Breastfeeding during a Pandemic.

BACKGROUND: The current pandemic and the concerns of vertical transmission of SARS-CoV-2 have contributed to increasing the rate of breastfeeding interruption. This tendency has been associated with negative effects on the well-being of lactating mothers and their infants. The aim of this review is to summarize the evidence on the strategies to support breastfeeding during the COVID-19 pandemic and on the safety of breastfeeding during a SARS-CoV-2 infection or after COVID-19 vaccination. SUMMARY: Available data show that the lack of support of lactating mothers during the pandemic has contributed to breastfeeding cessation worldwide. However, a few strategies have been proposed to overcome this issue. The risk of SARS-CoV-2 transmission from infected mothers to their offspring is extremely low. Furthermore, vaccination of lactating mothers is not associated with side effects in their infants. Key Messages: Increasing effort should be made to support breastfeeding during the COVID-19 pandemic. Mothers who are able to take care of their offspring and to adopt basic hygiene measures should not interrupt breastfeeding during a SARS-CoV-2 infection. Vaccination of lactating mothers might further strengthen the protective effect of breastfeeding against infections.

Milk donation and pandemic: human milk as a global good

The human milk donation has been an undervalued and very biasedly examined subject until relatively recently, in comparison with other types of human donation (organs, tissues, fluids), not being recognized its dimension of bodily altruistic and philanthropic act in the same way as other (mildly) analogous realities, as well as in its approach from the perspective of feminist and gender studies. On the other hand, although the COVID-19 pandemic and the various lockdown processes have had an onerous impact on human breastfeeding in general, we find data on the global increase in breastfeeding donation as a specific altruistic gesture during the pandemic in Spain and, even, on the decisions in the most complicated moments of the state of alarm about donating one's own milk in the tragedy of perinatal death. These altruistic donations contribute to carrying out the fulfillment of what has already been declared a human right and one of the social investments with the most advantageous cost-benefit index. The recognized, intensified and amplified need for milk banks in a pandemic brings to the fore in a specific way the condition of human milk as capital physiological resource, and, ultimately, as a global good. This article is dedicated to delving into a critical hermeneutics of milk donation in light of the pandemic and as an opportunity to rethink the studies of recent decades in this regard.

Anti-SARS-CoV-2 Immunoglobulins in Human Milk after Coronavirus Disease or Vaccination-Time Frame and Duration of Detection in Human Milk and Factors That Affect Their Titers: A Systematic Review.

Human milk (HM) of mothers infected with or vaccinated against SARS-CoV-2 contains specific immunoglobulins, which may protect their offspring against infection or severe disease. The time frame and duration after infection or vaccination, during which these immunoglobulins are detected in HM, as well as the major factors that influence their levels, have not been fully elucidated. This systematic review aimed to collect the existing literature and describe the immune response, specifically regarding the immunoglobulins in HM after COVID-19 disease or vaccination in non-immune women. We conducted a systematic search of PubMed and Scopus databases to identify studies published up until 19 March 2023. In total, 975 articles were screened, and out of which 75 were identified as being relevant and were finally included in this review. Infection by SARS-CoV-2 virus primarily induces an IgA immune response in HM, while vaccination predominantly elevates IgG levels. These immunoglobulins give HM a neutralizing capacity against SARS-CoV-2, highlighting the importance of breastfeeding during the pandemic. The mode of immune acquisition (infection or vaccination) and immunoglobulin levels in maternal serum are factors that seem to influence immunoglobulin levels in HM. Further studies are required to determine the impact of other factors, such as infection severity, lactation period, parity, maternal age and BMI on immunoglobulin level in HM.

Risk of transmission of COVID- 19 to newborns in COVID-19 positive mothers - a case series

Background: High risk of COVID-19 infection is reported in neonates of COVID-19-affected females along with adverse effects secondary to the infection. Limited work in literature is done on COVID-19 infection transmission from affected females to neonates born to them with few studies reporting vertical transmission of COVID-19. Aim: To evaluate SARS-CoV-2 vertical or perinatal transmission and describe neonatal clinical findings and short-term outcomes in babies born to Covid- 19 positive mothers. Methods: The study assessed 19 females and 19 neonates. All neonates immediately after birth were breastfed and kept with the mother in cases with the clinically stable situation for babies and mothers both. For all the babies, nasal swab samples were sent to detect SARS-CoV-2 on day 1 of their birth. The neonates were followed for 7-14 days after their birth followed by reassessment for SARS-CoV-2 from nasal swab specimens. Results: All babies were healthy with no detection of SARS-CoV-2 seen from the neonates from the nasopharyngeal swabs. Also, no separation was done from mothers, and breastfed was given to all the neonates which showed no transmission of SARS-CoV-2 from breast milk to the neonates. Conclusion: Benefits of breastfeeding are higher compared to the risk of perinatal or vertical transmission depicting that there is no need for separation of the neonate from SARS-CoV-2 positive mothers. Also, neonates can be breastfed from COVID-19-positive mothers without the risk of virus transmission.

SARS-CoV-2 detection in human milk: a systematic review.

PURPOSE: To synthesize the current evidence for the presence of SARS-CoV-2 RNA in the human milk of mothers with confirmed COVID-19 and its potential role in neonatal SARS-CoV-2 infection. MATERIALS AND METHODS: Using terms related to novel coronavirus 2019 and human milk, a systematic search was performed in three electronic databases (PubMed, EMBASE, and Web of Science) for studies published between December 2019 and 15 October 2020. Published peer-reviewed studies reporting the results of RT-PCR for SARS-CoV-2 RNA in human milk in mothers with confirmed COVID-19 were included. Proportion meta-analysis of case series and prospective cohort studies was performed using STATA version 14.2 (StataCorp, College Station, TX) and pooled estimate (with 95% confidence interval) of overall incidence of SARS-CoV-2 transmission was calculated. RESULTS: We identified 936 records, of which 34 studies (24 case-reports, 10 cohort studies) were eligible for this systematic review. A total of 116 confirmed COVID-19 lactating women (88 in cohort and 28 in case-reports) underwent RT-PCR testing in human milk, and 10 (six in case reports) were detected to have SARS-CoV-2 RNA. The overall pooled proportion (from cohort studies) for SARS-CoV-2 RNA detection in human milk was 2.16% (95% CI: 0.0-8.81%, I2: 0%). Four studies (six patients) also reported the presence of SARS-CoV-2 specific antibodies (along with RT-PCR) in human milk. CONCLUSIONS: The limited low-quality evidence suggests that SARS-CoV-2 RNA is detected in human milk in an extremely low proportion, however, based on current evidence no conclusion can be drawn about its infectivity and impact on the infants. In concordance with World Health Organization recommendations, exclusive breastfeeding should be considered in all cases unless any other contraindication exists.

Increase in SARS-CoV-2 RBD-Specific IgA and IgG Antibodies in Human Milk From Lactating Women Following the COVID-19 Booster Vaccination.

BACKGROUND: The United States Centers for Disease Control and Prevention recommended a third dose or booster of the Pfizer-BioNTech Comirnaty (BNT162b2) COVID-19 mRNA vaccine in September 2021 for high-risk individuals. Pregnant and high-risk lactating women were encouraged to receive the booster to obtain potential prolonged protection for themselves and their infants. RESEARCH AIM: To investigate the ability of the booster vaccine to increase IgA and IgG antibodies specific to the receptor-binding domain of the SARS-CoV-2 spike protein in human milk compared to levels pre-booster. METHODS: This was a prospective one-group study with a pretest-posttest design. Six of 12 participants were recruited prospectively. Participants were instructed to collect ≥ 2 ounces of milk in the morning at 30 days and 1-day pre-booster, and 7, 14, 21, 30, 45, and 60 days post-booster. Levels of IgA and IgG antibodies specific to the receptor-binding domain of the SARS-CoV-2 spike protein were quantified in human milk via an ELISA assay. RESULTS: We found a significant increase in anti-receptor-binding domain-specific IgA and IgG antibodies in human milk 1-2 weeks after the Pfizer-BioNTech booster and at the study endpoint (45- and 60-days post-booster). CONCLUSIONS: This suggests that the booster vaccination enhances SARS-CoV-2 specific immunity in human milk, which may be protective for infants.

Impact of the Presence Anti-SARS-CoV-2 IgA in the Colostrum of Women Infected by COVID-19 During the Pregnancy in Neonatal Clinical Outcomes: A Cross-Sectional Study.

OBJECTIVES: To describe the presence of anti-SARS-CoV-2 IgA and IgG in the blood and colostrum of women with COVID-19 infection during pregnancy and associate the presence of anti-SARS-CoV-2 IgA in colostrum with clinical symptoms of their newborns. METHODS: A cross-sectional study was developed with 165 participants with COVID-19 infection during pregnancy and their newborns. DATA COLLECTED: characteristics COVID-19 infection in pregnant women, gestational age, and clinical symptoms in their newborns (fever, hypothermia, respiratory distress, hypotonia, hypoactivity, hypoglycemia, cyanosis, vomiting/regurgitation, abdominal distention, and jaundice). Maternal blood and colostrum samples were collected postpartum to to detect the presence of IgA and IgG anti-SARS-CoV-2. RESULTS: The median interval between COVID-19 diagnosis and delivery was 37.5 days (IQ = 12.0, 73.0 days). Clinical symptoms during hospitalization were observed in 55 newborns (33.3%), and two (1.6%) tested RT-PCR positive for COVID-19. Positive colostrum for anti-SARS-CoV-2 IgA was found in 117 (70.9%) women. The presence of anti-SARS-CoV-2 IgA in colostrum was associated independently with lower clinical symptoms in their newborns (OR = 0.42; 95% CI 0.202 to 0.84; p = 0.015). CONCLUSIONS FOR PRACTICE: The presence of anti-SARS-CoV-2 IgA in colostrum was detected in more than two-thirds of the women evaluated and was associated with a lower frequency of clinical symptoms in their newborns.

Paediatricians' perspectives regarding breastfeeding during the Covid-19 pandemic: A cross-sectional study

Introduction: Covid-19 pandemic has raised queries regarding implications for breastfeeding (BF). Data are limited and recommendations for initial days after birth differ. Parents count on paediatricians for optimal information about feeding their infants, especially when the mother is infected. Objectives: To estimate knowledge of paediatricians about BF in suspected or confirmed maternal cases of Covid-19, its association with demographic variables, and participants' opinions about factors influencing their guidance to parents regarding infant nutrition in Covid-19 infected mothers. Method: This was a prospective cross-sectional study based on an online questionnaire administered to paediatricians in Uttar Pradesh, India, from February to March 2021. A total of 389 paediatricians participated. Knowledge questions were based on the World Health Organization guidance on BF for Covid-19. Results: Among the 389 participants, 44.5% had adequate knowledge, 38.3% had average knowledge, and 17.2% had inadequate knowledge;96.4% paediatricians preferred mothers' milk for infants with Covid-19 infected mothers. Fear of transmission of infection to infant was the major restraint, while the low risk of transmission to the infant if infection prevention and control practices were followed was the most useful factor perceived while counselling an infected mother for BF.Conclusions: Knowledge of paediatricians about BF in suspected or confirmed maternal cases of Covid-19 was adequate in 44.5%, average in 38.3% and inadequate in 17.2%. Majority (96.4%) of paediatricians favoured BF in maternal Covid-19 cases. © 2022,Sri Lanka Journal of Child Health. All Rights Reserved.

Breastfeeding and human milk bank in a neonatal intensive care unit: impact of the COVID-19 pandemic in an Italian cohort of very low birth weight infants.

BACKGROUND: Parental stress in neonatal intensive care units (NICU) is well known, as is the stress induced by the COVID-19 pandemic. This combination might increase stress to the extent of affecting the availability of maternal expressed milk and the success of establishing breastfeeding. This is particularly relevant in very preterm infants. METHODS: We conducted a single-centre retrospective analysis in two cohorts of very low birth weight infants born in a hospital in Italy. Babies born before the pandemic (September 2017 - December 2019) (n = 101) and during the pandemic (March 2020 - December 2021) (n = 67) were included in the analysis. We compared the rate of babies fed with maternal milk (both expressed and / or donated) at the achievement of full enteral feeding and the rate of those exclusively breastfed at discharge in the two groups. Then, we analysed the impact of donated human milk availability on infant formula use. We also compared mother's need for psychological support during NICU stay and the duration of psychological follow-up after discharge. RESULTS: In our NICU the availability of expressed maternal milk significantly decreased during the COVID-19 pandemic (86.1% before the pandemic vs 44.8% during the pandemic, p < 0.001) at the time of full enteral feeding achievement. Thanks to the availability of donated human milk, the rate of formula-fed babies remained almost unchanged (13.9% vs 14.9%). At discharge, the rate of breastfeeding was similar (73.3% vs 72.7%). The maternal need for psychological support was significantly higher during the pandemic (33% vs 64%, p < 0.001), as well as the duration of follow-up > 6 months (1% vs 15%, p < 0.001). No differences in the main clinical outcomes were found. CONCLUSION: Pandemic-induced stress had a significant impact on the availability of expressed maternal milk in NICU. However, the presence of human donated milk was fundamental in preventing increased use of infant formula during NICU stays. This underlines how strategies to implement the widespread establishment of donor milk banks on a national level are warranted. Further research is desirable to optimise the use of donated human milk banks during emergency situations.

The impact on colostrum oxidative stress, cytokines, and immune cells composition after SARS-CoV-2 infection during pregnancy.

Background: Limited data are available regarding the differences between immunological, biochemical, and cellular contents of human colostrum following maternal infection during pregnancy with coronavirus 2 disease (COVID-19). Objective: To investigate whether maternal COVID-19 infection may affect immunological, biochemical, and cellular contents of human colostrum. Methods: Using a case-control study design, we collected colostrum from 14 lactating women with a previous diagnosis of COVID-19 during pregnancy and 12 without a clear diagnosis during September 2020 to May 2021. Colostrum samples were analysed for some enzymes and non-enzymatic oxidative stress markers (SOD, CAT, GPx, MDA, GSH, GSSG, H2O2, MPO) and for IL-1ß, IL-6, tumour necrosis factor (TNF)-α, protein induced by interferon gamma (IP)-10, IL-8, IFN-λ1, IL12p70, IFN-α2, IFN-λ2/3, granulocyte macrophage colony stimulating factor (GM-CSF), IFN-ß, IL-10 and IFN-γ, along with IgA and IgG for the SARS-CoV-2 S protein. We perform immunophenotyping to assess the frequency of different cell types in the colostrum. Results: Colostrum from the COVID-19 symptomatic group in pregnancy contained reduced levels of H2O2, IFN-α2, and GM-CSF. This group had higher levels of GSH, and both NK cell subtypes CD3-CD56brightCD16-CD27+IFN-γ+ and CD3-CD56dimCD16+CD27- were also increased. Conclusion: The present results reinforce the protective role of colostrum even in the case of mild SARS-Cov-2 infection, in addition to demonstrating how adaptive the composition of colostrum is after infections. It also supports the recommendation to encourage lactating women to continue breastfeeding after COVID-19 illness.

Sequential interventions to maintain the safety and service provisions of human milk banking in India: keeping up with the call to action in response to the COVID-19 pandemic.

BACKGROUND: WHO recommends donor milk as the next best choice if Mothers' own milk (MOM) is unavailable. At our milk bank, during the COVID 19 pandemic, we observed a steep decline in the collection of donor milk, while Pasteurised Donor human milk (PDHM) demand increased. This called for active intervention. METHODS: We employed the quasi-experimental quality improvement initiative. During September 2020 (baseline period) the team members identified modifiable bottlenecks and suggested interventions (using WhatsApp to increase follow up, telehealth and digital tools) which were implemented in October 2020 and the impact was evaluated till March 2021. The SMART aim was "to meet the demand (estimated as 15,000 ml/month) of donor milk for adjoining 80-bedded NICU". Process measures were; daily amount of donor milk collected, pasteurized donor milk disbursed to NICU, number of donors and frequency of donations. The balancing measure was that the collection of donor milk should not undermine the provision of freshly expressed MOM for babies. RESULTS: Collection of donor milk increased by 180% from baseline during the Intervention phase. This was sustained throughout the sustenance phase (November 2020 and March 2021) with an average monthly collection of 16,500 ml. Strikingly, the increased follow-up of mothers with emphasis on MOM decreased the NICU's donor milk requirement from 13,300 ml (baseline) to 12,500 ml (intervention) to 8,300 ml (sustenance). Monitoring of daily MOM used in the NICU revealed a 32% surge from 20,000 ml (baseline) to 27,000 ml (intervention) sustained at 25,000 ml per month. CONCLUSION: By improving the provisions of human milk banks, near-exclusive human milk feeding can be ensured even during the pandemic time.

Role of milk glycome in prevention, treatment, and recovery of COVID-19.

Milk contains all essential macro and micro-nutrients for the development of the newborn. Its high therapeutic and antimicrobial content provides an important function for the prevention, treatment, and recovery of certain diseases throughout life. The bioactive components found in milk are mostly decorated with glycans, which provide proper formation and modulate the biological functions of glycosylated compounds. The glycome of milk consists of free glycans, glycolipids, and N- and O- glycosylated proteins. Recent studies have shown that both free glycans and glycan-containing molecules have antiviral characteristics based on different mechanisms such as signaling, microbiome modulation, natural decoy strategy, and immunomodulatory action. In this review, we discuss the recent clinical studies and potential mechanisms of free and conjugated glycans' role in the prevention, treatment, and recovery of COVID-19.

Human Milk Bank in a Rural Setup - A Success Story.

Background: This article describes the experience of a rural human milk bank, with the problems faced in first 6 months including the coronavirus disease (COVID) crisis and interventions leading to success. Methods: The study included individual counselling by dedicated counsellors, focused counselling of primipara mothers seeking the help of obstetricians, counselling of pre-term mothers by neo-natal nurses, periodically delivered information in post-natal wards, and counselling of grandmothers and husbands. Results: The COVID crisis was dealt with donations from reverse transcriptase-polymerase chain reaction-negative mothers with social distancing and mask use. Younger, educated, working mothers with normal delivery and from middle-income families were easy to counsel. Periodic announcements in wards significantly increased awareness about milk banks and donation. Pre-term mothers could be motivated when their baby was nil by mouth or they saw other babies in need of milk. Lactation support to mothers with breast problems, especially in primipara, helps in getting more donors. Counselling of fathers was easier than that of grandmothers. Conclusions: Structured awareness programs and counselling strategies along with education of grandmothers and husbands were very effective in increasing human milk donation.

Facilitators, Barriers, and Best Practices for In-Person and Telehealth Lactation Support During the COVID-19 Pandemic.

OBJECTIVE: To explore the perspectives of lactation support providers delivering breastfeeding education via in-person and telehealth consultations and assess the impact of COVID-19 on the provision of breastfeeding education. DESIGN: Qualitative descriptive study using purposive sampling. SETTING: Massachusetts-based lactation support providers who provided in-person and/or telehealth consultations in various practice settings (e.g., inpatient; outpatient; private practice; and the Special Supplemental Nutrition Program for Women, Infants, and Children). PARTICIPANTS: Fourteen Massachusetts-based lactation support providers, ages 36 to 68 years. MEASUREMENTS: Participants completed an online demographic and employment characteristics survey and virtual key informant interviews, from which six main themes were defined. RESULTS: The six main themes included Common Questions Asked by Clients, Prenatal and Postpartum Consultation Topics, Facilitators for Telehealth Versus In-Person Consultations, Barriers for Telehealth Versus In-Person Consultations, Best Practices, and COVID-19 Adaptations. From participant interviews, common subthemes emerged. The primary adaptation due to COVID-19 was shifting to telehealth. Content in lactation consultations was similar via in-person and telehealth sessions. Typical content areas included breast pumping and mother's milk supply. A notable difference was the lack of physical examinations for women and newborns in telehealth sessions. Scheduling flexibility was a key facilitator of telehealth consultations, whereas the inability to provide hands-on assistance and chaotic home environments were common barriers. In-person facilitators included weighing newborns to assess feeding success and insurance billing coverage, whereas unsupportive family members were noted as a barrier. Diversity, equity, and inclusion-related barriers (e.g., language barriers, lack of reflective diversity, lack of stable Internet access) were observed in both settings. Best practices for in-person and telehealth consultations included meeting mothers where they are and focusing on mothers' goals. CONCLUSION: Practice adaptations adopted during the pandemic and best practice recommendations may be useful for lactation support providers and other health care professionals caring for breastfeeding dyads.

Effects of Vaccination Against Influenza, Pertussis, and COVID-19 on Human Milk Antibodies: Current Evidence and Implications for Health Equity.

Human milk contains three antibody classes that confer mucosal immunity to the breastfed infant: secretory IgA (SIgA), secretory IgM (SIgM), and IgG. Influenza and pertussis vaccines administered during pregnancy induce pathogen specific SIgA and IgG responses in human milk that have been shown to protect the breastfed infant from these respiratory illnesses. In addition, mRNA vaccines against the SARS-CoV-2 virus administered during pregnancy and lactation induce anti-SARS-CoV-2 IgG and IgA responses in human milk. This review summarizes the immunologic benefits of influenza, pertussis, and COVID-19 vaccines conferred by human milk. Additionally, future research direction in human milk immunity and public health needs to improve lactational support are discussed.

SARS-CoV-2 and human milk presence of virus and antibodies in just delivered mothers and possible transmission to the babies: An observational study over a period of 1 year in the state of Mizoram

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a very virulent and contagious coronavirus and has caused a pandemic of acute respiratory disease, named “Coronavirus disease 2019” (COVID-19) that emerged in the late 2019. In breast milk (BM), presence of SARS-CoV-2 virus and its antibodies have been examined. Aims and Objectives: The current observational study was conducted over a period of 1 year in the state of Mizoram to investigate the presence of SARS-CoV-2 virus and antibodies in pregnant mothers and their newborn along with breast milk. Materials and Methods: A total of 115 breast milk samples and 70 breast swabs (before or after breast washing) from 115 women who were recently diagnosed with COVID-19 were collected. Samples were analyzed for SARS-CoV-2 RNA using RT-PCR. Breast milk was also analyzed for SARS-CoV2, IgA, and IgG receptor binding domain (RBD), S2 subunit of the spike protein of SARS-CoV-2. Results: BM RTPCR was found to be positive 78 and 37 BM samples were found to be negative for RTPCR. Among the infants, 32 were exclusively on breastfeed and 83 were mixed feeding infants. Post-breastfeeding four infants were shown the signs and symptoms of COVID-19. IgA and IgG RBD and S2 subunit of the spike protein of SARS-CoV-2 antibodies were positive in 17, 16, and 12 BM samples which show that maternal antibodies to be developed in BM take time for production and the mothers infected almost 10 days ago, only showed presence of those antibodies. Conclusion: Our findings have shown increase admissions of COVID-19 infected antenatal mothers with positive outcome despite the requirement of intensive care. SARS-CoV-2 was detected in BM which was significantly high, but there was no transmission to the babies during the postnatal period. [ FROM AUTHOR] Copyright of Asian Journal of Medical Sciences is the property of Manipal Colleges of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Breastfeeding patterns and stress among lactating women in Pune during the COVID-19 pandemic

Lactating mothers (n=126) residing in Pune, Maharashtra were interviewed to assess the prevalence of stress, rate of exclusive breastfeeding (EBF), and its association with different demographic factors. 75.4% mothers were found to be moderately stressed. Rate of EBF was 62.7%. Moderate stress and testing positive for COVID-19 were significantly negatively associated with EBF (P < 0.001).

The Content of Breast Milk and the Challenges Experienced by Breastfeeding Mothers during the COVID-19 pandemic: A Systematic Review

Introduction: Every postpartum mother is recommended to breastfeed her baby because breast milk is the main need of newborns. The COVID-19 pandemic has had an impact on life in various aspects, including on the breastfeeding mothers, especially if they suffer from COVID-19 infection. Aim: The study aims to provide comprehensive evidence regarding potential virus transmission and antibody transfer through breastmilk and the experiences of mothers related to breastfeeding during the COVID-19 pandemic. Methods: A systematic review was conducted following the PRISMA guidelines. The search strategy involved the use of keywords related to COVID-19 and breastfeeding in PubMed and Science Direct databases. Articles were selected according to inclusion and exclusion criteria. Results: Breastfeeding has been recommended to be continued during the pandemic due to the benefits associated with it and the absence of sufficient evidence for transmission of COVID-19 infection through breast milk. During the lockdown period, there was a change in breastfeeding patterns, although most mothers believed that breastfeeding should be continued. Anxiety and lack of support affected breastfeeding practices. Breastfeeding mothers reported a dilemmatic situation. They felt protected because of the lockdown policy but also struggled to get support from their social environment. The impact varied in terms of stopping breastfeeding practice altogether, breastfeeding irregularly, and even giving formula milk. Conclusion: Adherence to health protocols can reduce the risk of transmission of COVID-19 infection through breastfeeding from mother to baby. Support from the family and the environment is needed to ensure the continuity of breastfeeding practice. © 2022 Kurniawati et al.

The contribution of breastfeeding to a healthy, secure and sustainable food system for infants and young children: monitoring mothers' milk production in the food surveillance system of Norway.

OBJECTIVE: The mother-child breastfeeding dyad is a powerful force for achieving healthy, secure and sustainable food systems. However, food system reports exclude breastfeeding and mother's milk. To help correct this omission and give breastfeeding women greater visibility in food systems dialogue and action, we illustrate how to estimate mother's milk production and incorporate this into food surveillance systems, drawing on the pioneering experience of Norway to show the potential value of such analysis. DESIGN: The estimates use data on the proportion of children who are breastfed at each month of age (0-24 months), annual number of live births and assumptions on daily human milk intake at each month. New indicators for temporal and cross-country comparisons are considered. SETTING: It is assumed that a breastfeeding mother on average produces 306 l of milk during 24 months of lactation. PARTICIPANTS: The annual number of live births is from Statistics Norway. Data for any breastfeeding at each month of age, between 0 and 24 months, are from official surveys in 1993, 1998-1999, 2006-2007, 2013 and 2018-2019. RESULTS: Estimated total milk production by Norwegian mothers increased from 8·2 to 10·1 million l per year between 1993 and 2018-2019. Annual per capita production increased from 69 to 91 l per child aged 0-24 months. CONCLUSIONS: This study shows it is feasible and useful to include human milk production in food surveillance systems as an indicator of infant and young child food security and dietary quality. It also demonstrates significant potential for greater milk production.