Is it safe to breastfeed for mothers with an infection?

Mothers who wish to breastfeed during periods of acute infections need strong support, especially during the COVID-19 pandemic, suggests a Singapore study.

“As always, the decision to breastfeed remains deeply personal, and is dependent on multiple factors including societal norms, the individual’s unique circumstances, and personal desires,” the researchers said. [Int Breastfeed J 2020;15:16]

“It is important for physicians to be sensitive to the thoughts and needs of new mothers, to facilitate breastfeeding wherever possible,” they added.

Lead researcher Samantha Yeo from KK Women's and Children's Hospital, Singapore, and her team conducted a literature search on PubMed using various combinations of keywords related to breastfeeding and various infections. In addition, citations from included articles were reviewed for further studies.

Except for human immunodeficiency virus (HIV) and human T-cell lymphotropic virus types 1 and 2, most ongoing infections do not pose serious harm to children who are being breastfed by their mothers. Of note, increasing evidence indicates that with adequate antiretroviral therapy, breastfeeding could be safe even in the presence of HIV. [Proc Singap Healthc 2022;doi:10.1177/20101058221123395]

“In a World Health Organization bulletin entitled ‘Breast is always best, even for HIV-positive mothers’, it was recommended that HIV-positive mothers on antiretroviral therapy should breastfeed to maximize their babies’ health prospects,” the researchers said.

A study also showed that exclusive breastfeeding in the first 6 months of an infant’s life leads to a three- to fourfold reduction in the risk of HIV transmission relative to mixed feeding. [Bull World Health Organ 2010;88:9-10]

COVID-19 transmission

Even in mothers with SARS-CoV-2 infection, the causative agent of COVID-19, current evidence suggests that breastfeeding is safe. Thus, initiation and continuation of breastfeeding must be supported to protect the health of babies and mothers.

“If a mother mounts an immune response to a particular pathogen following symptomatic or asymptomatic infection, it is possible that some immunity can be transferred to her offspring in the same manner via antibodies in her breast milk,” the researchers said.

“Increasing evidence demonstrates that within the entero-mammary immune system, transport of plasma cells occurs continuously between gut-associated lymphatic tissue into the systemic circulation, and then back to the gut to provide local secretory immunity, as well as to distant sites to provide the same specific immunity,” they added.

In a previous study, the authors suggested that passive immunity from breast milk was protective against some infectious diseases and toxins to which infants are vulnerable. [Dig diseases sciences 1979;24:876-882]

Breast milk contains immune-active compounds, such as immune cells, antibodies, growth factors, and cytokines, which help boost an infant’s immature immune system. Its main antibody is immunoglobulin A (IgA). [Microorganisms 2020;8:289]

“Breast milk protects the offspring from infections via the secretory IgA antibodies, but also possibly via other factors such as the bactericidal lactoferrin,” the researchers said. [Ann Nutr Metab 2016;69(Suppl 2):16-26]

“During lactation, there is evidence of protection to the offspring against respiratory tract infections, urinary tract infections, diarrhoea, otitis media, neonatal septicaemia, and necrotizing enterocolitis,” they added.