Coronavirus and Breastfeeding

Coronavirus and Breastfeeding

Just a few months into the new year and 2020 has reminded many of us always to expect the unexpected. Most notably, the world has been taken by storm by the new strain of coronavirus, SARS-CoV-2. Initially dubbed 2019-nCOV or the Novel Coronavirus of 2019. 

While limited retrospective studies have shown that coronavirus or COVID-19 does not pass through breastmilk, it is still possible for an infected mother to pass on the virus while nursing her child through close contact. Coronaviruses are easily transmitted through droplets and via touching surfaces contaminated with bodily fluids such as saliva or mucus. The appropriate precautions are required to prevent passing the virus to your baby.

The coronavirus disease, or COVID-19, still needs to be extensively researched and studied. However, what doctors and scientists do know is that this is no ordinary bug like the seasonal flu or common cold. From the same family of viruses, COVID-19 is closely related to the deadly SARS and MERS outbreaks that occurred in previous decades. 

Despite a large number of COVID-19 cases spreading globally, many have recovered with adequate treatment. Deaths have been mostly attributed to COVID-19 infection in patients with preexisting comorbidities. Factors such as advanced age, diabetes, cardiovascular disease, and history of respiratory conditions are an important consideration.

While the approach to identification and treatment of the virus are based on the measures taken for SARS and MERS, COVID-19 carries its own challenges due to its extremely high virulence. The earliest symptoms are mild and identical to many illnesses. This makes arriving at a definitive diagnosis difficult without a special testing kit available at hospitals and clinics.

Recommendations from the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) urge people to practice self-quarantine and avoid close contact. This can lead to concerns with how to interact with and feed your child while preventing transmission of the virus. 

The key to properly managing your child’s health, as well as your own, is to remain calm and arm yourself with the right information from reputable sources.

Risk Factors and Symptoms of COVID-19

The SARS-CoV-2 virus has been noted to be transmitted in all age groups, from the very young to the very old. It seems that the virus causes more devastating effects in the middle-aged and elderly, especially those who have preexisting conditions or comorbidities. 

Risk Factors for Adults

  • History of smoking (including second-hand smoke exposure)
  • Previous lung conditions or disease (e.g., asthma, pneumonia, tuberculosis)
  • Living in cities with an unhealthy Air Quality Index
  • Cardiovascular disease
  • Hypertension
  • Diabetes mellitus
  • Compromised immunity (e.g., other infections, cancer, taking medications like corticosteroids)
  • History of travel to areas with confirmed cases or direct contact with a confirmed case

Interestingly, the children who were infected with the virus manifest very mild symptoms or remain asymptomatic. The number of infected children is also relatively smaller than that of the adult population. Experts are not quite sure why this is, but regardless of the symptoms (or lack thereof), children can still carry and transmit the virus to adults and other children.

Symptoms of COVID-19

General or Early Symptoms (2-14 days)

 Late Symptoms or Warning Signs

  • Fever
  •  Severe pneumonia
  • Cough
  •  Increased difficulty breathing
  • Shortness of breath
  •  Chest pain or pressure
  • Runny nose
  •  Confusion or disorientation
  • Vomiting
  •  Lethargy or loss of consciousness
  • Diarrhea
  •  Cyanosis

Note: Not every symptom may be experienced by every individual, while some may experience other symptoms not stated previously. Diagnosis can only be made by a health professional with access to a laboratory or test kit to confirm the presence of the virus.

Transmission of coronavirus during pregnancy

Pregnant women are considered one of the special populations of people in terms of healthcare. They are more vulnerable to infections, mainly due to the fluctuations in their hormones, as well as the progressive shift toward a sedentary lifestyle during pregnancy. In addition to the increased risk of infection, a pregnant woman’s health directly affects her fetus—namely through exposure to certain medications, pathogens, and environmental hazards.

One retrospective study was done in Wuhan, China – the epicenter of the COVID-19 outbreak – wherein pregnant women with laboratory-confirmed COVID-19 pneumonia had samples of amniotic fluid, cord blood, throat swabs, and breastmilk taken and tested.

After the birth of the babies, the samples of amniotic fluid and cord blood were all negative for the virus. These findings suggest that the virus does not vertically infect fetuses while they are in the womb, at least not in the third trimester. 

Transmission of coronavirus through breastmilk

Just as information on the viral transmission during pregnancy is scarce, viral transmission through breastmilk is not entirely known. In the retrospective study done in Wuhan, the samples of breastmilk taken from nine mothers who were confirmed to have COVID-19 pneumonia tested negative. 

While the virus does not seem to pass through breastmilk, it is still possible for an infected mother to pass on the virus while nursing her child through close contact. Coronaviruses are easily transmitted through droplets and via touching surfaces contaminated with bodily fluids such as saliva or mucus.

It is essential to get yourself tested if you have any travel history to cities with confirmed cases. Getting tested is also essential if you have had contact with patients confirmed to have COVID-19, especially if you are also experiencing symptoms. Even if you are asymptomatic and have no history of travel, it is still possible to carry and transmit the virus.

Proper handwashing with soap and water for a minimum of twenty seconds is the best way to prevent the spread of the virus. Hand sanitizer may be used as a substitute for handwashing only when access to soap and water is unavailable. Isolation and social distancing are encouraged, and family members who are suspected or confirmed to have the virus should be quarantined for 14 days to prevent the spread of disease to vulnerable groups such as the elderly, and immunocompromised.

Because breastfeeding is the best source of nutrition and passive immunity for infants, mothers are still encouraged to nurse or pump breastmilk. Mothers should avoid touching their eyes, nose, and mouth while nursing and holding her child. Frequent handwashing and cleansing of the breasts should be done to minimize viral transmission during feeding.

Treatment for COVID-19 while Breastfeeding

As of now, there is no specific medication, vaccine, or cure for COVID-19 whether a mother is breastfeeding her child or not. Viral infections tend to be self-limiting, and there have been cases of patients recovering from the disease within 1-2 weeks. Supportive treatment is done. This includes rest, hydration, oxygen supplementation, and adequate nutrition, depending on the patient’s symptoms and condition.

References

CDC. (2020, March 13). Symptoms. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html?CDC_AA_refVal=https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html

Chen, H., Guo, J., Wang, C., Luo, F., Yu, X., Zhang, W., … Zhang, Y. (2020). Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet395(10226), 809–815. doi: 10.1016/s0140-6736(20)30360-3

Jenco, M. (2020, March 14). Experts discuss COVID-19 impact on children, pregnant women. Retrieved from https://www.aappublications.org/news/2020/03/12/coronavirus031220

Odenbach, C. (2020, March 10). ABM STATEMENT CORONAVIRUS. Retrieved from https://www.bfmed.org/abm-statement-coronavirus

Pregnancy & Breastfeeding. (2020, March 14). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html?CDC_AA_refVal=https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-faq.html

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