





























COVID 19 and the impact on the beginning of life 

 

1. Ali Mahmood, MD, FACS, FASCRS 
a. Corresponding author 
b. StrikerMD@hotmail.com 
c. Attending Surgeon 

Houston Methodist Specialty Group 
Methodist Sugar Land Colon & Rectal Surgery 
  
Assistant Professor of Clinical Surgery 
Institute of Academic Medicine 
Houston Methodist Hospitals System 

Assistant Professor of Clinical Surgery 
Department of Surgery 
Weill Cornell Medical College 
 

2. Aiva Mariam Mahmood 
a. Research Assistant 
b. Houston Methodist Specialty Group 

i. Houston, TX 
 

 
ABSTRACT  

COVID 19 is a pandemic that has crippled the world.  The disease process started in the Hubei 
province of China, but has been successfully confirmed in 181 countries at the time of this 
article.  Much of the data and literature have centered around the adult population and there have 
been few reports pertaining to COVID 19 and pregnancy.  There have been even fewer studies 
addressing breastfeeding in postpartum mothers affected with COVID 19.   
The purpose of our study was to review and compile the literature addressing whether 
breastfeeding was a safe and viable option following delivery in COVID 19 mothers.   
Methods: 
We searched PubMed, Medline, Google Scholar, Scopus, Embase to find potential studies.  Data 
mining was focused around COVID 19 positive pregnancies with subsequent breastfeeding 
Results:  
We found 12 studies that were pertinent to our topic. Delivery methods were varied, with most 
studies calling for vaginal delivery, unless established criteria were met for a caesarean section.  
Breastfeeding was recommended in both studies and ultimately citing human milk was not a 
vector in viral transmission.13 
Discussion:  
There is sparse literature studying the effects of breastfeeding on infants born to mothers who 
have tested positive for COVID 19.  The benefits of breastfeeding are clearly significant, 

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mailto:StrikerMD@hotmail.com


however the disease is known to carry significant mortality for the immune compromised and the 
immune naïve patient population.   
 
Key Words: COVID 19, pandemic, pregnancy, breastfeeding, immune compromised, newborns, 
infants, 

 
 

COVID 19 is a pandemic that has crippled the world.  Fist described in the Hubei province of 
China in late 2019, the virus has since been confirmed in 181 countries.  COVID 19 is caused by 
the SARS-CoV-2 virus (Severe Acute Respiratory Syndrome Corona Virus).  Multiple sources 
have cited significant mortality, with the Johns Hopkins University Conoravirus Resource Center 
reporting 1.2 million cases, and 64,606 deaths.1 
 
While there has been significant data and literature encompassing the spread, virology, diagnosis 
and treatment of the disease entity in adults, there has been little addressing pregnancy.  
Furthermore, post partum, the question of breast feeding has remained almost unanswered with 
very little data in the literature.   The question of vertical transmission has yet to be firmly 
answered.  The disease is spread via droplets, and possibly aerosolized during certain procedures, 
however, the question remains if the virus is transmitted via breast milk, and are the transitive 
protective properties of breast milk transcended by the morbidity and mortality of the virus.   
 
The purpose of this paper was to investigate the literature and determine if breastfeeding was 
safe post partum in COVID 19 mothers.   
 
We searched PubMed, Medline, Google Scholar, Scopus, Embase to find potential studies.  Data 
mining was focused around COVID 19 positive pregnancies with subsequent breastfeeding.   
 
We found 12 studies that were pertinent to our topic.2-13  Only 2 of the 10 looked at breastfeeding 
in the postpartum COVID 19 patient cohort.12,13Diagnosis of the pregnant patients was 
established using real time reverse transcriptase polymerase chain reaction, RT-PCR and 
diagnostic imaging, CT Chest.  There was a single study that reported vertical transmission at 
14.2%, however this was not substantiated by other data.5  Two studies tested the products of 
conception for presence of SAR-CoV-2 and none was reported, 0%.10,11Delivery methods were 
varied, with most studies calling for vaginal delivery, unless established criteria were met for a 
caesarean section, however there was an outlier study, citing caesarean section for 84.3% 
patients.5,6,8,12  Breastfeeding was recommended in both studies and ultimately citing human milk 
was not a vector in viral transmission.13 
 
COVID 19 in a novel disease process.  Much of the literature is centered aroundthe patients 
affected and thus the pregnancy population comprises only a small subset.  The breastfeeding 
contingent is further smaller in number.  The gravid patient population did exhibit the same 
clinical symptoms as the remaining COVID 19 population, consisting of fever, cough and 
fatigue.5  Diagnosis was established using laboratory testing and diagnostic imaging.  The CT 
chest depicted the classic findings described in COVID 19.  Ground glass opacities in the 
peripheral lung parenchyma in the setting of clinical symptoms have a sensitivity and specificity 

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upwards of 90%.5,14,15,16  RT-PCR was used to confirm the diagnosis from sputum and 
nasopharyngeal swabs.4,7 
 
The benefit of breastfeeding has long been established.  The transmission of important 
immunological factors along with the psychosocial aspects of bonding are not being questioned 
or challenged.  The question of COVID 19 spread to an immune naïve newborn, however, have 
yet to be answered.  Data from Italy conferred that direct breastfeeding was allowable under 
“strict measures of infectious control” thus implying that the transmission was not spread via 
milk bodily fluids.12  The second study, much larger, from the United Kingdom also concurred 
with these findings.13  However the total number of patients studied was insufficient to arrive at a 
definitive conclusion.  Although the disease process is not thought to spread via vertical 
transmission, save one publication, the continual close proximity of the affected mother and 
newborn do raise some concerns.  Even the single case of reported vertical transmission could 
have been attributed to post partum care, rather than antepartum spread.  Until more data and 
studies are available, we recommend a cautious approach to breast feeding.  Furthermore, we 
recommend a baseline RT-PCR on the newborn, and should the baby exhibit any signs of fever, 
decreased appetite or a change in clinical condition, we recommend cessation of beast feeding 
and repeat testing for COVID 19.  The benefit of breast feeding, although crucial and beneficial, 
is yet to be accurately weight against the paramount devastation of this novel virus.   
 
 

References 
 
 

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15. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) 
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16. Clinical and High-Resolution CT Features of the COVID-19 Infection: Comparison of 

the Initial and Follow-up Changes.Xiong Y, Sun D, Liu Y, Fan Y, Zhao L, Li X, Zhu 

W. Invest Radiol. 2020 Mar 3. doi: 10.1097/RLI.0000000000000674. [Epub ahead of 

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