RAPID: Collaborative Research: COVID-19, human milk and infant feeding

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The COVID-19 pandemic has resulted in untold challenges to personal and public health, largely because scientists and clinicians know very little about the virus that causes it and how transmission occurs. Whereas respiratory droplets are known to be a major mode of transmission, it is very likely that there are other sources. One understudied possibility is transmission from mother to infant via breastfeeding. Although researchers know that some viruses can be passed from mother to infant in this fashion, almost nothing is known about SARS-CoV-2 (the virus that causes COVID-19). For this reason, there is substantial confusion as to whether breastfeeding is safe and/or beneficial when a mother is known to be infected. This study will provide fundamental information about this basic biological property of SARS-CoV-2, information that will be immediately usable by women, healthcare providers, and public policy makers. This study will investigate whether SARS-CoV-2 and anti-SARS-CoV-2 antibodies can be detected in breast milk produced by infected women. Results will provide needed information about potential spread of the disease between breastfeeding mothers and infants as compared to formula-feeding mothers and infants. This topic is urgent because women continue to give birth and breastfeed during the pandemic, and guidance is critically needed. The Broader Impacts of this project include both outreach to the public to inform breastfeeding mothers about breast-feeding choices, and education of an undergraduate and graduate student.Although respiratory droplets are a known source of SARS-CoV-2 transmission, other modes likely exist. One such possibility is SARS-CoV-2 vertical transmission during breastfeeding, but little is known about this type of transfer for any coronaviruses. For SARS-CoV-2, there are only a handful of studies that report analysis of milk produced by COVID-19+ women; all but three report no evidence of virus in milk. There is similarly limited research on the effects of maternal milk antibodies on infant immune responses and severity of symptoms. As a result, there is substantial confusion as to the risks and benefits of breastfeeding for SARS-CoV-2+ mothers. This proposed research is a longitudinal, repeated-measures study of 25 breastfeeding mothers and infants and 25 formula-feeding mothers and infants. Dyads will be recruited within 7 days of maternal COVID-19 diagnosis and followed for 2 months during which time milk and breast swabs will be repeatedly collected (from breastfeeding mothers) and analyzed for SARS-CoV-2 RNA using an RT-qPCR; milk will also be analyzed for SARS-CoV-2-specific antibodies. Stool samples will also be collected and analyzed to assess viral exposure/shedding; and dried blood spots collected and analyzed to assess viremia and antibody (IgG and IgA) titers. Results will immediately inform women, healthcare providers, and public policy makers regarding infant feeding choices during the postpartum period. This RAPID award is made by the Physiological and Structural Systems Cluster in the BIO Division of Integrative Organismal Systems, using funds from the Coronavirus Aid, Relief, and Economic Security (CARES) Act.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.