key: cord-0843428-nlfoi185
authors: Gao, Xuan; Wang, Shaoshuai; Zeng, Wanjiang; Chen, Suhua; Wu, Jianli; Lin, Xingguang; Liu, Yanyan; Sun, Ziyong; Feng, Ling
title: Clinical and immunological features among COVID-19 affected mother-infant pairs: antibodies to SARS- CoV- 2 detected in breast milk
date: 2020-09-01
journal: New Microbes New Infect
DOI: 10.1016/j.nmni.2020.100752
sha: 2187e72693a9b67f2b4c312a4c8da9c91e112ab6
doc_id: 843428
cord_uid: nlfoi185

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.

Severe acute respiratory virus 2 (SARS-CoV-2), first identified in December, 2019, Wuhan, China, 23 continued to spread rapidly causing the ongoing pandemic 1 . As corona virus disease 2019 24 unfolded, various investigations had launched to explore the pathophysiology of SARS-CoV-2. Up to 25 date the viral genome had been detected in multiple kinds of body fluids, including upper respiratory 26 droplets, bronchoalveolar lavage, saliva, tears, conjunctival secretions, faeces, urine, blood and 27 cerebrospinal fluids 2-4 . Breast milk, as a well studied body fluid with immunological, nutritional, 28 cognitive and maternal-fetal emotional privileges 5 , has not been fully characterized with the novel 29 virus yet. Clinical data was also limited, Chen et al. 6 described failure of detection of SARS-CoV-2 30 genome in breast milk of six affected mother in the third trimester. However, with more women of 31 early pregnancy, puerperium and lactation periods affected and recovering from COVID-19, question 32 raised upon the safety of breast feeding, role of breast feeding in transmission of SARS-CoV-2, 33 according precautions and whether maternal disease course will be interfered with breast feeding.

subsequently were consent to the study from baseline. Follow-up investigation focused on maternal 44 fetal outcomes, breast feeding and recovery. The last follow-up date was April 5, 2020. Patients 

Demographical information and clinical characteristics of the enrolled patients were extracted from the 56 electronic medical system, supplemented with telephone follow up. Within seven days postpartum 57 breast milk were self-pumped after hand sanitization and contained. Maternal-neonatal isolation was 58 performed immediately after cord clamping, neonates were either observed in neonatal intensive care 59 units (NICU) or kept in a quarantine center with proxy as close contacts for minimum 14 days. neonatal serum after introduced on February 26, 2020. IgM or IgG more than 10 AU/ml was 66 considered positive, otherwise negative. Table. 1. Four patients who co-tested with immunological assays of SARS-CoV-2 were 74 shown in details.

In this cohort, mean maternal age was 31 years (SD 2.4, range 27-35), all had singleton pregnancy, of 76 which four (28.5%) were primigravidas and ten are multigravidas. All patients were Wuhan residents, 77 two (14.2%) were health care workers, three (21.4%) had contact of confirmed or suspected cases, two 78 (14.2%) suffered from family aggregation occurrence. The most common onset symptoms were fever 79 (11, 78.1% ) and cough (6, 42.9% ), a pregnancy specific symptom was abnormal fetal movement, 

Respiratory support was applied for four hours after cesarean surgery as well as when blood oxygen 90 saturation dropped below 93%. Eight (57.1%) patients received oxygen via nasal catheter, no respirator 91 or mechanical ventilation was indicated.

All patients underwent successful term delivery with no severe complication or ICU admission.

Perinatal outcomes and neonate baseline information were shown in Table. 2. The mean interval from 94 disease from onset to delivery was 5.4 days (SD 6.3, range 1-46). Two (14.2%) patients had fetal 95 distress marked by variable decelerations observe on fetal heart tracing and third degree amniotic fetal 96 meconium pollution. 12 (85.8%) chose cesarean and two (14.2%) patient had vagina birth without 97 mechanical assistance. The surgeries were performed in isolated surgery room with continuous 98 lumbar-epidural analgesia. The mean birth weight of neonates was 3224g (SD 421, range 2700-4120), 99 one neonate from the mother complicated with ICP had mild asphyxia at birth. One neonate had Patient 2 was asymptomatic when admitted on Feb.29, 39 weeks pregnancy. Her nasopharyngeal swab 128 at admission was negative. She reported fever and cough during 36 weeks of pregnancy and was 129 suggested to home quarantine, the symptoms self-resolved. She underwent elective cesarean due to 

Based on current information, we hypothesis that breast feeding role in transmission is low and passive 201 acquisition of antibodies to SARS-CoV-2 is beneficial for the infants. However, due to other possible 202 infection routes during mother-infant contacts, prudent precautions should be taken. 272 Table. 2 Perinatal outcomes of patients with COVID-19 during pregnancy 

A case report of neonatal COVID-19 infection in