COVID-19 and pregnancy and breastfeeding: everything you need to know

Breast milk of mothers who have received COVID-19 vaccine contains disease-fighting antibodies

The breast milk of nursing mothers vaccinated against COVID-19 contains a significant amount of antibodies that can help protect infants from the disease, new US research shows.

We no longer have the many advantages breastfeeding for mother and child. In this time of health crisis, several health organizations have declared that it is not necessary to interrupt it during an infection with COVID-19 (provided the recommended precautions are taken), nor after the mother’s vaccination. In addition, based on the available scientific data and knowledge about the action of vaccines, vaccinating a nursing mother to protect her from COVID-19 poses no risk to her child. Breastfeeding mothers who have received the vaccine have antibodies in their milk, which could even help protect their baby from infection with the virus.

This is the finding drawn up by a study published in “Breastfeeding Medicine” by researchers at the University of Florida. When babies are born, their immune systems are underdeveloped, which prevents them from fight infections alone. They are also often too young to respond adequately to certain types of vaccines. During this vulnerable period, breast milk helps provide infants with “passive immunity”, which would be the case with COVID-19 when the mother is vaccinated. “Think of breast milk as a toolbox filled with all the different tools that help prepare the infant for life. “, Explain the researchers.

“Vaccines can protect both mother and baby”

They add: “Immunization adds another tool to the toolkit, which has the potential to be effective in prevent COVID-19 disease. Our results strongly suggest that vaccines can help protect both mother and baby, another reason for pregnant or breastfeeding women to get vaccinated. The study was conducted between December 2020 and March 2021, when Pfizer and Moderna vaccines have become available to healthcare workers. Researchers recruited 21 breastfeeding women who had never contracted COVID-19 and drew their breast milk and blood three times: before vaccination, after the first dose and after the second dose.

They found a strong antibody response in blood and breast milk after the second dose, about a hundred times higher than the levels before vaccination. “These levels are also higher than those seen after natural infection with the virus. They note, adding that vaccinating mothers to protect their babies is nothing new. “As a general rule, pregnant women are vaccinated against whooping cough and influenza, serious illnesses for infants. Babies can also get COVID-19, so routine vaccination of mothers against the virus may be something we will see in the future. », They say.

A conclusion confirmed by other studies

With this in mind, the research team continues to explore how breast milk containing COVID-19 antibodies obtained through vaccination protects babies who consume it. The next step will be to determine if the infants in question are developing their own protection against COVID-19 and to know more about these antibodies themselves, such as the duration of their presence. in breast milk and their effectiveness in neutralizing the virus. The scientific team also wishes to explore the potential therapeutic uses of breast milk produced by vaccinated mothers, but recalls that this present study already validates a growing body of evidence on this subject.

“We are delighted to see that many other studies conducted simultaneously around the world have also demonstrated the presence antibodies in breast milk of vaccinated mothers. », Conclude the researchers. A study in particular, published last June by Spanish public research, not only revealed that the breast milk of vaccinated women was a “ antibody transmission vector But also that the RNA of the virus was not detected in any of the breast milk samples analyzed. Note that in France, since April 2021, pregnant women can access mRNA vaccines (Pfizer and Moderna) from the second trimester of pregnancy.

Covid-19: a previous infection does not decrease the chances of IVF success

Researchers have been interested in the likelihood of successful IVF in women who have suffered from COVID-19 infection. Their study shows that their ovarian reserve has not been impacted by the disease, and that their chances are therefore not reduced.

It has already been scientifically proven that vaccines against Covid-19 do not cause fertility problems. Now a new study shows that Covid-19 does not affect the chances of getting pregnant thanks to IVF. Carried out within the IVI clinic in Madrid, it affirms more precisely that the ovarian reserve of women previously infected with the virus was not negatively affected, and that their chances of success of this fertility treatment remained as they were before infection. According to the scientific team, the question arose, however, because during infection, SARS-CoV-2 attacks cells by targeting the ACE2 receptor, which is expressed in the ovaries.

“It is only now, more than a year after COVID-19 infection rates hit their first peak and knowing that SARS-CoV-2 receptorshave present in the ovary, that we are able to assess the effect of the virus on reproductive function. “, Explain the researchers. The study, presented at the annual meeting of the European Society of Human Reproduction and Embryology, consisted of monitoring hormone levels in thes women who have had IVF dyears in one of the 11 group IVI clinics in Spain between May and June 2020. All the women in the study had baseline hormonal measurements before starting treatment.

The reviews included measurements anti-Müllerian hormone (AMH) as a marker of ovarian reserve: it makes it possible to obtain a good measure of ovarian reserve and therefore of the fertility of each patient. AMH has become a widely used measure in fertility clinics in recent years, capable of predicting how patients might respond to ovarian stimulation for in vitro fertilization, although its reliability as a marker of fertility. general feminine is more contested. The scientific team carried out new measurements of this hormone in 46 patients candidates for IVF and having been infected with Covid-19.

“The data showed no variation in AMH levels before and after infection with SARS-CoV-2, and we can assume that the chances of their IVF treatment being successful have remained intact. “, Add the researchers, according to whom COVID-19 infection is therefore unlikely to compromise ovarian reserve. “Several studies reported so far have been reassuring about the effect of COVID-19 infection on female fertility, which further reassures those planning a IVF fertility treatment. The latter nevertheless indicate that this is a small study and that it is not possible to draw any conclusions in terms of public health.

Covid-19, pregnancy and breastfeeding: all you need to know

Are we considered to be at risk for a severe form of Covid-19 when we are pregnant? Can the coronavirus be transmitted to the fetus? Can we breastfeed if we have Covid-19? What are the recommendations? We take stock.

COVID: Very low risk for newborns to be infected through breast milk

A new study offers more certainty as to the fact that mothers infected with SARS-CoV-2 can safely breastfeed their babies provided they respect the barrier gestures. A few months earlier, the World Health Organization and the Academy of Medicine were already of this opinion.

If a mother is infected with Covid-19 while breastfeeding, then three questions arise: can she continue to breastfeed her child And under what conditions ? Should the child be separated from its mother if breastfeeding is accepted and continued? If the mother is receiving drug treatment, should breastfeeding be stopped? To date, there is no contraindication to continuing to breastfeed your baby if you are infected with the coronavirus, the World Health Organization (WHO) considering that no transmission of the virus. through breast milk has been observed and that its benefits remain essential for the health and brain development of the child, and throughout his life.

A new study published in the journal Pediatrics confirms this recommendation from public health authorities, with supporting evidence. Conducted at the Albert Einstein College of Medicine in New York with 55 healthy infants born mothers with COVID-19 revealed that none of them had contracted the virus, although most began to obtain breast milk in hospital. However, on condition that certain precautions are observed, also already mentioned by the World Health Organization. “If you wash your hands frequently and wear a mask, there is no reason why you cannot breastfeed, ”explains Dr Marcel Yotebieng.

Bottle or breast, taking precautions

In an editorial published with this new study, the latter estimates that although breastfeeding recommendations already exist, it is important that studies continue to find out whether childhood infections linked to breast milk may occur. In the study, three-quarters of babies received breast milk during their hospital stay and 85% were breastfed after returning home. None of them have been infected with the coronavirus, based on screening tests performed two to three weeks after leaving the hospital. Note, however, that due to health measures in place, infants received bottle-fed breast milk.

Earlier in the pandemic, the hospital’s policy was indeed to separate newborns from their babies. mothers tested positive for SARS-CoV-2. But doctors say “it no longer seems necessary, as long as protective measures such as wearing a mask and washing hands are followed. “The latter therefore say they agree with the statements of the WHO in this area, according to which” women with confirmed or suspected COVID-19 can breastfeed if they wish because of the many advantages of skin-to-skin contact and breastfeeding far outweigh the potential risks transmission of the COVID-19 virus and associated disease. “

Promote immunity of the newborn against all kinds of infection

The science team raised another question: is it possible that breast milk is providing these infants antibodies against the coronavirus ? “Such antibodies have been detected in the breast milk of infected women but it is not known whether they help protect babies. This is why we need more research. What seems increasingly clear, however, is that the risk of babies contracting COVID-19 through breastfeeding is very low and any risk should be weighed against the enormous benefits of breastfeeding. », Adds Dr Marcel Yotebieng.

The scientific team recalls in this epidemic context that breastfeeding promotes immune system development babies. According to information from the Centers for Disease Control and Prevention in the United States, breastfed babies are less likely to develop ear infections, asthma and severe lung infections. “We must also remember that there are infections other than SARS-CoV-2. »She concludes. Note that in France, the Academy of Medicine has declared itself in favor of breastfeeding in mothers suffering from an asymptomatic or pauci-symptomatic form of Covid-19, with all necessary precautions, and not to interrupt it in the event of taking paracetamol subject to a conventional dosage.

The pregnant woman, a vulnerable person at risk of severe form?

Only pregnant women in the third trimester of pregnancy are considered vulnerable people with respect to Covid-19 (excluding associated pathologies such as diabetes, hypertension, etc.). In the 3rd trimester, a pregnant woman is considered more at risk of severe form of the disease, due to physiological and immunological upheavals occurring at the end of pregnancy. Doctors mention in particular the volume of the uterus, who limits lung capacity and reduces diaphragm movements. Moreover, all lung infections are difficult to manage in the third trimester of pregnancy. Childbirth, which requires significant breathing efforts, can also be more complicated.

What treatment for Covid-19 during pregnancy?

Above all, self-medication should be avoided, because many drugs are contraindicated during pregnancy because of a risk of malformation in the fetus, in particular.

In case of suggestive symptoms, we therefore consult without delay, in order to have the optimal care. Which will be adapted according to the severity of the disease and the state of pregnancy. Against fever, the use of paracetamol can be considered, but again on medical advice.

Can the coronavirus pass from a pregnant woman to her unborn child?

Although the press has reported on cases of transmission of the Sars-CoV2 coronavirus from mother to fetus, whether during pregnancy or – more likely – during childbirth and the very first contacts at birth, mother-to-child transmission in utero remains very rare. The scientific community agrees that these cases remain exceptional, and that in the majority of pregnancies, the infection of the expectant mother with Covid-19 is not transmitted to the unborn baby.

A fairly reassuring Chinese case study was published on March 16, 2020 on this subject, in the journal “Frontiers in Pediatrics”. Professors indicate that it does not appear that the viral infection with Covid-19 is transmissible from the mother to the fetus during pregnancy, nor at the time of childbirth.

In any case, pregnant women are advised, as with other diseases of human-to-human transmission (seasonal flu, gastroenteritis) to keep their distance from sick people, if only as a precaution. The “barrier” gestures (hand washing, safety distance, use of disposable handkerchiefs, etc.) recommended by the WHO should therefore be adopted with care.

Coronavirus: its impact on pregnant women and their infants

A synthesis of studies published by the World Health Organization (WHO) in September 2020 provides a better understanding of the symptoms, risk factors and consequences of the coronavirus for pregnant women and their babies.

Pregnant women and newborns are considered to be at risk during this period of the coronavirus epidemic. Following the various cases reported and the observations made, the publications are growing. As of June 26, 2020, the World Health Organization (WHO) listed more than 86 scientific works on the subject and published a summary in the British medical Journal (BMA).

Among the observations made, researchers at the University of Birmingham find that pregnant women suspected or actually affected by Covid-19 are less likely than others to have fever or muscle pain. On the other hand, if they contract a severe form of the disease, they are more likely to seek intensive care.

Covid-19 and pregnancy: special monitoring

Likewise, if the pregnant woman has another disease (diabetes, chronic arterial hypertension, etc.), is overweight or is older, the risk of complications increases.

In addition, pregnant women with Covid-19 are more likely to give birth prematurely. It is therefore important that the medical teams be prepared and be able to provide them with special care if necessary.

WHO also draws their attention to the fact of recognizing the stress and anxiety that these women and those around them can feel in this epidemic context in order to better support them.

Breastfeeding and Covid-19: can I breastfeed with the Sars-CoV-2 coronavirus?

“Given the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, the mother can continue to breastfeed, while observing the necessary precautions,” said Unicef. 

Breastfeeding and symptoms of Covid-19: can you touch and hug your newborn baby?

In the event of symptoms, breastfeeding women are advised to follow the recommended hygiene rules, wearing a mask including when breastfeeding, washing their hands before and after contact with their baby and disinfecting contaminated surfaces. If they are too sick to breastfeed, Unicef ​​believes that mothers with Covid-19 should be encouraged to express their milk and give it to the child via a spoon or cup-type container.

In its press release of March 30, 2020 relating to the conditions for taking charge of pregnancy and childbirth during the Covid-19 pandemic, the CNGOF and the SYNGOF specify: ” If the mom is COVID-19 positive, she will need to wear a surgical mask at all times. As long as there is no passage of the virus into the milk, direct breastfeeding or feeding after breastfeeding is possible in a mother with suspected or confirmed COVID-19 infection. For all mothers, it is therefore essential to respect the strict hygiene rules, with regular hand washing with soapy water, rubbing the hands with a hydro-alcoholic solution each time before taking care of the baby, wait until the hands are dry before picking up the baby, do not touch the mask or the face, and complete by washing the breasts with mild non-odorous soap and water. »

Breast milk: it does contain anti-Covid antibodies in women who have been infected

As we know, breast milk is a mine of antibodies, giving the baby precious immune defenses at the start of his life. From the start of the current pandemic, several studies reported the presence of antibodies against the Sars-CoV-2 coronavirus in women who were infected during their breastfeeding or shortly before. On the other hand, the nature and quantity of antibodies present in breast milk after infection remain relatively unknown and poorly evaluated.

In a new study, published this November 20 in the journal iScience, American researchers analyzed in detail the composition of the breast milk of women recently infected with the coronavirus, an infection confirmed by a PCR test or simply suspected due to symptoms. The study was conducted using 15 breast milk samples from 15 patients. Milk samples were collected 3-4 weeks after symptoms of Covid-19 resolved.

verdict: a robust immune response was found in all breast milk samples, so much so that the researchers estimate that the breast milk of women who have been infected could actually serve as therapy against Covid-19.

To understand the details of the results, it is necessary to look at the different types of antibodies produced after contact of the organism with a pathogen. In the case of Sars-CoV-2, attention is focused on the immunoglobulins IgA, IgM and IgG. IgA is mainly found in the respiratory tract and in secretions, such as saliva, sweat and breast milk. They work by preventing the virus from attacking cells in the respiratory mucous membranes. IgMs are found mainly in the blood and are the first antibodies made in response to infection. They are evidence of an ongoing infection. As for IgG, these molecules are the most abundant (70 to 80% of the antibodies circulating in the blood) and take a little longer to be produced, but remain longer in the body after an infection.

Of the 15 samples analyzed, 80% showed a strong IgA response directed against Sars-CoV-2. But that’s not all, since 67% of the samples also contained IgM and / or IgG. All of them bind directly to the Spike protein located on the surface of the coronavirus, which then allows it to be eliminated.

For the authors of the study, these results encourage the development of breast milk-based therapies of women exposed to the coronavirus, in particular to treat severe forms of Covid-19.

Finally, remember that, despite the pandemic, the benefits of exclusive breastfeeding are such for the baby that the World Health Organization and health authorities continue to recommend it to all women, even those who have contracted Covid-19. (with respect for barrier gestures if the infection is proven or in the event of suggestive symptoms).

Should pregnant women be vaccinated against Covid-19?

Should we recommend vaccination against Covid-19 to pregnant women? Are they all concerned by the current vaccination campaign? 

On July 20, the Minister of Health, Olivier Véran, declared that vaccination was not contraindicated for pregnant women from the first three months of pregnancy. Interviewed by FranceInfo, Jacky Nizard, gynecologist at Pitié Salpêtrière in Paris, confirms that “A lot of women have been vaccinated without knowing they were pregnant, so it’s a risk-benefit ratio. If there is a fourth big wave, it will be necessary to vaccinate the women from the beginning of their pregnancy. ” 

Pregnant women have been vaccinated in the United States, for example, or in Israel, and a study published in April in the New England Journal of Medicine involving more than 35 pregnant women vaccinated between December and February did not show increased risks of the vaccine during pregnancy, no complications at birth or for the fetus during its lifetime in utero.