A study of breastfeeding practices, SARS-CoV-2 and its antibodies in the breast milk of mothers confirmed with COVID-19

Peng, Sicong; Zhu, Huaping; Yang, Lixia; Cao, Li; Huang, Xiaona; Dynes, Michelle; Narayan, Anuradha; Xia, Jianbo; Yang, Chen; Zhang, Pei; Liu, Hongyan; Li, Hua; Xia, Shiwen

doi:10.1016/j.lanwpc.2020.100045

Cited by 54 publications

(63 citation statements)

References 47 publications

(71 reference statements)

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“… 31 To date, only a few studies have quantified virus-specific antibodies in prepandemic samples to establish cut-off values to discriminate between positive and negative samples, 7 12 32 which allows comparison of results between studies. We found a similar proportion of positive samples for both IgA (from 72.9% in our study to 80.0% 7 12 ) and IgM (72.9% in our study compared with 55.0% in the study reported by Peng et al 32 ). Of the samples, 17.1% did not present virus-specific antibodies, which is in accordance with a previous study (Fox Iscience).…”

Section: Discussionsupporting

confidence: 87%

SARS-CoV-2 RNA and antibody detection in breast milk from a prospective multicentre study in Spain

Bäuerl

Randazzo

Sánchez

et al. 2021

Arch Dis Child Fetal Neonatal Ed

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ObjectivesTo develop and validate a specific protocol for SARS-CoV-2 detection in breast milk matrix and to determine the impact of maternal SARS-CoV-2 infection on the presence, concentration and persistence of specific SARS-CoV-2 antibodies.Design and patientsThis is a prospective, multicentre longitudinal study (April–December 2020) in 60 mothers with SARS-CoV-2 infection and/or who have recovered from COVID-19. A control group of 13 women before the pandemic were also included.SettingSeven health centres from different provinces in Spain.Main outcome measuresPresence of SARS-CoV-2 RNA in breast milk, targeting the N1 region of the nucleocapsid gene and the envelope (E) gene; presence and levels of SARS-CoV-2-specific immunoglobulins (Igs)—IgA, IgG and IgM—in breast milk samples from patients with COVID-19.ResultsAll breast milk samples showed negative results for presence of SARS-CoV-2 RNA. We observed high intraindividual and interindividual variability in the antibody response to the receptor-binding domain of the SARS-CoV-2 spike protein for each of the three isotypes IgA, IgM and IgG. Main Protease (MPro) domain antibodies were also detected in milk. 82.9% (58 of 70) of milk samples were positive for at least one of the three antibody isotypes, with 52.9% of these positive for all three Igs. Positivity rate for IgA was relatively stable over time (65.2%–87.5%), whereas it raised continuously for IgG (from 47.8% for the first 10 days to 87.5% from day 41 up to day 206 post-PCR confirmation).ConclusionsOur study confirms the safety of breast feeding and highlights the relevance of virus-specific SARS-CoV-2 antibody transfer. This study provides crucial data to support official breastfeeding recommendations based on scientific evidence.Trial registration numberNCT04768244.

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Section: Discussionsupporting

confidence: 87%

SARS-CoV-2 RNA and antibody detection in breast milk from a prospective multicentre study in Spain

Bäuerl

Randazzo

Sánchez

et al. 2021

Arch Dis Child Fetal Neonatal Ed

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“…One hundred and three articles were obtained from the systematic search and five articles from other sources (ie, reference lists of selected articles). After excluding duplicates and screening for titles and abstracts for articles that met inclusion criteria, 14 articles [15][16][17][18][19][20][21][22][23][24][25][26][27][28] were analysed; 6 were case reports, 3 were case-control studies, 5 were case series (table 1). Flow diagram is presented in figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…The type of infant feeding was stated in 110 individuals; 66 (60.0%) were breast feeding exclusively, 16 17 19 20 22 24 26 27 31 (28.2%) breastfed and supplemented their infants with formula milk, [21][22][23] and 13 (11.8%) fed only formula to their infants. 17 Four infants were infected with COVID-19; three were likely a result of vertical transmission.…”

Section: Demographics and Clinical Manifestations Of Lactating Individuals With Sars-cov-2 Infectionmentioning

confidence: 99%

Titres and neutralising capacity of SARS-CoV-2-specific antibodies in human milk: a systematic review

Low

Zhong

et al. 2021

Arch Dis Child Fetal Neonatal Ed

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ObjectiveSynthesise evidence on production of SARS-CoV-2 antibodies in human milk of individuals who had COVID-19, and antibodies’ ability to neutralise SARS-CoV-2 infectivity.DesignA systematic review of studies published from 1 December 2019 to 16 February 2021 without study design restrictions.SettingData were sourced from PubMed, MEDLINE, Embase, CNKI, CINAHL and WHO COVID-19 database. Search was also performed through reviewing references of selected articles, Google Scholar and preprint servers. Studies that tested human milk for antibodies to SARS-CoV-2 were included.PatientsIndividuals with COVID-19 infection and human milk tested for anti-SARS-CoV-2 neutralising antibodies.Main outcome measuresThe presence of neutralising antibodies in milk samples provided by individuals with COVID-19 infection.ResultsIndividual participant data from 161 persons (14 studies) were extracted and re-pooled. Milk from 133 (82.6%) individuals demonstrated the presence of anti-SARS-CoV-2 immunoglobulin A (IgA), IgM and/or IgG. Illness severity data were available in 146 individuals; 5 (3.4%) had severe disease, 128 (87.7%) had mild disease, while 13 (8.9%) were asymptomatic. Presence of neutralising antibodies in milk from 20 (41.7%) of 48 individuals neutralised SARS-CoV-2 infectivity in vitro. Neutralising capacity of antibodies was lost after Holder pasteurisation but preserved after high-pressure pasteurisation.ConclusionHuman milk of lactating individuals after COVID-19 infection contains anti-SARS-CoV-2-specific IgG, IgM and/or IgA, even after mild or asymptomatic infection. Current evidence demonstrates that these antibodies can neutralise SARS-CoV-2 virus in vitro. Holder pasteurisation deactivates SARS-CoV-2-specific IgA, while high-pressure pasteurisation preserves the SARS-CoV-2-specific IgA function.

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“…A newborn baby of a COVID-19 mother should be breastfed if mother's clinical status is stable or may receive mother's milk if the milk is pumped in accordance with all basic hygiene regulations. Up to date there is no evidence that mothers milk contains replicable RNA of SARS-CoV-2, contrary to the evidence for IgM antibody presence[24]. 5.…”

mentioning

confidence: 82%

COVID-19 impact on perinatal care: risk factors, clinical manifestation and prophylaxis. Polish experts’ opinion for December 2020

et al. 2021

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Rapid spread of severe acute respiratory syndrome coranovirus-2 virus (SARS-CoV-2) caused the pandemic of Coronavirus Disease 19 . Clinical course of the disease presents symptoms mainly from the respiratory system such as: cough, dyspnea and fever, and among some patients, can deteriorate even further to acute respiratory distress syndrome (ARDS), eventually leading to death. This outbreak, as well as previous ones (SARS, MERS) pose a significant challenge for health care managers, epidemiologists and physicians. Below we are presenting the clinical profile of the COVID-19 among special group of patients; pregnant women and newborns, who require special clinical management during hospitalization. In the summary of this manuscript, we present practical guidelines for managing pregnant women infected with SARS-CoV-2, labor and care of the newborn of a positive mother, as well as practical guidelines for COVID-19 vaccinations. It is important to stress, that this manuscript is based on information available as of December 2020.

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A study of breastfeeding practices, SARS-CoV-2 and its antibodies in the breast milk of mothers confirmed with COVID-19

Cited by 54 publications

References 47 publications

SARS-CoV-2 RNA and antibody detection in breast milk from a prospective multicentre study in Spain

SARS-CoV-2 RNA and antibody detection in breast milk from a prospective multicentre study in Spain

Titres and neutralising capacity of SARS-CoV-2-specific antibodies in human milk: a systematic review

COVID-19 impact on perinatal care: risk factors, clinical manifestation and prophylaxis. Polish experts’ opinion for December 2020

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