scholarly journals COVID-19 and breastfeeding: can SARS-CoV-2 be spread through lactation?

Discoveries ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. e132
Author(s):  
Radu Marian Florea ◽  
◽  
Camelia Madalina Sultana ◽  
◽  
Keyword(s):  
Breast Milk ◽  
Vertical Transmission ◽  
Case Series ◽  
Hubei Province ◽  
Viral Rna ◽  
Limited Information ◽  
Maternal Milk ◽  
Viral Shedding ◽  
Milk Samples ◽  
In Pregnancy

SARS-CoV-2 is a new betacoronavirus that was first reported in the Hubei province, China, in December 2019. The virus is likely transmitted through air droplets. However, there are reported cases where SARS-CoV-2-RNA was found in other samples, such as blood or stool. Nonetheless, there is limited information concerning the presence of viral RNA in pregnancy-related samples, specifically breast milk. However unlikely, there is still uncertainty regarding the possibility of vertical transmission from mother to infant through breastfeeding. This review aims to synthetize the literature written so far on this topic. Despite not being extensively researched, vertical transmission through breast milk seems unlikely. Case series showed that milk samples from mothers with COVID-19 were almost entirely negative. So far, there have been only 9 recorded cases of viral shedding in milk samples, uncertain however of the viability of the particles. Furthermore, WHO and UNICEF strongly encourage commencing breastfeeding after parturition, underlining the benefits of lactation. Moreover, some studies have proven the existence of IgG and IgA anti-SARS-CoV-2-antibodies in the maternal milk that could possibly play an important part in the neonate’s protection against the virus. Vertical transmission through lactation seems unlikely, most studies pointing towards the safety of breastfeeding. However, further larger-scale studies need to be performed in order to clarify a yet uncertain matter.

scholarly journals Visceral Leishmaniasis in pregnancy and vertical transmission: A systematic literature review on the therapeutic orphans

2021 ◽  
Vol 15 (8) ◽  
pp. e0009650
Author(s):  
Prabin Dahal ◽  
Sauman Singh-Phulgenda ◽  
Brittany J. Maguire ◽  
Eli Harriss ◽  
Koert Ritmeijer ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Pregnant Women ◽  
Amphotericin B ◽  
Vertical Transmission ◽  
Liposomal Amphotericin ◽  
Case Reports ◽  
Case Series ◽  
Liposomal Amphotericin B ◽  
Cochrane Central Register ◽  
In Pregnancy

Background Reports on the occurrence and outcome of Visceral Leishmaniasis (VL) in pregnant women is rare in published literature. The occurrence of VL in pregnancy is not systematically captured and cases are rarely followed-up to detect consequences of infection and treatment on the mother and foetus. Methods A review of all published literature was undertaken to identify cases of VL infections among pregnant women by searching the following database: Ovid MEDLINE; Ovid Embase; Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; World Health Organization Global Index Medicus: LILACS (Americas); IMSEAR (South-East Asia); IMEMR (Eastern Mediterranean); WPRIM (Western Pacific); ClinicalTrials.gov; and the WHO International Clinical Trials Registry Platform. Selection criteria included any clinical reports describing the disease in pregnancy or vertical transmission of the disease in humans. Articles meeting pre-specified inclusion criteria and non-primary research articles such as textbook, chapters, letters, retrospective case description, or reports of accidental inclusion in trials were also considered. Results The systematic literature search identified 272 unique articles of which 54 records were included in this review; a further 18 records were identified from additional search of the references of the included studies or from personal communication leading to a total of 72 records (71 case reports/case series; 1 retrospective cohort study; 1926–2020) describing 451 cases of VL in pregnant women. The disease was detected during pregnancy in 398 (88.2%), retrospectively confirmed after giving birth in 52 (11.5%), and the time of identification was not clear in 1 (0.2%). Of the 398 mothers whose infection was identified during pregnancy, 346 (86.9%) received a treatment, 3 (0.8%) were untreated, and the treatment status was not clear in the remaining 49 (12.3%). Of 346 mothers, Liposomal amphotericin B (L-AmB) was administered in 202 (58.4%) and pentavalent antimony (PA) in 93 (26.9%). Outcomes were reported in 176 mothers treated with L-AmB with 4 (2.3%) reports of maternal deaths, 5 (2.8%) miscarriages, and 2 (1.1%) foetal death/stillbirth. For PA, outcomes were reported in 88 mothers of whom 4 (4.5%) died, 24 (27.3%) had spontaneous abortion, 2 (2.3%) had miscarriages. A total of 26 cases of confirmed, probable or suspected cases of vertical transmission were identified with a median detection time of 6 months (range: 0–18 months). Conclusions Outcomes of VL treatment during pregnancy is rarely reported and under-researched. The reported articles were mainly case reports and case series and the reported information was often incomplete. From the studies identified, it is difficult to derive a generalisable information on outcomes for mothers and babies, although reported data favours the usage of liposomal amphotericin B for the treatment of VL in pregnant women.

scholarly journals Copper and zinc concentrations in the breast milk of mothers undergoing treatment for Wilson’s disease: a prospective study

2021 ◽  
Vol 5 (1) ◽  
pp. e000948
Author(s):  
Hiroko Kodama ◽  
Yasumi Anan ◽  
Yoichi Izumi ◽  
Yasuhiro Sato ◽  
Yasumitsu Ogra
Keyword(s):  
Breast Milk ◽  
Prospective Study ◽  
Wilson’S Disease ◽  
Case Series ◽  
Wilson's Disease ◽  
Healthy Controls ◽  
Milk Samples ◽  
Copper And Zinc ◽  
Breast Feed ◽  
Zinc Concentrations

ObjectiveTo evaluate the concentrations of copper and zinc in the breast milk of mothers undergoing treatment for Wilson’s disease (WD) and clarify whether they can safely breast feed their infants.DesignThis was an observational and prospective study in an individual-based case series.SettingBreast milk samples were collected from participants across Japan from 2007 to 2018 at the Department of Pediatrics, Teikyo University in Tokyo. This was a primary-care level study. Clinical data were collected from the participants’ physicians.PatientsEighteen Japanese mothers with WD who were treated with trientine, penicillamine or zinc, and 25 healthy mothers as controls, were enrolled.Main outcome measuresWhey exacted from the milk was used to evaluate the distribution of copper by high-performance liquid chromatography-inductively coupled plasma mass spectrometry. Copper and zinc concentrations in the breast milk samples were analysed by atomic absorption spectrometry.ResultsCopper distribution was normal in the breast milk of mothers with WD treated with trientine, penicillamine or zinc. No peak was detected for trientine-bound or penicillamine-bound copper. The mean copper concentrations in the mature breast milk of patients treated with trientine, penicillamine and zinc were 29.6, 26 and 38 µg/dL, respectively, and were within the normal range compared with the value in healthy controls (33 µg/dL). Likewise, mean zinc concentrations were normal in the mature breast milk of patients treated with trientine and penicillamine (153 and 134 µg/dL, respectively vs 160 µg/dL in healthy controls). Zinc concentrations in the breast milk of mothers treated with zinc were significantly higher than those in control milk. All infants were born normally, breast fed by mothers undergoing treatment and exhibited normal development.ConclusionsOur results suggest that mothers with WD can safely breast feed their infants, even if they are receiving treatment for WD.

scholarly journals Manifestations in Neonates Born to COVID-19 Positive Mothers: a Case Series

2020 ◽  
Author(s):  
Parul Jain ◽  
Anup Thakur ◽  
Neelam Kler ◽  
Pankaj Garg
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Viral Infection ◽  
Clinical Outcomes ◽  
Vertical Transmission ◽  
Case Series ◽  
Limited Information ◽  
Global Pandemic

Abstract Coronavirus disease (COVID-19) or severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a novel viral infection is currently a global pandemic. Primarily transmitted by aerosols and fomites, limited information exists on its vertical transmission from mother and clinical outcomes in neonates. We report two neonates born to SARS-CoV-2 positive women.

scholarly journals Coronavirus in pregnancy and delivery: rapid review and expert consensus

2020 ◽  
Author(s):  
E Mullins ◽  
D Evans ◽  
RM Viner ◽  
P O’Brien ◽  
E Morris
Keyword(s):  
Vertical Transmission ◽  
Case Reports ◽  
Case Series ◽  
Case Fatality ◽  
Service Planning ◽  
Expert Consensus ◽  
Rapid Review ◽  
The Uk ◽  
The Impact ◽  
In Pregnancy

ABSTRACTBACKGROUNDPerson to person spread of COIVD-19 in the UK has now been confirmed. There are limited case series reporting the impact on women affected by coronaviruses (CoV) during pregnancy. In women affected by SARS and MERS, the case fatality rate appeared higher in women affected in pregnancy compared with non-pregnant women. We conducted a rapid, review to guide management of women affected by COVID -19 during pregnancy and developed interim practice guidance with the RCOG and RCPCH to inform maternity and neonatal service planningMETHODSSearches were conducted in PubMed and MedRxiv to identify primary case reports, case series, observational studies or randomised-controlled trial describing women affected by coronavirus in pregnancy and on neonates. Data was extracted from relevant papers and the review was drafted with representatives of the RCPCH and RCOG who also provided expert consensus on areas where data were lackingRESULTSFrom 9964 results on PubMed and 600 on MedRxiv, 18 relevant studies (case reports and case series) were identified. There was inconsistent reporting of maternal, perinatal and neonatal outcomes across case reports and series concerning COVID-19, SARS, MERS and other coronaviruses. From reports of 19 women to date affected by COVID-19 in pregnancy, delivering 20 babies, 3 (16%) were asymptomatic, 1 (5%) was admitted to ICU and no maternal deaths have been reported. Deliveries were 17 by caesarean section, 2 by vaginal delivery, 8 (42%) delivered pre-term. There was one neonatal death, in 15 babies who were tested there was no evidence of vertical transmission.CONCLUSIONSMorbidity and mortality from COVID-19 appears less marked than for SARS and MERS, acknowledging the limited number of cases reported to date. Pre-term delivery affected 42% of women hospitalised with COVID-19, which may put considerable pressure on neonatal services if the UK reasonable worse-case scenario of 80% of the population affected is realised. There has been no evidence of vertical transmission to date. The RCOG and RCPCH have provided interim guidance to help maternity and neonatal services plan their response to COVID-19.

scholarly journals Neonatal Coronavirus 2019 Infection in a tertiary setup of India: A case series

2021 ◽  
Vol 12 (3) ◽  
pp. 110-113
Author(s):  
Jinia Saha ◽  
Tapas Das ◽  
Kaustav Nayek
Keyword(s):  
Breast Milk ◽  
Vertical Transmission ◽  
Late Onset ◽  
Case Reports ◽  
Age Groups ◽  
Case Series ◽  
Good Prognosis ◽  
Late Onset Sepsis ◽  
The World

Covid-19 disease caused by SARS-COV-2 has been a pandemic throughout the world including India. It affects all age groups including children. The disease is much milder among children compared to adults. In neonates, the disease is often mild and has good prognosis. It is still doubtful whether there is vertical transmission to the neonates from infected mothers. Also, it is not proved whether the disease can be transmitted through breast milk. Here we present case reports of three neonates, two of which were born to COVID-19 positive mothers. Rest one got infected at 25 days of life. None of the two infants born to COVID-19 positive were positive at the time of birth. Our observation is similar to the previous studies that COVID-19 has not yet been proved to transmit vertically. One of them contracted the disease on day 7 of life from the mother in spite of strict precautions. It could not be proved whether it was transmitted from breast milk or faulty practice. One of the infants presented with late onset sepsis. All of the infants recovered well and was thriving well on follow up.

scholarly journals Management of COVID-19 Infected Patients in Pregnancy and Puerperium

2020 ◽  
Vol 15 (1) ◽  
pp. 76-78
Author(s):  
Basant Sharma ◽  
Ganesh Dangal ◽  
Bandana Khanal ◽  
Siddeshwar Angadi
Keyword(s):  
Mechanical Ventilation ◽  
Breast Milk ◽  
Supportive Care ◽  
Vertical Transmission ◽  
Severe Case ◽  
Pregnancy Prevention ◽  
Good Hygiene ◽  
In Pregnancy

COVID-19 is a pandemic affecting every group of people. Pregnancy itself is a partially immune compromised state, so chance of aggravation of symptom supposed to be more in pregnancy. Prevention is the best way to get away from this disease. Good hygiene, supportive care and possible mechanical ventilation for severe case are required. There is no proven role of antibiotic, antiretroviral and steroids. There is no proven vertical transmission. Baby has to be kept in isolation and breast milk can be expressed and given to newborn. Keywords: COVID-19, pandemic, pregnancy.

scholarly journals AB1294-HPR LOW CONCENTRATIONS OF BIOLOGIC DMARDS IN BREASTMILK OF PATIENTS TREATED DURING LACTATION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1937.1-1937
Author(s):  
A. Zbinden ◽  
K. Eriksson ◽  
F. Förger
Keyword(s):  
Breast Milk ◽  
Certolizumab Pegol ◽  
Average Concentration ◽  
Limited Information ◽  
Serum Samples ◽  
Limit Of Quantification ◽  
Biologic Dmards ◽  
Breastfed Infants ◽  
Milk Samples ◽  
Infant Dose

Background:There is very limited information about the passage of biologics into breast milk and into the peripheral blood of breastfed infants. However, based on pharmacological properties of biologic DMARDs (bDMARDs) lactation may not be discouraged in patients with chronic inflammatory rheumatic disease to treat or prevent postpartum relapses. We here report two cases treated with bDMARDs during lactation: one woman with Muckle-Wells syndrome (MWS) treated with canakinumab and one woman with microscopic polyangiitis (MPA) treated with rituximab.Objectives:To determine the level of rituximab and canakinumab in breast milk, in sera of breastfed infants as well as in sera of the mother and to calculate the average daily infant dose and the relative infant dose.Methods:Serum and milk levels of Rituximab were measured by ELISA using commercially available coating and detection antibodies. For Canakinumab an ELISA was established by coating of plates with recombinant human IL-1beta and detection of Canakinumab in samples by a polyclonal anti-human IgG coupled to HRP. In both cases separate standard curves for serum and milk were established. Serum samples and milk samples of unexposed healthy controls were used to determine the lower limit of quantification.Results:One patient with MWS received canakinumab 150 mg s.c. to treat a worsening of her disease ten days postpartum. She continued to breastfeed her child. The average concentration of canakinumab in milk samples collected on 10 consecutive days was 15.8 ng/ml. The average daily infant dose was 0.002 mg/kg/day. The relative infant dose, which refers infant to maternal exposure on a dose/weight basis, was 0.11%. There was no detectable canakinumab in the serum of the infant.One patient with MPA received rituximab 500 mg i.v. as a remission maintenance therapy four months postpartum. She continued to breastfeed her child. The average concentration of rituximab in milk samples collected on 4 consecutive days was 3.71 ng/ml. The average daily infant dose was 0.001 mg/kg/day. The relative infant dose was 0.01%. There was no detectable rituximab in the serum of the infant.Conclusion:Only minimal concentrations of canakinumab and rituximab can be detected in breastmilk. For both bDMARDs, the relative infant dose was below 1% of the maternal dose, which is considered unlikely to be of clinical concern. The lack of detectable levels of canakinumab and rituximab in the infants’ sera supports the notion of low oral bioavailability of large monoclonal antibodies. Together, the results are similar to those seen in TNF inhibitors which are regarded to be compatible with breastfeeding, yet more data are needed (1, 2, 3).References:[1]Götestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, da Silva J, Nelson-Piercy C, Cetin I, Costedoat-Chalumeau N, Dolhain R, Förger F, Khamashta M, Ruiz-Irastorza G, Zink A, Vencovsky J, Cutolo M, Caeyers N, Zumbühl C, Østensen M. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016 May;75(5):795-810. doi: 10.1136/annrheumdis-2015-208840. Epub 2016 Feb 17.[2]Clowse ME, Förger F, Hwang C, Thorp J, Dolhain RJ, van Tubergen A, Shaughnessy L, Simpson J, Teil M, Toublanc N, Wang M, Hale TW. Minimal to no transfer of certolizumab pegol into breast milk: results from CRADLE, a prospective, postmarketing, multicentre, pharmacokinetic study. Ann Rheum Dis. 2017 Nov;76(11):1890-1896. doi: 10.1136/annrheumdis-2017-211384. Epub 2017 Aug 16.[3]Matro R, Martin CF, Wolf D, Shah SA, Mahadevan U. Exposure Concentrations of Infants Breastfed by Women Receiving Biologic Therapies for Inflammatory Bowel Diseases and Effects of Breastfeeding on Infections and Development.Gastroenterology. 2018;155(3):696–704. doi:10.1053/j.gastro.2018.05.040Disclosure of Interests:Astrid Zbinden: None declared, Klara Eriksson: None declared, Frauke Förger Grant/research support from: Unrestricted grant from UCB, Consultant of: UCB, GSK, Roche, Speakers bureau: UCB, GSK

CASE SERIES: ERCP IN PREGNANCY- CAN WE AVOID RADIATION?

2018 ◽  
Author(s):  
F Rhodes ◽  
S Murray ◽  
R Aguilo ◽  
R Shidrawi
Keyword(s):  
Case Series ◽  
In Pregnancy

Pharmacokinetics, Placental and Breast Milk Transfer of Antiretroviral Drugs in Pregnant and Lactating Women Living with HIV

2019 ◽  
Vol 25 (5) ◽  
pp. 556-576 ◽  
Author(s):  
E.M. Hodel ◽  
C. Marzolini ◽  
C. Waitt ◽  
N. Rakhmanina
Keyword(s):  
Breast Milk ◽  
Protease Inhibitors ◽  
Drug Class ◽  
Drug Transporters ◽  
Maternal Plasma ◽  
Antiretroviral Drugs ◽  
Physiological Changes ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
In Pregnancy

Background:Remarkable progress has been achieved in the identification of HIV infection in pregnant women and in the prevention of vertical HIV transmission through maternal antiretroviral treatment (ART) and neonatal antiretroviral drug (ARV) prophylaxis in the last two decades. Millions of women globally are receiving combination ART throughout pregnancy and breastfeeding, periods associated with significant biological and physiological changes affecting the pharmacokinetics (PK) and pharmacodynamics (PD) of ARVs. The objective of this review was to summarize currently available knowledge on the PK of ARVs during pregnancy and transport of maternal ARVs through the placenta and into the breast milk. We also summarized main safety considerations for in utero and breast milk ARVs exposures in infants.Methods:We conducted a review of the pharmacological profiles of ARVs in pregnancy and during breastfeeding obtained from published clinical studies. Selected maternal PK studies used a relatively rich sampling approach at each ante- and postnatal sampling time point. For placental and breast milk transport of ARVs, we selected the studies that provided ratios of maternal to the cord (M:C) plasma and breast milk to maternal plasma (M:P) concentrations, respectively.Results:We provide an overview of the physiological changes during pregnancy and their effect on the PK parameters of ARVs by drug class in pregnancy, which were gathered from 45 published studies. The PK changes during pregnancy affect the dosing of several protease inhibitors during pregnancy and limit the use of several ARVs, including three single tablet regimens with integrase inhibitors or protease inhibitors co-formulated with cobicistat due to suboptimal exposures. We further analysed the currently available data on the mechanism of the transport of ARVs from maternal plasma across the placenta and into the breast milk and summarized the effect of pregnancy on placental and of breastfeeding on mammal gland drug transporters, as well as physicochemical properties, C:M and M:P ratios of individual ARVs by drug class. Finally, we discussed the major safety issues of fetal and infant exposure to maternal ARVs.Conclusions:Available pharmacological data provide evidence that physiological changes during pregnancy affect maternal, and consequently, fetal ARV exposure. Limited available data suggest that the expression of drug transporters may vary throughout pregnancy and breastfeeding thereby possibly impacting the amount of ARV crossing the placenta and secreted into the breast milk. The drug transporter’s role in the fetal/child exposure to maternal ARVs needs to be better understood. Our analysis underscores the need for more pharmacological studies with innovative study design, sparse PK sampling, improved study data reporting and PK modelling in pregnant and breastfeeding women living with HIV to optimize their treatment choices and maternal and child health outcomes.

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