Breastfeeding and COVID-19
Press release from the French National Academy of Medicine
September 8, 2020
In addition to its nutritional and immune benefits for newborns and infants, breastfeeding maintains and develops the mother-child relationship established during pregnancy [1]. In the event of Covid-19, current scientific data excludes the passage of a viable and contaminating virus in breast milk [2,3].
Two situations can arise:
– the mother, who developed a SARS-CoV-2 infection during the last trimester of pregnancy, is cured at the time of delivery: under these conditions, she must be encouraged to breastfeed because the antibodies pass into breast milk and protect her child;
– the mother is affected by Covid-19 while breastfeeding; three questions then arise:
1. Can she continue to breastfeed her child and under what conditions?
2. Should the child be separated from its mother if breastfeeding is accepted and continued?
3. if the mother is receiving drug treatment, should breastfeeding be stopped? or should the milk be discarded during the treatment? In the absence of evidence-based data, expert opinions [4,5] relayed by the “Société française de néonatologie” provide answers to the first two questions. The asymptomatic or pauci-symptomatic mother can continue to breastfeed. The child must not be in contact with his/her mother without precautions as long as she remains contagious, but breastfeeding can be continued provided that protective measures are taken with regard to the child: wearing a surgical mask and a gown changed at each feeding, careful washing of the hands, cleaning and disinfection of the nipples, then further disinfection of the hands with hydro-alcoholic gel before picking up the child, and hand washing again after breastfeeding. The only justified drug treatment in a mother with asymptomatic or pauci-symptomatic Covid-19 is paracetamol: for a conventional dosage, the concentrations ingested by the child are approximately 0.1% of the dose ingested by the mother, they are therefore safe and do not require interruption of breastfeeding [6].
In practice, the National Academy of Medicine recommends:
– to always favor breastfeeding to ensure immune protection for the newborn and the infant as well as a quality mother-child relationship;
– to encourage any mother suffering from an asymptomatic or pauci-symptomatic form of Covid-19 to breastfeed, observing all the necessary precautions (careful hand washing and wearing of surgical mask during feeding);
– not to interrupt breast-feeding if the mother is taking paracetamol.
References
[1] Rapport sur l’alimentation du nouveau-né et du nourrisson (Newborn and Infant Feeding Report): Bull Acad Natle Med. 2009, 192, 431.
[2] Chen HJ, Guo JJ, Wang C et al. Clinical characteristics and vertical intrauterine transmission potential of Covid-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020, 395 (10226): 809-15.
[3] Babata KL et al. Feeding strategies to prevent neonatal SARS-CoV-2 infection in term or late preterm babies born to mothers with confirmed Covid-19. Cochrane Database of Systematic Reviews 2020, 7; CD013691. https://doi.org//10.1002/14651858.CD013691
[4] Stuebe A. Should infants be separated from mothers with Covid-19? Breast Feeding Medicine 2020; 15. 351
[5] World Health Organization. Clinical Management of Severe Acute Respiratory Infection (SARI) when Covid-19 Disease is suspected. Interim guidance, 2020.
https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf
[6] Bitzén PO et al. Excretion of paracetamol in human breast milk. Eur J Clin Pharmacol nineteen eighty one; 20 (2): 123-5.
