It's Safe to Breastfeed with Covid, Study Says

Breastfeeding mothers recovering from Covid can breathe a sigh of relief. In the largest study to date looking at Covid in breast milk, a team of researchers from California found the likelihood of spreading the Covid virus to infants through breastfeeding is low.

The recent evidence published in the journal Pediatric Research found that it’s safe to breastfeed with Covid.

“Recent SARS-CoV-2 infection or detection of its RNA in human milk is not a contraindication to breastfeeding,” concluded the researchers.

While they found a small amount of genetic material for the virus that causes Covid in the breast milk of infected mothers, there was no evidence of infectious viral particles that could transmit to a baby via breast milk.

The findings support the current Centers for Disease Control and Prevention (CDC) guidelines stating that breast milk is unlikely to transfer the virus and cause an infection. To further reduce the chances of your baby getting sick, they advise people who are breastfeeding or planning to breastfeed to get vaccinated or get a booster shot as soon as possible.

What the study shows

From March 2020 to September 2020, the researchers collected breast milk samples from 110 women who were actively breastfeeding to look for any traces of SARS-CoV-2. Of the 110 women, 65 tested positive for Covid, nine showed Covid-like symptoms but tested negative for the virus, and 36 had symptoms but did not take a Covid test.

Of the women positive for Covid, seven had at least one sample of breast milk with detectable levels of SARS-CoV-2 viral RNA in their breast milk. Interestingly, the other breast milk samples donated by the same seven women showed no evidence of viral RNA.

Researchers detect no evidence of infectious Covid virus in breast milk

Finding viral RNA is not the same as finding an infectious virus. To see if breast milk had infective viruses or viral particles that could pass on to infants, the researchers also searched for evidence of subgenomic RNA (sgRNA). This type of viral RNA serves as a genetic marker, indicating that the virus is in the process of making copies of itself to infect nearby cells.

Results showed no evidence of sgRNA in any of the breast milk samples.

However, there is a possibility that the virus was present, but changes in temperature from refrigeration and warming of breast milk made it harder to detect the virus. A previous report suggested antimicrobial activity in breast milk stops SARS-CoV-2 from growing after several cycles of freezing and thawing. To test this theory, the team performed a separate set of experiments where SARS-CoV-2 grown in a lab was artificially placed into breast milk samples from two healthy women.

Despite several cycles of refrigerating and thawing, the researchers continued to detect high levels of infectious SARS-CoV-2 in the virus-containing breast milk.

The results suggest the lack of virus in breast milk is not because of temperature changes or differences in handling breast milk. Rather, the study provides strong evidence that infected mothers can breastfeed safely without risking the health of their child.

Breastfeeding with Covid may offer some protective benefits to infants

Not only is breastfeeding safe, the benefits a child can get from breast milk far outweigh the risk of getting Covid.

A growing body of evidence suggests breast milk from mothers who either recovered from Covid and/or were vaccinated may provide temporary immunity to the breastfeeding baby against Covid. According to the World Health Organization, mothers who recovered from a Covid infection had high IgA antibody levels in breast milk. Beyond its ability to protect against infections, IgA antibodies also boost your child’s immune system and their cognition.

Research from the University of Rochester also found IgG and IgA antibodies in the breast milk of mothers who had Covid or were vaccinated. While both antibody types were effective in neutralizing Covid, vaccinated mothers largely produced IgG antibodies and Covid-positive mothers produced more IgA antibodies in their breast milk.

Recently, a study published earlier this month found 87% of breast milk from vaccinated women had antibodies. The IgG and IgA antibodies were effective in neutralizing the original Covid virus, the Alpha variant, the Beta variant, and the Gamma variant. This may be especially helpful for kids under age 2, who are not yet eligible for Covid vaccination.

What to do if you have Covid and choose to breastfeed

The current study shows that it is safe to give breast milk to your child even when you’re positive with Covid. But because Covid can spread through the air, there is always a risk of passing on the virus to your child if you are sick.

If you decide to breastfeed, the CDC recommends the following:

Wear a mask when breastfeeding or within 6 feet of your baby
Wash your hands with soap and water for at least 20 seconds or use a hand sanitizer with at least 60% alcohol before breastfeeding

Having a close friend or family member feed the breast milk to the baby could help reduce the chances of infecting your child. If you go this route, consider choosing someone who is healthy, vaccinated and recently tested negative for Covid. As a further precautionary measure, you may want to have the person feeding your baby wear a mask to reduce the risk of coming into contact with Covid while you are isolating.

What to do if you have Covid and choose to pump

Whether or not you have Covid, you’ll want to make sure your breast pump is clean at all times. To prevent germs from growing in breast milk or in pump parts, the CDC has laid out several tips for keeping your breast pump clean:

When preparing to pump milk, wash your hands with soap for at least 20 seconds
If you have Covid, wear a mask throughout the process and avoid sharing breast pumps with other people
Use disinfectant wipes to clean the pump before and after each use
If any parts get moldy or soiled, replace it immediately
Clean each pump part that has touched your breast or breast milk by handwashing it and leaving it out to air dry
Steam pump parts for further sanitization

How to take care of your child while you’re sick with Covid

When caring for an infant while recovering from Covid, the best thing you can do is take your precautions.

Minimize the risk of spreading the virus through person-to-person contact by wearing a mask and washing your hands well after every interaction. You may also want to disinfect your home daily, including wiping down commonly touched items such as phones and doorknobs. Limiting contact with others outside the household and with your baby can prevent the virus from circulating to others.

In case the virus spreads, you’ll want to monitor any potential signs of infection. Some signs of Covid to watch out for in newborn infants are:

Fever
Lethargy
Runny nose and cough
Abnormally rapid or shallow breathing
Vomiting
Diarrhea
Little interest in feeding

Covid infections in newborn infants are uncommon, says the CDC. But babies with other health conditions or who were born prematurely are at a higher risk of developing severe illness. If your child presents with one or more of these symptoms, contact their pediatrician regarding testing and treatment.

Sources

Krogstad P, Contreras D, Ng H, Tobin N, Chambers CD, Bertrand K, Bode L, Aldrovandi GM. No infectious SARS-CoV-2 in breast milk from a cohort of 110 lactating women. Pediatric Research. 2022 Jan 19:1-6. doi:10.1038/s41390-021-01902-y

Narayanaswamy V, Pentecost BT, Schoen CN, Alfandari D, Schneider SS, Baker R, Arcaro KF. Neutralizing Antibodies and Cytokines in Breast Milk After Coronavirus Disease 2019 (COVID-19) mRNA Vaccination. Obstetrics & Gynecology. 2022 Feb 1;139(2):181-91. doi:10.1097/AOG.0000000000004661

Young BE, Seppo AE, Diaz N, et al. Association of Human Milk Antibody Induction, Persistence, and Neutralizing Capacity With SARS-CoV-2 Infection vs mRNA Vaccination. JAMA Pediatr. Published online November 10, 2021. doi:10.1001/jamapediatrics.2021.4897