Medela’s 2021 Symposium, Part I: Protecting Human Milk and Breastfeeding in a COVID-19 World

Breastfeeding During the COVID-19 Pandemic

For the nearly two years that COVID-19 has been a worldwide pandemic, scientists and researchers have worked hard to understand this virus in an effort to inform care and treatments; understand variants, symptoms, and short- and long-term effects; and how to best – and most safely – co-exist in the world alongside SARS-CoV-2. A strong area of focus during this time has been on pregnant and postpartum women, including examining and, if necessary, realigning on long-time best practices when it comes to critical things like breastfeeding, initiation, the benefits of human milk, NICU guidelines, and overall maternal and infant care.  

At our recent Global Breastfeeding and Lactation Symposium in September 2021, one of the primary topics addressed was “Protecting Human Milk and Breastfeeding in a COVID-19 World”, which brought leading researchers and experts from the healthcare and lactation fields together to share important insights and their latest research to help turn science into care and nurture health for generations – all while sharing data and expertise directly related to this sensitive and ever-evolving topic.

Meet the 2021 Symposium Speakers

Learn more about these global experts, their topics and research presented at this landmark event, and snippets from their abstracts below:

Professor Lars Bode

Safety Evaluation of Human Milk at the Onset of the COVID-19 Pandemic

“In times of crisis like the COVID-19 pandemic, we need to quickly assemble the most capable teams to generate robust data that allows us to make evidence-based recommendations and ultimately save lives.” - Professor Lars Bode

For most babies, human milk is considered the best form of early life nutrition with additional immediate and long-term benefits for health and development. During extreme circumstances and crises, it is therefore of utmost importance to monitor and protect the safety of breastfeeding and the use of human milk. At the onset of the recent COVID-19 pandemic, it was critical to rapidly establish rigorous scientific evidence to ensure that the emerging infectious agent SARS-CoV-2 is not transmitted through human milk.

As soon as the WHO declared COVID-19 a pandemic on March 11^th, 2020, we quickly assembled and activated a multidisciplinary team of human milk researchers and virologists and leveraged our existing Human Milk Biorepository called Mommy’s Milk to recruit lactating women and collect milk samples – literally from day 1 of the pandemic. We and others used RT-qPCR and found that human milk does indeed occasionally contain SARS-CoV-2 viral mRNA. However, a virus is more than a piece of mRNA, which alone is not able to cause disease. We therefore tested the hypothesis that viral mRNA found in human milk represents an active, replication competent virus. We validated a cell culture SARS-CoV-2 infectivity assay for use in human milk and discovered the following:

1. Presence of SARS-CoV-2 mRNA in human milk of infected women is rare.
2. Presence of viral RNA is not the same as presence of active, replicated competent virus. In fact, none of the breast milk samples from SARS-CoV-2-infected women contained replication-competent virus, including samples that tested positive by RT-qPCR.
3. Even if breast milk was contaminated by SARS-CoV-2 during pumping and handling, Holder pasteurization, which is commonly used by human milk banks, inactivates the virus in contaminated breast milk.

In summary, our research has provided scientific evidence that transmission of SARS-CoV-2 from mother to infant through breastfeeding and the use of human milk is highly unlikely. The current pandemic has uncovered the urgent and immediate need to invest in research that establishes the safety of human milk at crisis onset. We therefore call on governments, public health agencies, and the scientific community at large to establish a “rapid response task force” that is capable of rapidly and rigorously monitoring and assessing the safety of human milk and breastfeeding at the onset of the next global health crisis.

Dr. Rebecca Powell

The Protective Effect of Human Milk Against COVID-19

“My presentation will provide critical information about human milk immunity to COVID-19, as well as educate on the immunological components in milk and how milk is unique.” - Dr. Rebecca Powell

Approximately 10% of infants will experience COVID-19 illness requiring advanced care. A potential mechanism to protect this population could be provided by passive immunity through the milk of a previously infected mother. We and others have reported on the presence of SARS-CoV-2-specific antibodies in human milk. We now report on the prevalence of SARS-CoV-2 IgA in the milk of 75 COVID-19-recovered participants and find that 88% of samples are positive for Spike-specific IgA. In a subset of these samples, 95% exhibited robust IgA activity as determined by endpoint binding titer, with 50% considered high-titer. These IgA-positive specimens were also positive for Spike-specific antibodies bearing the secretory component. Levels of IgA antibodies and antibodies bearing secretory component were shown to be strongly positively correlated. The secretory IgA response was dominant among the milk samples tested compared to the IgG response, which was present in 75% of samples and found to be of high-titer in only 13% of cases.

Our IgA durability analysis using 28 paired samples, obtained 4 – 6 weeks and 4 – 10 months after infection, found that all samples exhibited persistently significant Spike-specific IgA, with 43% of donors exhibiting increasing IgA titers over time.

Finally, COVID-19 and pre-pandemic control milk samples were tested for the presence of neutralizing antibodies; 6 of 8 COVID-19 samples exhibited neutralization of Spike-pseudotype VSV compared to 1 of 8 controls. IgA binding and neutralization capacities were found to be strongly positively correlated. These data are highly relevant to public health, not only in terms of protective capacity of these antibodies for breastfed infants, but also for the potential use of such antibodies as a COVID-19 therapeutic, given that secretory IgA is highly stable – not only in milk and the infant mouth and gut, but in all mucosa including the gastrointestinal tract, upper airway, and lungs.

Dr. Dani Dumitriu

The Impact of COVID-19 on Breastfeeding

“My presentation will focus on the effects of the pandemic and SARS-CoV-2 infection during pregnancy and breastfeeding practices of prospectively followed women who gave birth at a large medical center in New York City, an early Western epicenter, highlighting health inequities brought to light and exacerbated by the pandemic.” - Dr. Dani Dumitriu

Direct breastfeeding has well-established benefits to the mother-infant dyad, including bonding, infant immune system support, and infant growth and metabolism. The COVID-19 pandemic disrupted hospital-based maternity and newborn care models, as well as post-discharge professional and peer breastfeeding support. We sought to better understand the impact of the pandemic on breastfeeding practices in our unique population in New York City, which was one of the first and hardest-hit spots of the pandemic in the United States.

The study was part of Columbia University’s COVID-19 Mother Baby Outcomes (COMBO) Initiative:

• Mother-infant dyads were recruited to COMBO as three groups: SARS-CoV-2 unexposed, SARS-CoV-2 exposed, and a stress and procedural control group comprised of pre-pandemic deliveries in February 2020.
• SARS-CoV-2 exposure was defined as a positive nasal PCR or serology during pregnancy.
• Breastfeeding practice surveys were completed longitudinally at approximately one, two, four, and six months postpartum.
• These three groups had different maternal ethnicity (56% Latinx in the pre-pandemic group vs. 42% Latinx in the unexposed group vs. 73% Latinx in the exposed group, p<0.001) and different medical coverage (49% Medicaid in the pre-pandemic group vs. 39% Medicaid in the unexposed group vs. 57% Medicaid in the exposed group, p<0.001).

We found that more unexposed dyads reported a feeding type of exclusively or mostly breast milk at the one, two, and four month study time points. Additionally, women who self-reported Latinx ethnicity were less likely to breastfeed regardless of exposure. In a logistic regression model, we found the interaction between infection status and ethnicity to be the significant predictor of less breastfeeding. This, combined with increased risk of SARS-CoV-2 exposure in the Latinx group, resulted in a “two-hit” decrease in breastfeeding. Our data highlights an additional example of health inequities brought to light and exacerbated by the pandemic.

Her Excellency Toyin Saraki

The Sub-Saharan Effect: COVID-19, Maternal, and Neonatal Health & The Community Centered Approaches to Building Back Better

“This is a timely presentation that seeks to analyze the factors contributing to Nigeria’s existing low rates of exclusive breastfeeding while exploring how investments made in creating and strengthening the continuum of care have stood the test of resilience during COVID-19, and proved to be the enabler for a strong start to building back better. It is an opportunity to share learnings and success stories central to which are our Community Midwives – the heart of a frontline, promoting and protecting breastfeeding as a shared responsibility.” - Her Excellency Toyin Saraki

Beginning with a situational analysis that explores key indicators and health trends in Nigeria since 2014, Her Excellency Toyin Saraki walks us through the historical interventions of her pioneering philanthropic foundation – The Wellbeing Foundation Africa – chronologically detailing strategic actions and collaborations successfully taken over the last decade through its flagship Mamacare360 Antenatal and Postnatal Education program alongside other collaborative programs implemented with global partners including UNFPA, Nutrition International, supported by Global Affairs Canada, and others.

This presentation also sheds light on “Midwives at the Frontline of Promoting and Protecting Breastfeeding as a Shared Responsibility”, exploring the instrumental role of health and care workers in advancing the continuum of care throughout the COVID-19 pandemic. Lactation-specific upskilling is given further inspection as a demonstration of progress, a reinvigoration of existing knowledge, and a path to solidarity and restoration of autonomy before then exploring the demand and respect on environment and infrastructural WASH for infection prevention and control.

Her Excellency goes on to explore the ancillary role of women in leadership, donorship, and the power of philanthropy, concluding with a strong call to action to mobilize for healthcare resilience and leveraging the role of leaders, advocates, and citizens in building back better.

Professor Hans van Goudoever

Clinical Practices to Preserve and Promote Breastfeeding in a COVID-19 Era

“Every child deserves mother’s own milk.” - Professor Hans van Goudoever

The impact of COVID-19 on public health around the world has been profound. Public health measures in response to the pandemic have severely jeopardized hospital- and community-based breastfeeding promotion programs. Studies report a reduction of breastfeeding rates, due to measures like infant-parent separation, fear of transmission of SARS-CoV-2 through breastfeeding, rapid discharge from the hospital, and lack of in-person counseling in the postnatal period.

Several actions need to be taken to restore and improve breastfeeding rates, as the benefits for both mother and child are well-established. These include specific antenatal care planning tailored to breastfeeding and meeting the individual needs. Not only is the provision of information important, but the way it is delivered can make a huge difference. One-on-one and face-to-face support is favored, due to its ability to deliver both practical advice as well as emotional support. Alternatively, well-designed internet-based information is easily accessible and may even provide a tool to reach out to populations that were not reached prior to the pandemic.

Delivery care providers should have a comprehensive breastfeeding plan implemented to form the intersection between maternal education and readiness and facility preparedness (i.e. the implementation of breastfeeding-promoting protocols and processes), with respect to early postpartum support of breastfeeding.

These factors, when managed with practices known to be positive for lactation initiation (such as informed decision-making, initiation and maintenance of milk supply, skin-to-skin care, and direct breastfeeding) will allow for an increase in the rates of human milk usage at discharge. Perhaps now, more than previously, it is important for healthcare professionals to acknowledge the value of such antenatal planning, as well as staff education, related to breastfeeding and human milk policy and protocol development.

Did You Know the Full 2021 Symposium is Still Available On-Demand?

If you were unable to attend our live event in September, you can still join over 1,400 attendees from around the world committed to sharing the latest research, understanding new clinical evidence, and turning science into care to nurture health for generations by learning from some of the most renowned minds in the human milk, healthcare, and lactation fields – including the experts highlighted above.

By signing up for on-demand access (available through June 2022) and having the flexibility to take the Symposium with you wherever you go, you’ll still receive:

• Access to all recorded sessions and presentations, including those featured above and others from additional keynote speakers like Dr. Rosalina Barroso, Professor Donna Geddes, Professor Paula Meier, and more.
• Access to all posters from our popular poster session, including more than 40 posters organized into 7 categories spanning the latest research, clinical evidence, and science around breastfeeding, human milk, and lactation.
• Content available in English, Spanish, Japanese, and Mandarin.
• Your full EUR 40 registration fee (approximately $45 U.S. dollars, as of this publication) will be used to donate breastfeeding supplies to several Ronald McDonald House^® chapters chosen by Medela to celebrate our 60th anniversary.

Don’t Miss Out – Sign Up Now!

References

1. Groß R, Conzelmann C, Müller JA, Stenger S, Steinhart K, Kirchhoff F, Münch J. Detection of SARS-CoV-2 in human breastmilk. Lancet. 2020 Jun 6;395(10239):1757-1758 

2. Chambers C, Krogstad P, Bertrand K, Contreras D, Tobin NH, Bode L, Aldrovandi G. Evaluation for SARS-CoV-2 in Breast Milk From 18 Infected Women. JAMA 2020;324(13):1347-1348 

3. Krogstad P, Contreras D, Ng H, Tobin N, Chambers CD, Bertrand K, Bode L, Aldrovandi G. No Evidence of Infectious SARS-CoV-2 in Human Milk: Analysis of a Cohort of 110 Lactating Women. medRxiv. 2021 Apr 7:2021.04.05.21254897. 

4. Dong Y et al. Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China. Pediatrics. 2020; doi:10.1542/peds.2020-0702. 

5. Fox A et al. Robust and specific secretory IgA against SARS-CoV-2 detected in human milk. iScience. 2020; doi:10.1016/j.isci.2020.101735:101735. 

6. Pace RM et al. Characterization of SARS-CoV-2 RNA, Antibodies, and Neutralizing Capacity in Milk Produced by Women with COVID-19. mBio. 2021; 12(1). 

7. Lebrao CW et al. Early Identification of IgA Anti-SARSCoV-2 in Milk of Mother With COVID-19 Infection. J Hum Lact. 2020; 36:609-613. 

8. Favara DM et al. Detection of breastmilk antibodies targeting SARS-CoV-2 nucleocapsid, spike and receptor-binding-domain antigens. Emerg Microbes Infect. 2020; 9:2728-2731. 

9. Hurley WL, Theil PK. Perspectives on immunoglobulins in colostrum and milk. Nutrients. 2011; 3:442-474.