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Original research
SARS-CoV-2 genome and antibodies in breastmilk: a systematic review and meta-analysis
  1. Faith Zhu1,2,
  2. Carlos Zozaya1,2,
  3. Qi Zhou1,2,
  4. Charmaine De Castro3,
  5. Prakesh S Shah1,2
  1. 1 Department of Pediatrics, Sinai Health System, Toronto, Ontario, Canada
  2. 2 Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
  3. 3 Sidney Liswood Health Sciences Library, Sinai Health System, Toronto, Ontario, Canada
  1. Correspondence to Dr Prakesh S Shah, Department of Pediatrics, Sinai Health System, Toronto, M5G 1X5, Canada; pshah{at}mtsinai.on.ca

Abstract

Objective To systematically review and meta-analyse the rate of SARS-CoV-2 genome identification and the presence of SARS-CoV-2 antibodies in breastmilk of mothers with COVID-19.

Design A systematic review of studies published between January 2019 and October 2020 without study design or language restrictions.

Setting Data sourced from Ovid Embase Classic+Embase, PubMed, Web of Science, Scopus, relevant bibliographies and the John Hopkins University COVID-19 database.

Patients Mothers with confirmed COVID-19 and breastmilk tested for SARS-CoV-2 by RT-PCR or for anti-SARS-CoV-2 antibodies.

Main outcome measures Presence of SARS-CoV-2 genome and antibodies in breastmilk.

Results We included 50 articles. Twelve out of 183 women from 48 studies were positive for SARS-CoV-2 genome in their breastmilk (pooled proportion 5% (95% CI 2% to 15%; I2=48%)). Six infants (50%) of these 12 mothers tested positive for SARS-CoV-2, with one requiring respiratory support. Sixty-one out of 89 women from 10 studies had anti-SARS-CoV-2 antibody in their breastmilk (pooled proportion 83% (95% CI 32% to 98%; I2=88%)). The predominant antibody detected was IgA.

Conclusions SARS-CoV-2 genome presence in breastmilk is uncommon and is associated with mild symptoms in infants. Anti-SARS-CoV-2 antibodies may be a more common finding. Considering the low proportion of SARS-CoV-2 genome detected in breastmilk and its lower virulence, mothers with COVID-19 should be supported to breastfeed.

  • COVID-19
  • epidemiology
  • neonatology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. As this study was a systematic review and meta-analysis, all included data were publicly available from published research articles. A complete reference list of included studies is provided in the supplemental references in the supplemental material.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/archdischild-2020-321074

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. As this study was a systematic review and meta-analysis, all included data were publicly available from published research articles. A complete reference list of included studies is provided in the supplemental references in the supplemental material.

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    Footnotes

    • Contributors FZ performed an independent literature search, selected studies for inclusion, extracted and interpreted the data, assessed the risk of bias of included studies and wrote the first draft of the manuscript. CZ performed an independent literature search, selected studies for inclusion, verified the extracted data, assessed risk of bias, interpreted data, translated studies in Spanish, reviewed the manuscript and provided critical feedback. QZ participated in extracting data from studies in Chinese, assessed the risk of bias of included studies and reviewed the manuscript. CDC was the information specialist who developed the search strategy, performed the database search and reviewed the manuscript. PSS conceptualised and designed the study, interpreted the data, oversaw the meta-analysis and revised the final draft of the manuscript.

    • Funding PSS holds an Applied Research Chair in Reproductive and Child Health Services and Policy Research and has received funding for the Canadian Preterm Birth Network from the Canadian Institutes of Health Research (APR-126340).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.