our aim was to review international COVID-19 guidance for maternal and newborn care, assessing alignment with WHO recommendations and the extent to which policy supported or undermined breastfeeding.MethodsGuidance documents from 33 countries on the care of infants whose mothers were suspected or confirmed as having COVID-19 were assessed for alignment with WHO recommendations regarding: (1) skin-to-skin contact; (2) early initiation of breastfeeding; (3); rooming-in; (4) direct breastfeeding; (5) provision of expressed breastmilk; (6) provision of donor human milk; (7) wet nursing; (8) provision of breastmilk substitutes; (9) psychological support for separated mothers; and (10) psychological support for separated infants.ResultsConsiderable inconsistency in recommendations were found. Recommendations against practices supportive of breastfeeding were common, even in countries with high infant mortality rates. None of the guidance documents reviewed recommended all aspects of WHO guidance. The presence of influential guidance conflicting with WHO recommendations and an undervaluing of the importance of maternal proximity and breastfeeding to infant health appeared to contribute to this poor alignment.ConclusionThose developing guidance in the COVID-19 pandemic and other infectious disease outbreaks need to appropriately consider the importance of skin-to-skin contact, early initiation of breastfeeding, rooming-in and breastfeeding to maternal and infant physical and psychological health. In weighing the value of recommendations of others in future guidance development, countries should consider past reliability and value placed on breastfeeding. Recommendations against maternal proximity and breastfeeding should not be made without compelling evidence that they are necessary, and less harmful than maintaining dyad integrity.

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“…The Center for Disease Control and Prevention and the World Health Organization (WHO) recommend breast-feeding for mothers infected with SARS-CoV-2, as the benefits of mother's milk are thought to outweigh potential risks of transmitting the virus to the infant 1,2 . A recent systematic review, reporting on 77 nursing mothers from 37 studies concluded that there was no convincing evidence of transmission of SARS-CoV-2 via breastmilk 3 . As of December 14 th , 2020, the WHO reported over 71 million people infected by SARS-CoV-2 globally, and over 1.5 million deaths.…”

Section: Introductionmentioning

confidence: 99%

Humoral and cell-mediated response in colostrum after exposure to severe acute respiratory syndrome coronavirus 2

Narayanaswamy¹,

Pentecost²,

Alfandari³

et al. 2021

Preprint

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BackgroundColostrum provides an immune sharing between a mother and her infant. The transfer in colostrum of antibodies against SARS-CoV-2 and the elicited cytokines may provide crucial protection to the infant. There is limited literature on the immune response to SARS-CoV-2 present in colostrum.ObjectiveTo evaluate the presence of antibodies specific to SARS-CoV-2 and the associated cytokines in colostrum from women who tested positive for the virus.Study DesignBetween March and September 2020 we obtained bilateral colostrum samples collected on spot cards within 48 hours of delivery from 15 new mothers who had previously tested positive for SARS-CoV-2. Five of these 15 COVID-19 positive women also provided bilateral liquid colostrum within 1-2 days of providing the spot card samples. Archived bilateral colostrum samples collected from 8 women during 2011-2013 were used as pre-COVID-19 controls. All samples were tested for reactivity to the Receptor Binding Domain (RBD) of the SARS-CoV-2 spike protein using an ELISA that measures SARS-CoV-2 RBD-specific IgA, IgG, and IgM, and for concentrations of 10 inflammatory cytokines (IFNγ, TNFα, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13) using a multiplex electrochemiluminescent sandwich assay.ResultsBilateral colostrum samples from 73%, 73% and 33% of the 15 COVID-19 mothers exhibited IgA, IgG, and IgM reactivity to RBD respectively. Colostrum samples from two of the 8 pre-pandemic controls showed IgA and IgG reactivity to RBD. Additionally, COVID-19 mothers had significantly higher levels of 9 of the 10 inflammatory markers (all except IFNγ) as compared to the pre-COVID-19 controls. Comparable results were obtained with both the spot card-eluates and liquid samples.ConclusionsA strong humoral immune response is present in the colostrum of women who were infected with SARS-CoV-2 before delivering. High levels of 9 inflammatory markers were also present in the colostrum. The evolution and duration of the antibody response, as well as dynamics of the cytokine response, remain to be determined. Our results also indicate that future large-scale studies can be conducted with milk easily collected on paper spot cards.

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Transmission of SARS‐CoV‐2 through breast milk and breastfeeding: a living systematic review

Cited by 148 publications

References 302 publications

Possible vertical transmission and antibodies against SARS‐CoV‐2 among infants born to mothers with COVID‐19: A living systematic review

Possible vertical transmission and antibodies against SARS‐CoV‐2 among infants born to mothers with COVID‐19: A living systematic review

Misalignment of global COVID-19 breastfeeding and newborn care guidelines with World Health Organization recommendations

Humoral and cell-mediated response in colostrum after exposure to severe acute respiratory syndrome coronavirus 2

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