Clinical and immunological features among COVID-19 affected mother-infant pairs: antibodies to SARS- CoV- 2 detected in breast milk

Gao, Xuan; Wang, Shaoshuai; Zeng, Wanjiang; Chen, Suhua; Wu, Jianli; Lin, Xingguang; Liu, Yanyan; Sun, Ziyong; Feng, Ling

Background The pandemic caused by Coronavirus disease 2019 (COVID-19) remain threatening to women and children, while clinical evidences regarding women during pregnancy, puerperium and lactation periods are limited. Objective We aim to discuss clinical, immunological features and breast feeding advices among mother-infant pairs. Study design This observational analysis was conducted in a tertiary center located in Wuhan, China. Pregnant patients with laboratory confirmed COVID-19 who delivered during hospitalization were enrolled. Clinical characteristics and serial specimens of the mother-infant pairs were examined, supplemented with follow-ups regarding recovery and breast feeding. Results 14 pregnant patients had live birth and achieved good recovery, four patients continued breast feeding with precautions, no neonatal infection was found. No infants observed developed COVID-19 during breastfeeding. Common maternal symptoms were fever (11/14, 78.1%) and cough (6/14, 42.9%), a pregnancy specific symptom was abnormal fetal movement, noticed in three (21.4%) patients. The mean viral shedding time was nine days (SD 6, range 1-22), SARS- CoV- 2 genome was non-detected in breast milk or maternal vaginal secretions. Immunological assay showed seroconversion of IgM on day eight of onset, IgG on day 28. Both IgM and IgM antibodies to SARS- CoV- 2 are detected in breast milk, cord blood and neonatal serum. Conclusion The study suggested passive acquisition of antibody against SARS- CoV- 2 through breast milk ingestion. Breast feeding role is low risk in transmission of SARS- CoV- 2 or cause maternal disease escalation, continue breast feeding with prudent precautions is encouraged.