BackgroundLimited data are available regarding the balance of risks and benefits from human milk and/or breastfeeding during and following maternal infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).ObjectiveTo investigate whether SARS-CoV-2 can be detected in milk and on the breast after maternal coronavirus disease 2019 (COVID-19) diagnosis; and characterize concentrations of milk immunoglobulin (Ig) A specific to the SARS-CoV-2 spike glycoprotein receptor binding domain (RBD) during the 2 months after onset of symptoms or positive diagnostic test.MethodsUsing a longitudinal study design, we collected milk and breast skin swabs one to seven times from 64 lactating women with COVID-19 over a 2-month period, beginning as early as the week of diagnosis. Milk and breast swabs were analyzed for SARS-CoV-2 RNA, and milk was tested for anti-RBD IgA.ResultsSARS-CoV-2 was not detected in any milk sample or on 71% of breast swabs. Twenty-seven out of 29 (93%) breast swabs collected after breast washing tested negative for SARS-CoV-2. Detection of SARS-CoV-2 on the breast was associated with maternal coughing and other household COVID-19. Most (75%; 95% CI, 70-79%; n=316) milk samples contained anti-RBD IgA, and concentrations increased (P=.02) during the first two weeks following onset of COVID-19 symptoms or positive test. Milk-borne anti-RBD IgA persisted for at least two months in 77% of women.ConclusionMilk produced by women with COVID-19 does not contain SARS-CoV-2 and is likely a lasting source of passive immunity via anti-RBD IgA. These results support recommendations encouraging lactating women to continue breastfeeding during and after COVID-19 illness.

Because breastfeeding provides optimal nutrition and other benefits for infants (e.g., lower risk of infectious disease) and benefits for mothers (e.g., less postpartum bleeding), health organizations recommend that healthy infants be exclusively breastfed for 4 to 6 months in the United States and 6 months internationally. Recommendations related to how long breastfeeding should continue, however, are inconsistent. The objective of this article is to review the literature related to evidence for benefits of breastfeeding beyond 1 year for mothers and infants. In summary, human milk represents a good source of nutrients and immune components beyond 1 year. Some studies point toward lower infant mortality in undernourished children breastfed for >1 year, and prolonged breastfeeding increases interbirth intervals. Data on other outcomes (e.g., growth, diarrhea, obesity, and maternal weight loss) are inconsistent, often lacking sufficient control for confounding variables. There is a substantial need for rigorous, prospective, mixed-methods, cross-cultural research on this topic. Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Synopsis The mammary gland has evolved to accommodate the developmental needs of offspring in species-specific ways. This is particularly true for marsupials. Marsupial milk content changes dramatically throughout lactation in ways appearing timed with neonatal ontogeny and behavior. Here we investigate morphological restructuring within the mammaries throughout lactation in the gray short-tailed opossum, Monodelphis domestica. Substantial remodeling of the mammaries occurs throughout the first half of active lactation. It is not until the latter half of lactation that opossum mammaries appear histologically similar to active eutherian mammaries. Noteworthy was the presence of eosinophils in early developing mammary tissue, which correlated with elevated abundance of transcripts encoding the chemokine IL-16. The presence and abundance of whey protein transcripts within the opossum mammaries were also quantified. Whey acidic protein (WAP) transcript abundance peaked in the latter half of lactation and remained elevated through weaning. Minimal transcripts for the marsupial-specific Early and Late Lactation Proteins (ELP/LLP) were detected during active lactation. Elevated abundance of LLP transcripts was only detected prior to parturition. Overall, the results support the role of eosinophils in mammary restructuring appearing early in mammalian evolution, and describe key similarities and differences in nutritional protein transcript abundance among marsupial species.

The sodium (Na) concentration and the ratio of Na to potassium (K; Na/K) in human milk are used commonly as biomarkers of subclinical mastitis, but limited data exist on their relationship to and ability to predict clinical mastitis. Here, we assessed concentrations of Na, K, Na/K, and somatic cell count (SCC), a mammary health biomarker used in the dairy industry, in milk prospectively collected from both breasts of 41 women over the first 6 weeks postpartum. Although values differed over time postpartum, there were no differences in mean values between breasts. Nearly one-quarter (24%) of participants experienced clinical mastitis. Somatic cell counts >4.76 × 105 cells/mL were most strongly related to development of clinical mastitis in the following week (odds ratio, 7.81; 95% CI, 2.15–28.30; p = 0.002), although relationships were also observed for SCC > 4.00 × 105 cells/mL and Na concentration >12 mmol/L. Estimates of the prevalence of subclinical mastitis in women who never progressed to clinical mastitis differed by biomarker but ranged from 20 to 75%. Despite these findings, positive predictive values (PPV) of the biomarkers for identifying clinical mastitis were low (≤0.34), indicating additional research is needed to identify single biomarkers or composite measures that are highly specific, sensitive, and predictive of clinical mastitis in women.

Marsupials, with short gestation times, have more complex and changing patterns of milk composition than eutherians. Maternal immunoglobulins (Ig) that confer immunity on offspring are among the components that change during marsupial lactation. In the present study we quantified the abundance of mammary transcripts encoding Ig heavy chains and their corresponding transporters in the laboratory opossum Monodelphis domestica. IgA transcripts were the most abundant in opossum mammary and, with IgM, increased in abundance linearly from birth to weaning. Similarly, the Fc receptor for IgA, the poly-Ig receptor, also increased in abundance throughout lactation. There were few transcripts for IgG or IgE within the opossum mammaries. This is in contrast with reports for Australian marsupial species. Transcripts for the Neonatal Fc Receptor (FcRN), which transports IgG, were detected throughout lactation, and opossum milk is known to contain IgG. Therefore, milk IgG is likely to be taken from the maternal circulation, rather than resulting from local production. There is a parallel increase in FcRN in the newborn gut that declines around the time when neonates have matured to the point where they can make their own IgG. These results are consistent with a transfer of maternal Ig that is coordinated with the development of the neonatal immune system.