Evidence on the impact of COVID-19 on breastfeeding

Preserving breastfeeding in the age of COVID-19: A call to action

COVID-19 has so far shown significant impact on maternity clinical practice, lactation counselling and support services. More than half of the healthcare professionals in the maternity ward and NICU have reported important changes in clinical practice. Also, the healthcare system is under considerable pressure and supporting staff are being reduced, with midwives and breastfeeding specialists being most affected by these reductions. As a result, new mothers lack essential support in the first critical days to help their infants to breastfeed or if the infant cannot breastfeed to initiate and build an adequate milk supply for the long term. In addition, COVID-19 has caused significant stress in breastfeeding mothers due to diverse factors.

Despite the initial intentions of mothers to breastfeed, COVID-19 has seen a signifcant negative impact on reastfeeding duration and rates as new reduced access to maternity services become the norm.

Click here to download the White Paper from the FMR research

Janis Müller, PhD Institute of Molecular Virology, Ulm University Medical Centre, Germany In our study we noticed that the entry of the viral RNA into milk might be transient, occurring infrequently during very small periods. Even though we have detected viral RNA in human milk, this does not mean that it is infectious. Also, I am not aware of any publication in which active virus in human milk has been confirmed.

Human Milk, COVID-19 and breastfeeding - A scientific literature review on COVID-19 and breastfeeding to date

As the pandemic unfolded, many questions were asked with respect to transmission routes and modes of infection, with particular interest devoted to the mother-infant dyad and the status of breastfeeding and breast milk. Whilst the benefits of breast milk and breastfeeding to the mother and the infant are well documented, there was uncertainty in the early stages of the pandemic with respect to hospital practices and recommendations around COVID-19 and breastfeeding. What was clear, however, was the need for evidence-based recommendations addressing the issue of transmission whilst accounting for the value of breastfeeding. Such recommendations would enable new mothers and their babies to continue benefitting from the advantages of breastfeeding and the use of human milk in this COVID-19 era.

Click here to download a comprehensive and updated literature review of the scientific evidence to date by Leon Mitoulas, Nania Schärer-Hernandez and Severine Liabat (Front. Pediatr. 20 November 2020)

Click here to download a summary of the literature review

Click here for the webinar on this topic

Lars Bode, Professor of Pediatrics and Director of the Mother-Milk-Infant Center of Research Excellence (MOMI CORE), University of California, San Diego, USA None of the milk samples from COVID-19-infected mums tested positive for presence of active virus, and the presence of viral RNA is rare. The data indicate that transmission from the mum to the infant via human milk is unlikely.

Scientific roundtables to understand and act on the impact of COVID-19 on maternity clinical practice and breastfeeding support

Global roundtable
German roundtable

Medela hosted a series of virtual roundtable discussions with leading researchers to understand the impact of COVID-19 on breastfeeding at a global and local level and to share their thoughts on current changes in clinical maternity practices and breastfeeding support.

Nine experts in breastfeeding, lactation, immunology and virology, including Lars BodeRiccardo DavanzoDonna GeddesJanis MüllerHans van GoudoeverRebecca PowellVirginie Rigourd, Diane Spatz and Ann Yates shared their expert observations, research and recommendations for supporting breastfeeding mums and clinicians during the pandemic. Key findings included that the presence of SARS-CoV-2 RNA is rare in breast milk and that a vast majority of mums have a strong antibody response to SARS-CoV-2 in their breast milk when infected or upon recovery. Concerned about the changes in clinical practice, all experts have emphasised the importance of providing mothers with evidence-based information and guidance and breastfeeding support as there is a critical window of opportunity to establish milk supply effectively.

Their viewpoint is published in a paper in the journal Frontiers in Pediatrics ‘Promoting and Protecting Human Milk & Breastfeeding in a COVID-19 World’.

During a roundtable conducted in Germany including Silke Mader, Aleyd von Gartzen, Ursula Felderhoff-Müser, Monika Berns, Vera Hesels, Prof. Dr. med. Michael Abou-Dakn, Thomas Kühn, Johannes Middelanis, the experts discussed the impact of COVID-19 on breastfeeding in Germany and concluded that breastfeeding should be promoted particularly in times of COVID-19, that the separation of mother and child should be avoided and that parents must be informed early on about breastfeeding and about suitable hygiene measures.

Medela 2020/21 webinar series on breastfeeding and lactation in the COVID-19 era

As coronavirus suddenly spread around the globe, so did inaccurate and unsubstantiated information that led to great uncertainty on the part of mothers and health care professionals. In addition, the COVID-19 situation has brought changes in clinical practice on the maternity ward: a shortened length of stay in the hospital after delivery, the possible separation of the mother from her baby and increased pressure on healthcare personnel. All these factors can impact the appropriate initiation of the mother’s breastfeeding journey as well as its duration. In order to provide the latest information and research results on breastfeeding, breast milk, safety and health of pregnant women, nursing mothers and their babies in the COVID-19 era, we have created a bespoke webinar series.                                

The Psychosocial Impact of Covid 19 on NICU Families
Visitation restrictions and limited access to mental health services due to COVID-19 have had a substantially additive effect to the stressors already felt by NICU families - who are at higher risk for Postpartum Depression, anxiety disorders and PTSD.

The Antibody Response Against SARS-CoV-2 (COVID-19) in Human Milk
In this webinar, Dr. Powell will describe the human milk immune system, focusing on the antibody response after infection or vaccination, and the functions of those antibodies for infants, or as a potential therapeutic for all.

Protecting Human Milk and Breastfeeding in a COVID 19 World & Beyond
Dr. Diane L. Spatz, PhD, RN-BC, FAAN and Dr. Lars Bode

Protecting the Mother-Baby Dyad During the COVID-19 Pandemic: The Columbia University Experience
Dr. Dani Dumitriu, MD, PhD and Cynthia Gyamfi-Bannerman, MD, MSc, FACOG

Breastfeeding, Human Milk and COVID-19 – what does the evidence say?
Leon Mitoulas, PhD and Nania Schärer-Hernández, PhD

Breast Milk - a Source of SARS-CoV-2 Antibodies
Prof. Dr. J. (Hans) B. van Goudoever, MD, PhD

Evidence of a strong and specific antibody response against SARS-CoV-2 in human milk
Assistant Professor Rebecca Powell, PhD

The impact of the COVID-19 pandemic on the use of human milk and breastfeeding in the NICU
Prof. Jae Kim MD, PhD

Protecting maternal milk supply during the COVID-19 pandemic
Diane L. Spatz PhD, RN-BC, FAAN

COVID-19 in human milk: What do we know?
Lars Bode, Professor of Pediatrics and Director of the Mother-Milk-Infant Center of Research ...

Using the COVID-19 pandemic as an opportunity to address the use of human milk and breastfeeding as lifesaving medical interventions
Diane L. Spatz PhD, RN-BC, FAAN.

Rebecca Powell, Assistant Professor Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, USA We found that the vast majority of mums have a strong antibody response to SARS-CoV-2 in their breast milk and that this antibody response could neutralise the virus. This is important for mums and healthcare professionals to realise and shows the value of breastfeeding.
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