Multi‐centre study showed reduced compliance with the World Health Organization recommendations on exclusive breastfeeding during COVID‐19

Abstract

The COVID-19 pandemic has raised numerous questions about the care of pregnant women and newborn infants. Few studies have evaluated how the pandemic has affected mothers' mental health, bonding and breastfeeding during the postpartum period. However, there is plenty of scientific evidence on how breastfeeding reduces physiological reactivity to various stressful stimuli and has positive effects on the physical and mental health of mothers and newborn infants.1 Our aim was to assess what impact the measures applied to mothers and infants during a specific pandemic study period had on the incidence of exclusive breastfeeding at the time of hospital discharge. A descriptive, multi-centre study explored mothers who had tested positive for the virus that causes COVID-19 and their infants. The infants were born in 15 Spanish hospitals, who were members of the Neo-COVID-19 research group, between 13 March and 31 May 2020 (Appendix S1). The study was approved by the research ethics committees of the participating hospitals. Only mothers who had tested positive for the virus using real-time reverse transcriptase polymerase chain reaction tests or serological tests were included. After the mothers provided informed consent, data were collected from their medical records on the incidence of exclusive breastfeeding, as defined by the World Health Organization (WHO), at the time of discharge. Data were also collected on skin-to-skin contact after birth, mother-child separation and whether a companion was present during the birth. We described our data by using absolute and relative frequencies for categorical data and median 25th and 75th percentiles for numerical data. The final sample was 242 mothers and 248 live newborn infants, including six sets of twins and a single twin whose sibling was not hospitalised. The median gestational age of the whole cohort was 39 weeks, with an interquartile range (IQR) of 38–40 and a mean birth weight of 3,084 ± 605 g. The twins were born at 32–38 weeks, and their birth weights ranged from 1,311 to 2,930 grams. During the study period, thirteen of the infants tested positive for the virus but we considered them to be false positives. We found that 115 newborn infants (46.3%) were admitted to neonatal units, including all 13 of the twins. Of these 28 were admitted to neonatal intensive care units (NICUs), including five of the twins. The median stay of the whole cohort was 3 days (IQR 2–10), and it was 10 days (IQR 3–21) for the twin newborn infants. Of the 248 infants, 108 (43.5%) did not receive immediate skin-to-skin contact after birth, including 11 of the 13 twins. In addition, 114 (45.9%) were separated from their mothers, including all of the twins. A companion was allowed to attend 39.2% of the singleton births and 42.8% of the twin deliveries. These data varied between centres and throughout the study period (Figure 1). Pearson's correlation coefficient was used to assess the association between the studied variables. A strong positive correlation was observed between the percentage of newborn infants who received exclusive breastfeeding at discharge and infants who received immediate skin-to-skin contact after birth (r = 0.828) and mothers who had a companion present during the birth (r = 0.833). Meanwhile, a strong negative correlation was observed between the percentage of newborn infants who were receiving exclusive breastfeeding at discharge and were separated from their mothers at birth (r = −0.862). Our study showed that during the COVID-19 pandemic study period, the recommendations established by the WHO,2 which include some steps recognised by UNICEF's Baby Friendly Initiative, were not immediately applied. There is evidence that compliance with these steps, such as skin-to-skin contact at birth and not separating the mother and her infant, had a positive impact on the initiation and maintenance of breastfeeding.3 Some hospitals have not adopted the UNICEF recommendations and, as expected, this led to clear reductions in exclusive breastfeeding at the time of discharge. For example, the reduced exclusive breastfeeding rates in the eighth week of the study period were because 40% of the deliveries had taken place in hospital centres that did not apply the UNICEF recommendations. Guidelines have frequently suggested that breastfeeding should cease during emerging diseases, due to the fear of further contagion. A clear, and sensible, example of this was the emergence of the human immunodeficiency virus in the 1980s, when mothers who tested positive were isolated and banned from breastfeeding.4 However, scientific evidence about the need to separate mothers and infants has not been provided during the COVID-19 pandemic. It is important to carry out adequate research during the pandemic to explore whether the virus can be transmitted through breast milk and whether barrier methods, such as masks, are effective. This can avoid the potential harm of suspending breastfeeding and skin-to-skin contact and separating mothers and their children at the time of delivery. We must take into account that not being able to breastfeed newborn infants reduces the transfer of immunoglobulins and other factors with immunological activity. It also has a negative influence on mother-baby bonding and increases healthcare costs,5 because hospitals need to rely on other feeding methods, such as formula and donor milk. The authors have no conflicts of interest to declare. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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