Research on COVID-19, Pregnancy and Bodyfeeding
What have we learned about COVID-19 in the past year? Although we have been living in a global pandemic for a calendar year there are still so many questions people have about this virus and its implications on our health. While long-term effects will continually be studied as time goes on, we have learned some things about SARS-CoV-2 and its relationship to pregnancy and bodyfeeding.
Currently, this first week of March 2021, both the global infection rate and the overall infection rate in the United States is falling. While the 1,779 new cases reported in Illinois last week is lower than the previous few weeks (The New York Times, 2021), Cook County still has the second highest death rate of all counties in the U.S. at just under 10,000 deaths (John Hopkins, 2021). In addition, the increase of variant strains has raised more questions and has epidemiologist concerned that we may see a rise in infection rates and deaths once again. Because we won’t see a significant impact on viral spreading due to vaccines for months, until many more people are vaccinated, it is important to continue to focus on prevention. Mask wearing, social distancing and regular hand washing should still be your priority. If you are exposed or contract COVID-19, remaining isolated to prevent further transmission while you recover, is still essential.
Observation has shown being pregnant puts you at no greater risk of contracting COVID-19. But multiple studies have indicated that outpatient pregnant people are more likely to suffer symptoms longer than nonpregnant people and simply being pregnant puts you at greater risk for a severe or critical case of COVID-19 (Dekker, 2021). The Center for Disease Control has included pregnant people in its “increased risk” category regarding COVID-19. The good news is, even though the risks for symptomatic COVID-19 is greater, the overall risk for acute illness or death is remarkably low.
Treatment While Pregnant
There is very little data on actual medications that treat COVID-19 during pregnancy. Corticosteroid treatments have been studied and shown to lower the 28-day mortality rate (Dekker, 2021). In a randomized trial that include both pregnant and nonpregnant people, use of the corticosteroid dexamethasone proved to reduce the 28-day mortality rate. In a separate study of dexamethasone and hydrocortisone, both had similarly lowered 28-day mortality rates. The American College of Obstetrics and Gynecology recommends that “dexamethasone a corticosteroid be used for pregnant people with COVID-19 who are receiving supplemental oxygen or are mechanically ventilated. And that dexamethasone should not be withheld for treatment of COVID-19 due to pregnancy status. Dexamethasone is used in a wide range of conditions for its anti-inflammatory and immunosuppressant effects (Dekker, 2021).” So, we now know that corticosteroids should not be withheld from pregnant people who are hospitalized with severe or critical cases of COVID-19. If you are hospitalized with COVID-19 while pregnant treatment including corticosteroids is considered safe.
Another concern regarding care and treatment for pregnant people with COVID-19 is blood clotting. Blood clots are associated with some severe cases of COVID-19 and can cause rashes, kidney failure, stroke or even death. Pregnant and postpartum people are at an increased risk for blood clots and should be monitored more closely if they develop COVID-19. According to the ACOG “People with active COVID-19 infections during pregnancy, particularly those with severe or critical disease may benefit from anticoagulants, but the treatment is only recommended right now for those who are hospitalized (Dekker, 2021). If you are pregnant or recently postpartum and diagnosed with COVID-19, talk to your care provider about monitoring you for blood clots.
Bodyfeeding While Infected With COVID-19
Both the CDC and The World Health Organization continue to encourage breast and chestfeeding during this pandemic. Human milk is not a known source of infection. “Neonatal COVID‐19 infection is uncommon, rarely symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or remains with the mother” (Walker, O’Donoghue, Grace, Dorling, Comeau, Li, Thornton). Parents with suspected or confirmed COVID-19 can bodyfeed if they desire and are well enough to do so comfortably. If you have COVID-19 and wish to breast or chestfeed the CDC recommends proper sanitary practices such as hand-washing, cleaning surfaces you are in contact with, sneezing and coughing into a tissue that is immediately disposed of and wearing a mask while feeding and during any close contact with your baby. If you are too ill to bodyfeed your child, seek support to express or pump, supplement with human donor milk, have someone else breastfeed your baby, or supplement with formula until you are well enough to bodyfeed once again. Support from a lactation consultant can help you navigate these options and help keep your milk supply up while you are unable to chestfeed. A fed baby is best, and if formula is the best option for your family while you navigate COVID-19, or at any other time, than that is the right option for you. Formula may be the more practical option, but it is not considered “safer” than milk from someone infected with COVID-19. If you are concerned about the safety of bodyfeeding your baby while infected with COVID-19 the WHO states “The numerous benefits of breastfeeding substantially outweigh the potential risks of transmission and illness associated with the COVID-19 virus.” If pumping or formula is used, be sure to properly clean and sanitize all pump parts, bottles and surfaces where these items are kept. Wash your hands before pumping, preparing formula and feeding your baby. Never put a mask on a child under 2 years old as it puts them in danger for suffocation (CDC).
An early fear of SARS-CoV-2 and pregnancy was that infection would lead to higher rates of miscarriage or developmental problems for the fetus. These fears have been dispelled. After a year of studying this virus there is no evidence that infection causes or increases the risk for loss or fetal damage. According to Evidence Based Birth there is an observed increase in risk of preterm birth especially in patients who contract pneumonia. But it is unclear if the increase in early delivery is solely because of COVID-19 illness or due to other factors as well (Dekker, 2021).
Antibodies Passed Through Human Milk From Vaccinated Parents
Pregnant and lactating people have been historically excluded from medical and vaccine trials. There is a trial currently underway which is studying the Pfizer vaccine and human milk, and that data should be available later this year. Both the WHO and the CDC have encouraged pregnant healthcare workers to go ahead a get the vaccine. We know that lactating parents can pass influenza antibodies through their milk to their children. And it appears that the same is true for SARS-CoV-2 infections as well. Antibodies for COVID-19 have been found in human milk when the lactating parent recovered from a COVID-19 infection during pregnancy. Antibodies have also been found in human milk when the lactating parent received a vaccination for COVID-19 (Shapiro). A very small study done in Oregon found that lactating parents who were given both doses of the Pfizer vaccine had increased levels of IgG and IgA antibodies which were detected in their bodymilk (Shapiro).
Overall, the data that we have regarding pregnant and lactating people and COVID-19 is limited but hopeful. Currently, neither the CDC or the WHO are discouraging people from planning pregnancies or bodyfeeding if so desired. While COVID-19 puts pregnant people at a higher risk for blood clots, length of time that symptoms are experienced and severity of illness, these risks are still considered low. Pregnancy can still be maintained safely even when diagnosed with COVID-19. The benefits of skin-to-skin contact after delivery, delayed cord clamping and chest or breastfeeding still outweigh the low risks of transmitting a COVID-19 infection to your newborn. If these customs are important to you, they can still be practiced safely. More information is continuing to be available as we observe vaccination rollout. Deciding to get vaccinated while pregnant is a personal choice and one that should be discussed with your care provider. To date there is no indication that it is not safe although more data is needed. Vaccinated parents who are bodyfeeding or had COVID-19 during pregnancy are passing on protective antibodies to their babies along with other valuable nutrients critical for healthy development. Talk to your care provider about how they can support you and your pregnancy or bodyfeeding as we continue to navigate the SARS-CoV-2 pandemic.
*The data from this article was pulled on March 6th, 2021 and may not reflect the most current statistics or guidelines when you access it.
Resources
Illinois Coronavirus Map and Case Count”. The New York Times, 6 March, 2021 https://www.nytimes.com/interactive/2020/us/illinois-coronavirus-cases.html.
“Covid-19 United States Cases by County”. John Hopkins University & Medicine, 6 March, 2021 https://coronavirus.jhu.edu/us-map.
Dekker, Rebecca, Host. “Updated Evidence on COVID-19 and Pregnancy.” Evidence Based Birth Podcast, episode 164, 17 February 2021, https://evidencebasedbirth.com/covid19/.
Walker KF, O’Donoghue K, Grace N, Dorling J, Comeau JL, Li W, Thornton. “Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis.” BJOG: An Internal Journal of Obstetrics and Gynaecology. March 6, 2021. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.16362.
“Coronavirus disease (COVID-19):Breastfeeding”. World Health Organization, 6 March, 2021 https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19-breastfeeding.
“Coronavirus Disease (COVID-19) and Breastfeeding”. The Center For Disease Control and Prevention, 6, March, 2021 https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/covid-19-and-breastfeeding.html.
Shapiro, Nina. “Antibodies For Covid-19 Found in Breast Milk After Vaccine.” Forbes, 6 March, 2021, https://www.forbes.com/sites/ninashapiro/2021/03/04/antibodies-for-covid-19-found-in-breast-milk-after-vaccine/?sh=652858ed6f4e.