A recent study published in The Lancet has examined the milk from two nursing mothers infected with SARS-CoV-2. The researchers found SARS-CoV-2 RNA in the second mother for four consecutive days. Even so, it remains unclear if a newborn can be infected by the consumption of infected breast-milk. So far, little is known about the presence of virus in breastmilk and the transmission of the virus from infected breastmilk to an infant.
What we know about pregnancy and coronavirus
The US Centers for Disease Prevention and Control (CDC) maintains that if a Covid-19 patient chooses to breastfeed her child, she should wear a facemask while doing so and wash her hands before each feeding. Further, she should use a dedicated breast pump and follow recommendations for proper pump cleaning.
The CDC maintains that mother-to-child transmission (vertical transmission) of Covid-19 is “unlikely”. “However, after birth, a newborn can be infected after being in close contact with an infected person, including the baby’s mother or other caregivers,” it says.
Earlier in April, the Indian Council of Medical Research (ICMR) laid down the need for healthcare workers and obstetricians to factor in the consequences of the “probable” vertical transmission of Covid-19.
Vertical transmission can occur before birth (antenatal), weeks immediately prior to or after birth (perinatal), or after birth (postnatal). The guidelines noted, “With regard to vertical transmission (transmission from mother to baby antenatally or intrapartum), emerging evidence now suggests that vertical transmission is probable, although the proportion of pregnancies affected and the significance to the neonate has yet to be determined.”
Pregnant women are at a higher risk of developing more severe illness from Covid-19, as pregnancy weakens the immune system.
Another reason that pregnant women may develop more severe outcomes is because during pregnancy, the upper respiratory tract tends to be swollen due to high levels of estrogen and progesterone and restricted lung expansion, which may make such women susceptible to respiratory pathogens.
A review article published in the Journal of Reproductive Immunology in April states that Covid-19 could affect the wellbeing of mothers and infants by altering the immune responses in pregnant women. Further, it says that maternal infection and inflammation that resulted as a response to the infection could also affect the developing foetus.
Recently, a study carried out by researchers from Northwestern University in Chicago found that in 16 women who had tested positive for Covid-19, tests conducted immediately after birth found their placentas had evidence of injury. However, it is not yet clear if the damaged placenta could cause health issues in babies. A co-author of the study, Dr Emily Miller, said in a statement that while it was a preliminary study, the findings may have implications on how pregnant women should be monitored during the pandemic.
What does the new study in The Lancet tell us?
Researchers collected milk samples from two infected mothers after feeding and milk disinfection and viral loads were determined using RT-qPCR tests. Following admission and delivery (day 0), four samples taken from Mother 1 tested negative. On the other hand, virus RNA was detected in the milk taken from Mother 2 at 10 days, 12 and 13. Further, the detection of virus RNA in Mother 2 coincided with mild COVID-19 symptoms.
While it cannot be said for certain if breastmilk with virus RNA can go on to infect newborns who consume it, the finding adds to the emerging evidence about the possible locations where virus RNA can be found. For instance, the presence of viral RNA of SARS-CoV-2 has also been found in faeces, but that does not necessarily mean that it is infectious.
Researchers have called for further studies of breastmilk samples to determine if transmission is possible through this medium.
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