TORONTO -- Mothers infected with COVID-19 are unlikely to pass the virus to their newborns while breastfeeding if appropriate safety measures are taken, according to a new study.
The study, published Thursday in The Lancet Child & Adolescent Health, found that wearing a face mask while breastfeeding and cleaning hands before handling the babies kept the novel coronavirus from spreading from mothers to their infants.
The study observed mothers and their babies at three New York City hospitals between March 22 and May 17. Researchers reported no cases of viral transmission among the 120 babies born to COVID-positive mothers, even when both shared a room and the mothers breastfed.
The babies remained in enclosed cribs, six feet apart from their mothers, except while breastfeeding. Mothers were also required to wear masks when handling their child and followed proper hand- and breast-washing procedures.
The babies were tested for COVID-19 within 24 hours after birth, and researchers conducted follow-up exams and tests even after many of the mothers were discharged to their homes.
Two weeks after birth, the study found that none of the babies tested positive for the virus. None of the babies had COVID-19 symptoms either.
However, the researchers noted that the babies were only tested via nasal swab as blood, fecal and urine coronavirus tests had not been approved at the time of the study. A nasal swab test might not have detected the virus if the baby was infected in the womb, according to the study.
Despite evidence that COVID-19-positive mothers can pass the virus on to their unborn infants, the new study found that babies are rarely becoming infected with the virus after birth when proper safety measures are followed.
"We know that skin-to-skin contact and breastfeeding are important both for mother-infant bonding and for long-term child health. Our findings suggest that babies born to mothers with COVID-19 infection can still benefit from these safely, if appropriate infection control measures are followed," co-author of the study Dr. Patricia DeLaMora said in a press release.
Though strong evidence for COVID-19 transmission from a mother to her unborn child was reported earlier this month in a study published in Nature Communications, researchers say coronavirus infection in the womb is rare.
According to data from the American Academy of Pediatrics (AAP), between 2 and 5 per cent of babies born to an infected mother have tested positive for COVID-19 in the first 24 to 96 hours after birth.
However, the primary lead of the new study cautioned that larger studies are needed to better understand the risks of transmission from mother to child.
"Data on the risk of COVID-19 transmission during pregnancy or while breastfeeding are limited to a small number of case studies. Consequently, guidelines for pregnant women and new mothers vary. We hope our study will provide some reassurance to new mothers that the risk of them passing COVID-19 to their babies is very low," Dr. Christine M. Salvatore of Weill Cornell Medicine-New York Presbyterian said.
BREASTFEEDING AND COVID-19
The new study affirms current guidelines by the World Health Organization (WHO) that mothers with suspected or confirmed COVID-19 should continue to breastfeed.
The UN health agency says the benefits provided by breastfeeding, such as nurturing mother-infant interaction, "substantially outweigh" the potential transmission risks of the virus.
The Canadian Paediatric Society (CPS) issued an advisory in April in line with the WHO’s guidance.
The CPS said the main concern is the virus being transmitted from mother to infant through respiratory droplets, not breast milk.
"Women who choose to breastfeed should wear a mask (if available), wash their hands, and clean their breast area with soap and water before each feeding," the guidelines said.
Mothers can also pump breast milk, but must ensure they wash their hands and clean all equipment. Frequently touched household surfaces should also be regularly disinfected.
While researchers have detected genetic evidence of coronavirus and its antibodies in breast milk, it is unclear whether the virus in the milk was viable and could infect a baby.
The new study has prompted the American Academy of Pediatrics to update its guidance on the care of newborns to mothers with COVID-19.
The AAP's initial recommendations in early April advised a temporary separation between infected mothers and newborns based on limited data from China that involved separating newborns from their mothers for 14 days.
The updated pediatrician-issued guidance now states that a baby is at low risk of infection when staying with the mother after delivery if she wears a mask and cleans hands before holding her infant. The guidance has not recommended against breastfeeding.
