Reduced initiation and duration of breastfeeding in SARS-CoV-2-positive mothers

A recent study published in the journal Academic Pediatrics evaluated the associations between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and early breastfeeding.

Study: Association of SARS-CoV-2 Infection with Early Breastfeeding. Image Credit: HTeam / Shutterstock

Breastfeeding offers profound benefits to children and mothers. However, some demographic characteristics are linked to lower breastfeeding rates. Besides, shorter postpartum stays in the hospital have been associated with early termination of breastfeeding.

The coronavirus disease 2019 (COVID-19) pandemic has created challenges for patients and healthcare providers. The American Academy of Pediatrics initially suggested that SARS-CoV-2-infected individuals should not probably breastfeed directly. However, subsequent guidance suggested continuing breastfeeding with precautions. There is no information on the association between maternal COVID-19 and breastfeeding. Patients have been discharged early postpartum due to the caution about SARS-CoV-2 transmission during the COVID-19 pandemic.

Shorter hospital stays prevent mothers from receiving adequate support on lactation and result in unreadiness at postpartum discharge. Telehealth has been a critical tool during the pandemic, allowing timely and safe clinical care. Its rapid implementation has been pivotal in ensuring prenatal and postpartum care among vulnerable populations.

About the study

In the present study, researchers compared breastfeeding initiation, duration, and exclusivity between SARS-CoV-2-positive and -negative mothers in the first two months of neonatal life. Mother-infant dyads presenting for ambulatory postpartum visits between April 7, and June 30, 2020, were screened for eligibility.

Mothers were encouraged to continue breastfeeding during this period by wearing face masks. The study included mothers without medical conditions that could impact breastfeeding and full-term singleton neonates with one week or less postpartum hospital stays. The authors reviewed every documented pediatric contract (in-person visit, phone call, and telehealth visit) within 90 days of life.

Days 1 – 45 were defined as month one, and the remaining days as month two. Maternal demographics, delivery characteristics, and feeding status were obtained. The researchers described breastfeeding initiation as breastfeeding in the first week of life. Exclusivity was defined as breastfeeding alone, without supplemental formula, during subsequent pediatric contacts.

Breastfeeding duration was the continuance of breastmilk beyond the first week of life. Differences between SARS-CoV-2-positive- and -negative mothers were assessed using Wilcoxon tests for continuous variables and chi-squared tests for categorical variables.

Associations of breastfeeding initiation, duration, and exclusivity with maternal COVID-19 status were evaluated using Wald tests. Multivariable logistic regression was performed to examine the contributions of maternal COVID-19 status to breastfeeding outcomes, controlling for pediatric contacts, maternal demographics, and delivery characteristics.

Findings

The researchers included 285 mother-infant dyads in the study. Fifty-four mothers (19%) were SARS-CoV-2-positive; their infants were SARS-CoV-2-negative at/before discharge. Maternal/infant characteristics, delivery characteristics, and maternal demographics between SARS-CoV-2-positive and -negative mothers were not significantly different.

Overall, there were no differences in the total number of pediatric contacts between the two cohorts, but SARS-CoV-2-positive mothers had significantly more virtual contacts and fewer in-person visits than SARS-CoV-2-negative mothers. Fewer infected mothers (78%) started breastfeeding in the first week of life than non-infected mothers (87%).

The proportion of breastfeeding mothers during month 1 was similar in the two cohorts. However, twice as many mothers in the SARS-CoV-2-negative group (29%) reported breastfeeding exclusivity compared to 15% of SARS-CoV-2-positive mothers. The authors noted that race and ethnicity were significant predictors of breastfeeding initiation during the first week. Mothers who underwent a Cesarean (C) section had 53% lower odds of breastfeeding by month two than those with vaginal delivery.

Besides, postpartum length of stay was related to exclusivity. Each additional 12 hours in the hospital decreased the breastfeeding odds by 24% during month 1. In-person visits were associated with more significant breastfeeding initiation, whereas virtual contacts were not. Multivariable analyses similarly maintained the associations of breastfeeding outcomes with SARS-CoV-2 infectivity.

Conclusions

The findings suggest that maternal SARS-CoV-2 infection at delivery is associated with adverse outcomes in breastfeeding initiation and duration in the first two months of neonatal life. Multivariable analyses, controlling for pediatric contacts, maternal demographics, and maternal/infant characteristics, revealed that breastfeeding initiation in the first week of life was significantly reduced in infected mothers.

Notably, subjects with C-section deliveries were less likely to breastfeed during month 2. Moreover, there were disparities in breastfeeding initiation between multiracial/Black and White individuals. In summary, maternal SARS-CoV-2 positive status at the time of delivery was significantly and independently associated with decreased breastfeeding initiation and duration. Therefore, pediatricians should continue to encourage breastfeeding, emphasizing the neurodevelopmental benefits.