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1.
Front Immunol ; 12: 801797, 2021.
Article in English | MEDLINE | ID: covidwho-1793017

ABSTRACT

Background: Limited data are available regarding the balance of risks and benefits from human milk and/or breastfeeding during and following maternal infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective: To investigate whether SARS-CoV-2 can be detected in milk and on the breast after maternal coronavirus disease 2019 (COVID-19) diagnosis; and characterize concentrations of milk immunoglobulin (Ig) A specific to the SARS-CoV-2 spike glycoprotein receptor binding domain (RBD) during the 2 months after onset of symptoms or positive diagnostic test. Methods: Using a longitudinal study design, we collected milk and breast skin swabs one to seven times from 64 lactating women with COVID-19 over a 2-month period, beginning as early as the week of diagnosis. Milk and breast swabs were analyzed for SARS-CoV-2 RNA, and milk was tested for anti-RBD IgA. Results: SARS-CoV-2 was not detected in any milk sample or on 71% of breast swabs. Twenty-seven out of 29 (93%) breast swabs collected after breast washing tested negative for SARS-CoV-2. Detection of SARS-CoV-2 on the breast was associated with maternal coughing and other household COVID-19. Most (75%; 95% CI, 70-79%; n=316) milk samples contained anti-RBD IgA, and concentrations increased (P=.02) during the first two weeks following onset of COVID-19 symptoms or positive test. Milk-borne anti-RBD IgA persisted for at least two months in 77% of women. Conclusion: Milk produced by women with COVID-19 does not contain SARS-CoV-2 and is likely a lasting source of passive immunity via anti-RBD IgA. These results support recommendations encouraging lactating women to continue breastfeeding during and after COVID-19 illness.


Subject(s)
Antibodies, Viral/analysis , Immunoglobulin A/analysis , Milk, Human/immunology , SARS-CoV-2/immunology , Adult , Antibodies, Viral/immunology , Breast Feeding , COVID-19/immunology , Female , Humans , Immunization, Passive , Immunoglobulin A/immunology , Lactation , Longitudinal Studies , Milk, Human/virology , RNA, Viral/genetics
3.
Int Breastfeed J ; 17(1): 22, 2022 03 21.
Article in English | MEDLINE | ID: covidwho-1753119

ABSTRACT

BACKGROUND: In response to the COVID-19 pandemic, billions of people were asked by their state and local governments not to go to work and not leave the house unless they had to. The goal of this qualitative study was to collect the lived experiences of a small group of parents and lactation professionals in the United States about what it was like to feed babies human milk under these conditions of quarantine. METHODS: This project is a social constructionist analysis of lactation narratives of 24 parents feeding their children human milk and 13 lactation professionals. They were interviewed remotely in 2020-21 via videoconferencing about their experiences and perspectives on the pandemic's effect on lactation. Additionally, photographs of 16 of the parents are provided to visualize their practices and how they chose to represent them. RESULTS: Four interrelated themes were identified in participants' narratives about how they experienced and made sense of human milk feeding during the pandemic: the loneliness of lactation during the pandemic, the construction of human milk as a resource to cope with the crisis, the (in)visibility of lactation amidst heightened multitasking, and the sense of connection created by human milk feeding at a time of unprecedented solitude. CONCLUSIONS: While the pandemic may have had both positive and negative effects on lactation, it exposed continuing inequities in infant feeding, generating new forms of (in)visibility for lactating labor. Going forward, one lesson for policy and lawmakers may be that to adequately support lactation, they should take cues from the families who had positive experiences during the crisis. This would call for systemically overhauling of US laws and policies by guaranteeing: universal basic income, paid parental leave for at least six months, paid lactation leaves and breaks, affordable housing, universal health care, subsidized childcare programs, and equal access to high-quality, non-discriminatory, and culturally appropriate medical care-including lactation counseling-, among other initiatives.


Subject(s)
COVID-19 , Pandemics , Breast Feeding , COVID-19/prevention & control , Child , Female , Humans , Infant , Lactation , Milk, Human , Quarantine , United States
4.
Viruses ; 14(3)2022 03 05.
Article in English | MEDLINE | ID: covidwho-1732243

ABSTRACT

(1) Objective: This systematic review summarizes current knowledges about maternal and neonatal outcomes following COVID-19 vaccination during pregnancy and breastfeeding. (2) Study design: PubMed, Cochrane Library, and the Education Resources Information Center (ERIC) were searched up to 27 October 2021. The primary outcome was to estimate how many pregnant and lactating women were reported to be vaccinated and had available maternal and neonatal outcomes. (3) Results: Forty-five studies sourcing data of 74,908 pregnant women and 5098 lactating women who received COVID-19 vaccination were considered as eligible. No major side-effects were reported, especially during the second and third trimester of pregnancy and during breastfeeding. Conversely, available studies revealed that infants received specific SARS-CoV-2 antibodies after maternal vaccination. (4) Conclusions: Vaccination against the SARS-CoV-2 virus should be recommended for pregnant women, after the pros and cons have been adequately explained. In particular, given the still limited evidence and considering that fever during the first months of gestation increases the possibility of congenital anomalies, they should be carefully counseled. The same considerations apply to breastfeeding women, also considering the immune responses that mRNA vaccines can generate in their human milk.


Subject(s)
COVID-19 Vaccines , COVID-19 , Breast Feeding , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Humans , Infant , Infant, Newborn , Lactation , Pregnancy , SARS-CoV-2
5.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(12): 1386-1391, 2021 Dec 28.
Article in English, Chinese | MEDLINE | ID: covidwho-1726803

ABSTRACT

The coronavirus disease 2019 (COVID-19) continues to spread around the world, and how to build an immune barrier against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the population is the work we need to do for a long time in the future. The vaccination is an important strategy to construct and improve the herd immunity barrier. Therefore, our country is currently actively and extensively implementing the anti-epidemic policy of SARS-CoV-2 vaccination. However, because of insufficient data on the safety of the SARS-CoV-2 vaccine in the population, especially the lack of clinical research in pregnant and lactating women, China has adopted a conservative approach on whether women in this special physiological period receive SARS-CoV-2 vaccine based on the safe consideration. However, with the widespread application of the SARS-CoV-2 vaccine in the prevention and control of the global epidemic, and the emergence of a large number of clinical research evidences at home and abroad, if we still exclude pregnant and lactating women from the vaccinated population, this part of the population will be fully exposed to the SARS-CoV-2 threat, which will weak the national prevention and control policy. Therefore, it is necessary to reconsider the vaccination of people in this special physiological period based on the experience of vaccination at home and abroad.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , China/epidemiology , Female , Humans , Lactation , Pregnancy , Vaccination
6.
Diabetes Metab Syndr ; 16(3): 102449, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1719624

ABSTRACT

AIM: The study aimed to assess the knowledge, attitude, perceptions, and concerns of pregnant and lactating women regarding COVID-19 vaccination. METHODS: A cross-sectional survey was conducted using a pre-validated questionnaire to assess the knowledge, attitude, perceptions, and concerns about COVID 19 vaccination among pregnant and lactating women. RESULTS: Most (90%) of the study participants(n =313) agreed that it was essential to get vaccinated for COVID-19 and were aware that pregnant (72.2%) or lactating women (65.2%) are eligible for vaccination. There was a significant positive association between willingness to pay for the vaccine and the socio-economic status (p<0.01). Women residing in rural areas wanted to wait to see the effect of the vaccine on other pregnant and lactating women (p<0.001). The major factors associated with vaccine hesitancy were unforeseen future effects of vaccines on the foetus (58.6%) and rapid development and approval of vaccine without including pregnant and lactating women in vaccine trials (53.6%). These factors were positively associated with socioeconomic status (p<0.05) and residence (p<0.01) CONCLUSION: The safety concerns regarding the COVID-19 vaccine is a major reason for vaccine hesitancy. The policymakers should advocate, investigate, and publicize relevant data on vaccine efficacy and safety among these women.


Subject(s)
COVID-19 Vaccines , COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Cross-Sectional Studies , Female , Health Knowledge, Attitudes, Practice , Humans , India/epidemiology , Lactation , Pregnancy , SARS-CoV-2 , Tertiary Care Centers , Vaccination
7.
Front Immunol ; 12: 783975, 2021.
Article in English | MEDLINE | ID: covidwho-1699418

ABSTRACT

Background: There is limited information on the functional neutralizing capabilities of breastmilk SARS-CoV-2-specific antibodies and the potential adulteration of breastmilk with vaccine mRNA after SARS-CoV-2 mRNA vaccination. Methods: We conducted a prospective cohort study of lactating healthcare workers who received the BNT162b2 vaccine and their infants. The presence of SARS-CoV-2 neutralizing antibodies, antibody isotypes (IgG, IgA, IgM) and intact mRNA in serum and breastmilk was evaluated at multiple time points using a surrogate neutralizing assay, ELISA, and PCR, over a 6 week period of the two-dose vaccination given 21 days apart. Results: Thirty-five lactating mothers, median age 34 years (IQR 32-36), were included. All had detectable neutralizing antibodies in the serum immediately before dose 2, with significant increase in neutralizing antibody levels 7 days after this dose [median 168.4 IU/ml (IQR 100.7-288.5) compared to 2753.0 IU/ml (IQR 1627.0-4712.0), p <0.001]. Through the two vaccine doses, all mothers had detectable IgG1, IgA and IgM isotypes in their serum, with a notable increase in all three antibody isotypes after dose 2, especially IgG1 levels. Neutralizing antibodies were detected in majority of breastmilk samples a week after dose 2 [median 13.4 IU/ml (IQR 7.0-28.7)], with persistence of these antibodies up to 3 weeks after. Post the second vaccine dose, all (35/35, 100%) mothers had detectable breastmilk SARS-CoV-2 spike RBD-specific IgG1 and IgA antibody and 32/35 (88.6%) mothers with IgM. Transient, low intact vaccine mRNA levels was detected in 20/74 (27%) serum samples from 21 mothers, and 5/309 (2%) breastmilk samples from 4 mothers within 1 weeks of vaccine dose. Five infants, median age 8 months (IQR 7-16), were also recruited - none had detectable neutralizing antibodies or vaccine mRNA in their serum. Conclusion: Majority of lactating mothers had detectable SARS-CoV-2 antibody isotypes and neutralizing antibodies in serum and breastmilk, especially after dose 2 of BNT162b2 vaccination. Transient, low levels of vaccine mRNA were detected in the serum of vaccinated mothers with occasional transfer to their breastmilk, but we did not detect evidence of infant sensitization. Importantly, the presence of breastmilk neutralising antibodies likely provides a foundation for passive immunisation of the breastmilk-fed infant.


Subject(s)
Antibodies, Neutralizing/analysis , Antibodies, Viral/analysis , Milk, Human/immunology , Adult , Antibodies, Neutralizing/blood , Antibodies, Viral/blood , /blood , Cohort Studies , Female , Health Personnel , Humans , Immunoglobulin Isotypes/analysis , Immunoglobulin Isotypes/blood , Infant , Lactation , Milk, Human/chemistry , Prospective Studies
8.
J Perinat Neonatal Nurs ; 36(1): 25-26, 2022.
Article in English | MEDLINE | ID: covidwho-1691753
9.
Adv Exp Med Biol ; 1353: 151-171, 2021.
Article in English | MEDLINE | ID: covidwho-1680583

ABSTRACT

INTRODUCTION: The coronavirus disease (COVID-19) has been found to influence almost all sectors starting from socio-religious to educational and environmental levels. However, the systematically planned or unplanned implementation of sudden lockdown across the globe, including India, has pushed the migrant workers into huge troubles. Without savings and transport systems, food security and other problems pushed migrant workers to walk to home from working places covering over 1000 km. Walking under the hot sun with heavy luggage and child in the womb or arm has affected the lactating mothers or pregnant women the most. The objective of this review article was to analyse the problems faced especially by the women migrant workers in India in order to point out and to adapt future strategies for their protection. METHODS: All published relevant literature from scientific sources and reputed news channels are considered to write the current review. RESULTS: Tremendous adverse effects of COVID-19 have been observed at social/cultural/religious/economic levels and other sectors of the society albeit its huge progressive but temporary effects are also observed on environment. The environment is self-regenerating, while the economy is pushed to an unseen manner. This is because many countries including India have adopted social lockdowns as a measure of prevention against the highly contagious disease. The results of lockdowns are encourageable as far as the reduced infection and death rate is concerned. For example, India being the second largest populous country with less advanced healthcare system is enjoying a comparatively low rate of death in COVID-19. However, sudden lockdowns followed by shutdowns mediated by industrial closure have pushed many migrant workers to walk to home by passing over even >1000 kilometres of distance on barefoot. Without transport systems, proper food and medications, many migrant workers faced un-imaginary difficulties, and some of them have also died on the way. Pregnant women and lactating mothers were also in the list and found to face unseen problems while migrating to their home from their working places with a load of child in the womb or on arm. So, phronesis of such problems and hierarchical strategies are suggested. CONCLUSION: Since such zoonotic pandemics cannot be avoided in the near future, solid future strategies must be adopted by different nations especially under developed and poor countries to tackle the problem of the migrant workers including the pregnant women and the lactating mothers.


Subject(s)
COVID-19 , Pandemics , Child , Communicable Disease Control , Disease Outbreaks , Female , Humans , Lactation , Mothers , Pregnancy , SARS-CoV-2
10.
Pediatrics ; 149(2)2022 02 01.
Article in English | MEDLINE | ID: covidwho-1607590

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibodies have been detected in human milk up to 6 weeks post-coronavirus disease 2019 (COVID-19) vaccination. We evaluated SARS-CoV-2-specific antibodies, neutralization activity, effect of pasteurization, and persistence through 6 months after vaccination. METHODS: This prospective longitudinal study enrolled 30 pregnant or lactating women. SARS-CoV-2 antibodies and neutralization capacity were analyzed using an enzyme-linked immunosorbent assay compared at prevaccination and 1, 3, and 6 months postvaccination, and through Holder pasteurization. RESULTS: Human milk SARS-CoV-2-specific IgG levels peaked at 1 month postvaccination and persisted above prevaccination levels for at least 6 months (P = .005). SARS-CoV-2-specific IgA was detected at 1 and 3 months (both P < .001) but waned by 6 months compared with baseline (P = .07). Milk SARS-CoV-2-specific IgG and IgA correlated with serum IgG at the same time point (R2 = 0.37, P < .001 and R2 = 0.19, P < .001). Neutralization activity was seen in 83.3%, 70.4%, and 25.0% of milk samples at 1, 3, and 6 months postvaccination. Neutralization most strongly correlated with SARS-CoV-2-specific IgG (R2 = 0.57, P < .001). Pre- and postpasteurization samples showed similar IgG (0.84 vs 1.07, P = .36) and neutralizing activity (57.7% vs 58.7% inhibition, P = .27), but lower IgM and IgA levels postpasteurization (0.09 vs 0.06, P = .004 and 0.21 vs 0.18, P = .043). CONCLUSIONS: The data suggest that human milk SARS-CoV-2-specific antibodies may be available to milk-fed infants for up to 6 months. In addition, donor milk from vaccinated mothers retain IgG and neutralizing activity.


Subject(s)
Antibodies, Viral/analysis , COVID-19 Vaccines , Milk, Human/chemistry , SARS-CoV-2/immunology , Adult , Breast Feeding , Female , Humans , Immunoglobulin A/analysis , Immunoglobulin G/analysis , Infant , Infant, Newborn , Lactation , Longitudinal Studies , Pasteurization , Prospective Studies
11.
PLoS One ; 16(12): e0261700, 2021.
Article in English | MEDLINE | ID: covidwho-1597256

ABSTRACT

Dietary adequacy and diversity during the lactation period are necessary to ensure good health and nutrition among women and children. Behavioral interventions pertaining to health and nutrition counselling during pregnancy and lactation are critical for awareness about dietary diversity. The issue assumes salience for marginalized communities because of the Covid-19 pandemic and associated economic and societal disruptions. This paper assesses the dietary patterns among 400 lactating mothers in the tribal-dominated district of Palghar in Maharashtra, India in 2020. The study is based on primary data regarding consumption of 10 food groups among women across 10 food groups based on 24-hour recall period. The primary outcome variable was binary information regarding Minimum Dietary Diversity defined as consumption from at least 5 food groups. Econometric analysis based on multilevel models and item-response theory is applied to identify food groups that were most difficult to be received by mothers during the early and late lactation period. We find that the daily diet of lactating mothers in Palghar primarily consists of grains, white roots, tubers, and pulses. In contrast, the intake of dairy, eggs, and non-vegetarian food items is much lower. Only Half of the lactating women (56.5 percent; 95% CI: 37.4; 73.8) have a minimum diversified diet (MDD). The prevalence of lactating women with MDD was higher among households with higher income (73.1 percent; 95% CI: 45.2; 89.9) than those in lower income group (50.7 percent; 95% CI: 42.3; 58.9). Lactating Women (in early phase) who received health and nutrition counseling services are more likely (OR: 2.37; 95% CI: 0.90; 6.26) to consume a diversified diet. Food groups such as fruits, meat, poultry, fish, nuts, and seeds were among the rare food items in daily diet. The dietary pattern lacking in fruits, nuts, and heme (iron) sources indicates more significant risks of micronutrient deficiencies. The findings call for improving dietary diversity among lactating mothers, particularly from the marginalized communities, and are driven by low consumption of dairy products or various fruits and vegetables. Among the different food items, the consumption of micronutrient-rich seeds and nuts is most difficult to be accessed by lactating mothers. Also, diet-centric counseling and informing lactating mothers of its benefits are necessary to increase dietary diversity for improving maternal and child nutrition.


Subject(s)
Breast Feeding , COVID-19/epidemiology , Diet/methods , Lactation/physiology , Nutritional Status/physiology , Pandemics , SARS-CoV-2 , Adolescent , Adult , Cross-Sectional Studies , Dairy Products , Female , Fruit , Humans , Income , India/epidemiology , Infant , Infant, Newborn , Middle Aged , Pregnancy , Vegetables , Young Adult
12.
Clin Microbiol Infect ; 28(1): 51-57, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1594531

ABSTRACT

BACKGROUND: Tocilizumab is a monoclonal antibody that interrupts interleukin-6 signalling, reducing downstream effects on inflammation and the innate immune response. It was shown to reduce mortality in patients with severe or critical coronavirus disease 2019 (COVID-19). Pregnant and breastfeeding people were largely excluded from clinical trials and hence, the extent to which results can be applied to these populations is not clear. OBJECTIVES: To synthesize published data on tocilizumab in pregnancy and lactation, highlight important knowledge gaps, and help inform clinical decision-making about tocilizumab's use in these populations with COVID-19. SOURCES: PubMed was searched for studies evaluating tocilizumab in pregnancy and lactation for COVID-19 and other indications. Literature on pharmacokinetics and reproductive/fetal safety of monoclonal antibodies in general was also sought. The US Food and Drug Administration and the European Medicines Agency guidance for the industry and regulatory approval documents were reviewed. CONTENT: Published data on tocilizumab in pregnancy include 610 cases (n = 20 with COVID-19) together with seven mother-infant breastfeeding pairs. Higher rates of spontaneous abortion and premature birth have been reported compared with the general population, but multiple confounding variables limit interpretation. There is little data on tocilizumab exposure in the second and third trimesters when transplacental transport is highest. The effects of tocilizumab on the developing immune system are unclear. Pregnant patients with COVID-19 who received tocilizumab were often critically ill and corticosteroid use was uncommon. Neonatal follow up was limited. Tocilizumab appears to be compatible with breastfeeding. IMPLICATIONS: Although the available data do not raise serious safety signals, they have significant limitations and are not sufficient to delineate the complete spectrum of potential adverse outcomes that may be associated with tocilizumab exposure during pregnancy and lactation. Diligent follow up and documentation of pregnancy outcomes will be important moving forward. A more effective regulatory framework to ensure equitable inclusion of pregnant people in research is clearly needed.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19 , Lactation , Pregnancy Complications, Infectious , Antibodies, Monoclonal , Breast Feeding , COVID-19/drug therapy , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/drug therapy , SARS-CoV-2 , United States
13.
Int J Environ Res Public Health ; 18(24)2021 12 19.
Article in English | MEDLINE | ID: covidwho-1580719

ABSTRACT

Pregnant and lactating women (PLW) represent a particular population subset with increased susceptibility for COVID-19 morbidity and mortality, even though the evidence about the safety and efficacy of COVID-19 vaccines was delayed due to their initial exclusion from development trials. This unclear situation could have led to increased COVID-19 vaccine hesitancy levels among PLW; therefore, this study aimed to evaluate the attitudes of Czech PLW towards COVID-19 vaccines and the determinants of their attitudes. An analytical cross-sectional survey-based study was carried out in the University Hospital Brno (South Moravia, Czechia) between August and October 2021. The study utilised a self-administered questionnaire (SAQ) adapted from previous instruments used for the same purpose. The SAQ included closed-ended items covering demographic characteristics, clinical and obstetric characteristics, attitudes towards COVID-19 vaccination, and potential psychosocial predictors of vaccine acceptance. Out of the 362 included participants, 278 were pregnant (PW) and 84 were lactating women (LW). The overall COVID-19 vaccine acceptance (immediate and delayed) level was substantially high (70.2%), with a significant difference between PW (76.6%) and LW (48.8%). Out of the 70.2% who agreed to receive the vaccine, 3.6% indicated immediate acceptance, and 66.6% indicated delayed acceptance. Only 13.3% of the participants indicated their acceptance of their physician's vaccination recommendation during pregnancy or while lactating, and 62.2% were against it. Our results agreed with the recent studies that revealed that PW tended to have a high level of COVID-19 vaccine acceptance, and they were also inclined to resist professional recommendations because they predominantly preferred to delay their vaccination. The pregnancy trimester, education level, employment status, and previous live births were significant determinants for COVID-19 vaccine acceptance. The most commonly preferred vaccine type was mRNA-based vaccines, followed by viral vector-based and inactivated virus vaccines. The first top priority of PLW was vaccine safety for their children, followed by vaccine safety for the PLW and vaccine effectiveness. Regarding psychosocial predictors, media/social media, trust in the government, the pharmaceutical industry, and healthcare professionals, partners, and a positive risk-benefit ratio were significant promoters for COVID-19 vaccine acceptance. Findings from this study suggest that promotional interventions targeting PLW should use web platforms and focus on vaccine safety evidence, the expected benefits of vaccines and potential harms of the infection.


Subject(s)
COVID-19 Vaccines , COVID-19 , Child , Cross-Sectional Studies , Czech Republic , Female , Humans , Lactation , Pregnancy , Pregnant Women , SARS-CoV-2 , Vaccination
14.
Am J Obstet Gynecol MFM ; 4(2): 100557, 2022 03.
Article in English | MEDLINE | ID: covidwho-1588391

ABSTRACT

BACKGROUND: Healthcare workers were prioritized for COVID-19 vaccination roll-out because of the high occupational risk. Vaccine trials excluded individuals who were trying to conceive and those who are pregnant and lactating, necessitating vaccine decision-making in the absence of data specific to this population. OBJECTIVE: This study aimed to determine the initial attitudes about COVID-19 vaccination in pregnancy-capable healthcare workers by reproductive status and occupational exposure. STUDY DESIGN: We performed a structured survey distributed via social media of US-based healthcare workers involved in patient care since March 2020 who were pregnancy-capable (biologic female sex without history of sterilization or hysterectomy) from January 8, 2021 to January 31, 2021. Participants were asked about their desire to receive the COVID-19 vaccine and their perceived safety of the COVID-19 vaccine using 5-point Likert items with 1 corresponding to "I strongly don't want the vaccine" or "very unsafe for me" and 5 corresponding to "I strongly want the vaccine" or "very safe for me." We categorized participants into the following 2 groups: (1) reproductive intent (preventing pregnancy vs attempting pregnancy, currently pregnant, or currently lactating), and (2) perceived COVID-19 occupational risk (high vs low). We used descriptive statistics to characterize the respondents and their attitudes about the vaccine. Comparisons between reproductive and COVID-19 risk groups were conducted using Mann-Whitney U tests. RESULTS: Our survey included 11,405 pregnancy-capable healthcare workers: 51.3% were preventing pregnancy (n=5846) and 48.7% (n=5559) were attempting pregnancy, currently pregnant, and/or lactating. Most respondents (n=8394, 73.6%) had received a vaccine dose at the time of survey completion. Most participants strongly desired vaccination (75.3%) and very few were strongly averse (1.5%). Although the distribution of responses was significantly different between respondents preventing pregnancy and those attempting conception or were pregnant and/or lactating and also between respondents with a high occupational risk and those with a lower occupational risk of COVID-19, the effect sizes were small and the distribution was the same for each group (median, 5; interquartile range, 4-5). CONCLUSION: Most of the healthcare workers desired vaccination. Negative feelings toward vaccination were uncommon but were significantly higher among those attempting pregnancy and those who are pregnant and lactating and also among those with a lower perceived occupational risk of contracting COVID-19, although the effect size was small. Understanding healthcare workers' attitudes toward vaccination may help guide interventions to improve vaccine education and uptake in the general population.


Subject(s)
COVID-19 Vaccines , COVID-19 , Attitude , COVID-19/epidemiology , COVID-19/prevention & control , Female , Health Personnel , Humans , Lactation , Pregnancy , SARS-CoV-2
15.
Breastfeed Med ; 16(12): 995-1003, 2021 12.
Article in English | MEDLINE | ID: covidwho-1561752

ABSTRACT

Background: Vitamin D deficiency was associated with an increased risk of coronavirus disease 2019 (COVID-19) infection. Vitamin D deficient mothers are more likely to have infants with vitamin D deficiency, affecting their immunity and protection against infection. This study aimed at comparing the concentrations of vitamin D3 and T cell-related cytokines in milk between mothers with confirmed COVID-19 polymerase chain reaction (PCR) test, mothers with viral infections suggestive of COVID-19, and mothers without infection. Materials and Methods: Concentrations of vitamin D3 and T cell-related cytokines in milk samples were determined by ELISA from 10 mothers who had a positive COVID-19 PCR test, 10 mothers with viral symptoms suggestive of COVID-19, and 20 mothers without infection. Results: Vitamin D3 concentration in human milk was higher in women without infection than in women with viral symptoms or COVID-19 PCR. Interleukin-2 level in milk was higher in the no-infection group than the COVID-19 PCR group but it did not differ with the viral symptoms group. Vitamin D3 did not correlate with any cytokines in human milk. Prenatal vitamin intake did not affect the vitamin D3 in human milk. The percentage of milk from mothers with <20 ng/mL of vitamin D3 was 50% in the COVID-19 PCR group, 60% in the viral symptoms group, and 5% in the no-infection group. Conclusions: Vitamin D3 level in breast milk may influence maternal immunity against COVID-19 infection. A larger study is needed to evaluate the relationship between vitamin D3 concentration in breast milk, maternal immune response, and the incidence of COVID-19 infection in lactating mothers.


Subject(s)
COVID-19 , Milk, Human , Breast Feeding , Cholecalciferol , Cytokines , Female , Humans , Infant , Lactation , Pregnancy , SARS-CoV-2 , T-Lymphocytes
16.
Cell Rep Med ; 2(12): 100468, 2021 12 21.
Article in English | MEDLINE | ID: covidwho-1550142

ABSTRACT

In view of the scarcity of data to guide decision making, we evaluated how BNT162b2 and mRNA-1273 vaccines affect the immune response in lactating women and the protective profile of breastmilk. Compared with controls, lactating women had a higher frequency of circulating RBD memory B cells and higher anti-RBD antibody titers but similar neutralizing capacity. We show that upon vaccination, immune transfer to breastmilk occurs through a combination of anti-spike secretory IgA (SIgA) antibodies and spike-reactive T cells. Although we found that the concentration of anti-spike IgA in breastmilk might not be sufficient to directly neutralize SARS-CoV-2, our data suggest that cumulative transfer of IgA might provide the infant with effective neutralization capacity. Our findings put forward the possibility that breastmilk might convey both immediate (through anti-spike SIgA) and long-lived (via spike-reactive T cells) immune protection to the infant. Further studies are needed to address this possibility and to determine the functional profile of spike T cells.


Subject(s)
COVID-19 Vaccines/immunology , Immunoglobulin A, Secretory/immunology , Milk, Human/immunology , SARS-CoV-2/immunology , Spike Glycoprotein, Coronavirus/immunology , T-Lymphocytes/immunology , Antibodies, Viral/blood , Antibodies, Viral/immunology , COVID-19/immunology , COVID-19/prevention & control , Female , Humans , Immunity, Maternally-Acquired , Lactation/immunology , Vaccination , /immunology
18.
Eur J Obstet Gynecol Reprod Biol ; 263: 106-116, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1544979

ABSTRACT

The novel severe acute respiratory syndrome (SARS) coronavirus-2 which causes COVID-19 disease results in severe morbidity and mortality especially in vulnerable groups. Pregnancy by virtue of its physiological and anatomical adaptations increases the risk of severe infections especially those of the respiratory tract. This single stranded RNA virus is transmitted by droplets as well as soiled fomites. There are various degrees of disease severity- asymptomatic, mild, moderate severe and critical. Most infections in pregnancy are asymptomatic or mildly symptomatic. For these women, the consequences on the mother or pregnancy are minimal unless they have additional risk factors such as diabetes, hypertension, cardiorespiratory disease, obesity or are of ethnic minority background. Most women with symptoms will present with fever, unproductive cough, sore throat, myalgia, nasal congestion, loss of smell and taste with associated leukocytosis and lymphopenia. Diagnosis is by RT-PCR on nasopharyngeal flocked swabs or saliva and pathognomonic features of ground-glass appearance and pulmonary infiltrates on chest X-ray or CT scans. Management in pregnancy is same as that for non-pregnant women with COVID-19. It is not an indication for elective delivery but assisted delivery in the second stage for those with moderate, severe or critical disease may be required to shorten this stage. COVID-19 is not an indication for interrupting pregnancy or caesarean section but the latter may be performed to facilitate ventilation support or resuscitation in those with severe disease. Pain relief in labour should not be different but regional analgesia is preferred for operative deliveries. Postpartum thromboprophylaxis should be considered and breast feeding encouraged with appropriate precautions to minimize vertical transmission. Pregnant and lactating women should be encouraged to receive the mRNA based vaccines as there is no evidence of adverse outcomes with these.


Subject(s)
COVID-19 , Labor, Obstetric , Pregnancy Complications, Infectious , Venous Thromboembolism , Anticoagulants , Cesarean Section , Female , Humans , Infectious Disease Transmission, Vertical , Lactation , Minority Groups , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Outcome , SARS-CoV-2
19.
Sci Transl Med ; 13(617): eabi8631, 2021 Oct 27.
Article in English | MEDLINE | ID: covidwho-1532951

ABSTRACT

Substantial immunological changes occur throughout pregnancy to render the mother immunologically tolerant to the fetus and allow fetal growth. However, additional local and systemic immunological adaptations also occur, allowing the maternal immune system to continue to protect the dyad against pathogens both during pregnancy and after birth through lactation. This fine balance of tolerance and immunity, along with physiological and hormonal changes, contributes to increased susceptibility to particular infections in pregnancy, including more severe coronavirus disease 2019 (COVID-19). Whether these changes also make pregnant women less responsive to vaccination or induce altered immune responses to vaccination remains incompletely understood. To define potential changes in vaccine response during pregnancy and lactation, we undertook deep sequencing of the humoral vaccine response in a group of pregnant and lactating women and nonpregnant age-matched controls. Vaccine-specific titers were comparable between pregnant women, lactating women, and nonpregnant controls. However, Fc receptor (FcR) binding and antibody effector functions were induced with delayed kinetics in both pregnant and lactating women compared with nonpregnant women after the first vaccine dose, which normalized after the second dose. Vaccine boosting resulted in high FcR-binding titers in breastmilk. These data suggest that pregnancy promotes resistance to generating proinflammatory antibodies and indicates that there is a critical need to follow prime-boost timelines in this vulnerable population to ensure full immunity is attained.


Subject(s)
COVID-19 Vaccines , COVID-19 , Female , Humans , Lactation , Pregnancy , RNA, Messenger , SARS-CoV-2
20.
Front Immunol ; 12: 777103, 2021.
Article in English | MEDLINE | ID: covidwho-1528826

ABSTRACT

Background: Data regarding symptoms in the lactating mother-infant dyad and their immune response to COVID-19 mRNA vaccination during lactation are needed to inform vaccination guidelines. Methods: From a prospective cohort of 50 lactating individuals who received mRNA-based vaccines for COVID-19 (mRNA-1273 and BNT162b2), blood and milk samples were collected prior to first vaccination dose, immediately prior to 2nd dose, and 4-10 weeks after 2nd dose. Symptoms in mother and infant were assessed by detailed questionnaires. Anti-SARS-CoV-2 antibody levels in blood and milk were measured by Pylon 3D automated immunoassay and ELISA. In addition, vaccine-related PEGylated proteins in milk were measured by ELISA. Blood samples were collected from a subset of infants whose mothers received the vaccine during lactation (4-15 weeks after mothers' 2nd dose). Results: No severe maternal or infant adverse events were reported in this cohort. Two mothers and two infants were diagnosed with COVID-19 during the study period before achieving full immune response. PEGylated proteins were not found at significant levels in milk after vaccination. After vaccination, levels of anti-SARS-CoV-2 IgG and IgM significantly increased in maternal plasma and there was significant transfer of anti-SARS-CoV-2-Receptor Binding Domain (anti-RBD) IgA and IgG antibodies to milk. Milk IgA levels after the 2nd dose were negatively associated with infant age. Anti-SARS-CoV-2 IgG antibodies were not detected in the plasma of infants whose mothers were vaccinated during lactation. Conclusions: COVID-19 mRNA vaccines generate robust immune responses in plasma and milk of lactating individuals without severe adverse events reported.


Subject(s)
Antibodies, Viral/immunology , COVID-19 Vaccines/administration & dosage , Lactation/immunology , Milk, Human/immunology , SARS-CoV-2/immunology , Adult , Antibodies, Viral/blood , COVID-19/prevention & control , Female , Humans , Immunoglobulin A/immunology , Immunoglobulin G/blood , Immunoglobulin G/immunology , Immunoglobulin M/blood , Immunoglobulin M/immunology , Infant , Infant, Newborn , Male , Middle Aged
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