Impact of Maternal SARS-CoV-2 Detection on Breastfeeding Due to Infant Separation at Birth

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Objective

To assess the impact of separation of SARS-CoV-2 PCR-positive mother–newborn dyads on breastfeeding outcomes.

Study design

This is an observational longitudinal cohort study of SARS-CoV-2 PCR-positive mothers and their infants at three NYU Langone Health hospitals from March 25, 2020 through May 30, 2020. Mothers were surveyed by telephone regarding pre-delivery feeding plans, in-hospital feeding, and home feeding of their neonates. Any change prompted an additional question to determine whether this change was due to COVID-19.

Results

Of the 160 mother–newborn dyads, 103 mothers were reached by telephone, and 85 consented to participate. No significant difference was observed in pre-delivery feeding plan between the separated and unseparated dyads (P = .268). Higher rates of breastfeeding were observed in the unseparated dyads compared with the separated dyads in the hospital (p<0.001), and at home (p=0.012). Only two mothers in each group reported expressed breast milk as the hospital feeding source (5.6% of unseparated vs 4.1% of separated). COVID-19 was more commonly cited as the reason for change among the separated compared with the unseparated group (49.0% vs 16.7%, p<0.001). When dyads were further stratified by symptom status into four groups (asymptomatic separated, asymptomatic unseparated, symptomatic separated, and symptomatic unseparated), results remained unchanged.

Conclusion

In the setting of COVID-19, separation of mother–newborn dyads impacts breastfeeding outcomes, with lower rates of breastfeeding both during hospitalization and at home following discharge compared with unseparated mothers and infants. No evidence of vertical transmission was observed; one case of postnatal transmission occurred from an unmasked symptomatic mother who held her infant at birth.

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for coronavirus disease-2019 (COVID-19), spread globally, reaching pandemic status on March 11, 2020.[] Cases of COVID-19 in New York State reached a peak in April, 2020, with over 386,000 cases and 24,000 deaths by June, 2020.[,]
Early in the COVID-19 pandemic, limited data existed regarding the risk of adverse outcomes for pregnant women infected with SARS-CoV-2, and the risk of vertical or horizontal transmission to their newborns was unknown. Given the uncertainty surrounding potential transmission from infected mother to neonate, early guidance relied on a cautious approach and recommended separation of mother–newborn dyads to minimize the risk of transmission. The Centers for Disease Control and Prevention (CDC)[

National Center for Immunization and Respiratory Diseases (U.S.). Division of Viral Diseases., editor. Interim considerations for infection prevention and control of coronavirus disease 2019 (COVID-19) in inpatient obstetric healthcare settings 2020.