Importance: Limited data are available on COVID-19 vaccine impact in lactating women. Objective: To evaluate the impact of different COVID-19 vaccines on specific anti-SARS-CoV-2 IgA and IgG levels in human milk. Design, Settings and Participants: In this prospective observational study in Spain, 75 lactating women from priority groups receiving vaccination against SARS-CoV-2 were included (January to April 2021). Human milk samples were collected at seven-time points. A group with confirmed SARS-CoV-2 infection (n=19) and a group of women from prepandemic time (n=13) were included. Exposure: mRNA vaccines (BNT162b2 and mRNA-1273) and adenovirus-vectored vaccine (ChAdOx1 nCoV-19). Main Outcome(s) and Measure(s): Presence of IgA and IgG against RBD SARS-CoV-2 in breast milk. Results: Seventy-five vaccinated lactating women [mean age, 34.9±3.7 years] of whom 96% were Caucasic and 92% were health care workers. A total of 417 milk samples were included and vaccine distribution was BioNTech/Pfizer (BNT162b2, n=30), Moderna (mRNA-1273, n=21), and AstraZeneca (ChAdOx1 nCoV-19, n=24). For each vaccine, 7 time points were collected from baseline up to 25 days after the 1st dose and same points were collected for mRNA vaccines 30 days after 2nd dose. A strong reactivity was observed for IgG and IgA after vaccination mainly after the 2nd dose. Presence and the persistence of specific SARS-CoV-2 antibodies in breast milk were dependent on the vaccine-type and, on previous virus exposure. High inter-variability was observed, being relevant for IgA antibodies. IgG levels were significantly higher than those observed in milk from COVID-19 women while IgA levels were lower. Women with previous COVID-19 increased the IgG levels after the 1st dose to a similar level observed in vaccinated women after the 2nd dose. Conclusions and Relevance: Breast milk from vaccinated women contains anti-SARS-CoV-2 IgA and IgG, with highest after the 2nd dose. Levels were dependent on vaccine type and previous exposure to SARS-CoV-2. Previous COVID-19 influenced the vaccine effect after a single dose, which could be especially relevant in the design of vaccination protocols . Further studies are warranted to demonstrate the potential protective role of these antibodies against COVID-19 in infants from vaccinated and infected mothers through breastfeeding.

Background Breast milk is a vehicle to transfer protective antibodies from the lactating mother to the neonate. After SARS-CoV-2 infection, virus-specific IgA and IgG have been identified in breast milk, however, there are limited data on the impact of different COVID-19 vaccine types in lactating women. This study is aimed to evaluate the time course of induction of SARS-CoV-2-specific IgA and IgG in breast milk after vaccination. Methods In this prospective observational study in Spain, 86 lactating women from priority groups receiving the vaccination against SARS-CoV-2 were included. Breast milk samples were collected longitudinally at seven or eight-time points (depending on vaccine type). A group with confirmed SARS-CoV-2 infection (n=19) and a group of women from pre-pandemic time (n=20) were included for comparison. Results Eighty-six vaccinated lactating women [mean age, 34.6 ± 3.7 years] of whom 96% were Caucasian and 92% were healthcare workers. A total number of 582 milk samples were included, and vaccine distribution was BioNTech/Pfizer (BNT162b2, n=34), Moderna (mRNA-1273, n=20), and AstraZeneca (ChAdOx1 nCoV-19, n=32). For each vaccine, 7 and 8 longitudinal time points were collected from baseline up to 30 days after the second dose for mRNA vaccines and adenovirus-vectored vaccines, respectively. A strong reactivity was observed for IgG and IgA after vaccination mainly after the 2nd dose. The presence and persistence of specific SARS-CoV-2 antibodies in breast milk were dependent on the vaccine type, with higher IgG and IgA levels in mRNA-based vaccines when compared to AstraZeneca, and on previous virus exposure. High intra- and inter-variability were observed, being relevant for IgA antibodies. In milk from vaccinated women, anti-SARS-CoV-2 IgG was significantly higher while IgA levels were lower than in milk from COVID-19-infected women. Women with previous COVID-19 increased their IgG antibodies levels after the first dose to a similar level observed in vaccinated women after the second dose. Conclusions COVID-19 vaccination induced anti-SARS-CoV-2 IgA and IgG in breast milk with higher levels after the 2nd dose. Levels of anti-SARS-CoV-2 IgA and IgG are dependent on the vaccine type. Further studies are warranted to demonstrate the protective antibody effect against COVID-19 in infants from vaccinated and infected mothers. Trial registration NCT04751734 (date of registration is on February 12, 2021)

Interventions in mHealth have had positive effects on establishing and maintaining breastfeeding, but we still do not know what content women consult when downloading a breastfeeding mobile application. We conducted an observational, descriptive, and retrospective study using the data recorded by LactApp in 2019. The most frequently consulted topics were those related to breastfeeding technique, infant sleep, human milk management and storage, breastfeeding myths, breastfeeding stages, complementary feeding, infant care, and returning to work. Our study results suggest that LactApp's support seems to develop with mothers' needs according to their infant's development stage. The first breastfeeding days include more physiological answers. Between 15 days and 3 months, mothers look for support in topics like breastfeeding crisis/complications and returning to work. At 3 months to 1 year, answers are related to complementary feeding and weaning. When the user's infant is 1 year of age, mothers seek support for weaning, weaning management, and tandem breastfeeding.

Background: Mobile applications related to health issues are currently expanding.Different uses of new technologies have produced positive results regarding breastfeeding support. Breastfeeding applications are increasing.Objective: We conducted a descriptive analysis of a mobile application for breastfeeding (LactApp) to study the user profile and the most frequent queries. Materials and Methods:This was a retrospective, comparative and descriptive ecological time series study of LactApp from 2016 to 2019. Google Analytics and the app itself were used for data collection. The data were analysed in Excel, and for the time series, Prais-Winsten auto-regressions were applied based on the Durbin-Watson method in Stata.Results: A total of 115,830 users and 71,780 infants were registered in the application. A total of 1.91% of these users obtained the medical version. The application was used for both queries and surveys and for users to interact through chat. A total of 30.17% of the responses were related with "baby's sleep" (8.94%), 8.91% were related to "preservation of milk", 6.16% were related to "breastfeeding crisis", and 6.15% were related to "physiological evolution of breastfeeding", all with an increasing trend. Conclusion:LactApp is a resource for breastfeeding that is widely downloaded and used by a substantial number of individuals. The most recurring topics were baby's sleep, milk extraction and preservation, breastfeeding crisis and physiological evolution of breastfeeding.

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Introduction:Breastfeeding is an unquestionable right of mothers and their children; however, it is not a one-woman job. For breastfeeding to succeed, women must have access to appropriate support and guidance. The COVID-19 pandemic and subsequent restriction measures and lockdown to reduce community spread of the disease have negatively impacted breastfeeding support from health services and thus, in mothers' breastfeeding experiences.Objective: The present study aims to evaluate the impact of COVID-19 pandemic on breastfeeding consultations in LactApp (a mobile app for mHealth focused on breastfeeding support, www.lactapp.com) during the COVID-19 pandemic. Materials and Methods: We conducted an observational, descriptive, and retrospective study with LactApp data recorded between July 2018 and March 2021 including 9,151,456 queries classified in 48 topics among 137,327 active users. We used Interrupted time series model to evaluate the increase of number of queries consulted and active users due to the COVID-19 pandemic. Wilcoxon test was used to study the increase of certain topics due to the COVID-19 pandemic.Results: LactApp active users increased by 12,092 users (p-value<0.001) during the COVID-19 outbreak and confinement and queries consulted in LactApp also significantly increased by 10,899 queries per month after the pandemic outbreak. The breastfeeding topics that significantly increased are those related to growth spurts, breastfeeding stages, breastfeeding technique, breast pain and mastitis, problems with infants not gaining weight correctly, hypogalactia, increased milk demand, and relactation. These findings are important to understand the potential of online tools when face-to-face professional support is unavailable.

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