COVID-19 no deterrent for breastfeeding

While mothers largely feel uncertain about the safety of breastfeeding during COVID-19, the pandemic did not seem to significantly discourage the practice, according to a study presented at the 2022 Annual Clinical & Scientific Meeting of the American College of Obstetricians and Gynecologists (ACOG 2022).

“Current evidence suggests that the benefit of breastfeeding during the pandemic outweighs potential risks and may provide protection for the infant and mother,” the researchers said.

Through a retrospective chart review of 916 randomly selected women, rates of breastfeeding were compared between pre-COVID-19 (April 2019 to February 2020) and post-COVID-19 (April 2020 to February 2021) time periods. Potential correlates assessed included birth history, demographic factors, and insurance status.

The overall rate of breastfeeding was 72.5 percent before the pandemic, which rose slightly and nonsignificantly to 74.6 percent after COVID-19, despite the initial uncertainty regarding its safety. [ACOG 2022, abstract A305]

In the first few months of the COVID-19 pandemic, scientific evidence regarding the risk of transmitting the disease to newborns through breastfeeding was divided. A November 2020 review of studies and cases found evidence that vertical viral transmission was possible, though these findings were limited by the small number of reported cases. [Front Public Health 2020;8:558144]

On the other hand, a case series from Spain, published a few months prior, revealed minimal safety concerns as regards breastfeeding in COVID-19-positive mothers, as long as adequate infection control measures were in place. [Int Breastfeed J 2020;15:69]

As recently as March 2021, conclusive evidence regarding the safety of breastfeeding amid COVID-19 was sparse, with a literature review stating that “[b]ased on the currently available limited evidence … direct breastfeeding or extracted breastmilk should be encouraged by the healthcare providers after a careful discussion of the risks of vertical transmission to the mother and her family.” [Curr Nutr Rep 2021;10:71-75]

Current guidelines from both the WHO encourage breastfeeding, pointing out that risks of infant morbidity, mortality, and developmental delays associated with skipping breastfeeding far outweigh that of COVID-19 transmission. [https://www.who.int/news-room/commentaries/detail/breastfeeding-and-covid-19]

Predictors of breastfeeding

To assess potential indicators of breastfeeding prevalence, the researchers conducted bivariate correlation analysis, which revealed that mothers who were Medicaid beneficiaries were significantly less likely to breastfeed before the pandemic (r, –0.13; p<0.01), and even less so after (r, –0.23; p<0.001), as compared to those who were not on Medicaid.

A similar effect was reported for multiparous women, who were significantly less likely to breastfeed before (r, –0.12; p<0.05) and after (r, –0.15; p<0.01) COVID-19.

Meanwhile, women who were privately insured were significantly more likely to breastfeed before the pandemic (r, 0.13; p<0.01), an effect that was stronger after COVID-19 (r, 0.22; p<0.001).

Race also emerged as a correlate of breastfeeding, with Black mothers being less likely to breastfeed than other racial groups both pre-COVID-19 (r, –0.16; p<0.01) and post-COVID-19 (r, –0.10; p<0.05). Nevertheless, breastfeeding rates improved in this group during vs before the pandemic.

“Private insurance and age positively influenced breastfeeding rates pre– and post–COVID-19, while Medicaid, Black race, and a higher number of pregnancies negatively influenced breastfeeding rates,” the researchers said.