{"id":1271,"date":"2021-07-03T14:04:37","date_gmt":"2021-07-03T08:34:37","guid":{"rendered":"https:\/\/www.diabetesasia.org\/magazine\/?p=1271"},"modified":"2025-03-20T11:07:27","modified_gmt":"2025-03-20T05:37:27","slug":"pasteurizing-breast-milk-inactivates-sars-cov-2","status":"publish","type":"post","link":"https:\/\/www.diabetesasia.org\/magazine\/pasteurizing-breast-milk-inactivates-sars-cov-2\/","title":{"rendered":"Pasteurizing Breast Milk Inactivates COVID-19"},"content":{"rendered":"
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Pasteurizing Breast Milk Inactivates SARS-CoV-2<\/h1>\n<\/div>\n
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PHOTO BY GOLFXX, DREAMSTIME TOPIC Metabolism and Nutrition\u00a0<\/a><\/p>\n

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RESEARCHERS\u00a0Sharon Unger, Deborah O\u2019Connor<\/p>\n<\/div>\n<\/div>\n

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Researchers at the University\u00a0of\u00a0Toronto and Sinai Health have found that a common technique to pasteurize breast milk inactivates the virus that causes COVID-19, making it safe for use.<\/p>\n

The findings provide further assurance for parents and families who use human milk banks to feed their infants. Current advice is for women with COVID-19 to continue to breastfeed their own infants, and it is standard care in Canada to provide pasteurized breast milk to very-low-birth-weight babies in hospital until their own mother\u2019s milk supply is adequate.\u201cIn the event that a woman who is COVID-19-positive donates human milk that contains SARS-CoV-2, whether by transmission through the mammary gland or by contamination through respiratory droplets, skin, breast pumps and milk containers, this method of pasteurization renders milk safe for consumption,\u201d the authors write in their study, published this week in the Canadian Medical Association Journal.<\/p>\n

The lead author on the paper was\u00a0Sharon Unger<\/strong>, a professor of\u00a0pediatrics<\/a>\u00a0and\u00a0nutritional sciences<\/a>\u00a0at U\u00a0of\u00a0T and neonatologist at\u00a0Sinai Health<\/a>, who is medical director of the\u00a0Rogers Hixon Ontario Human Milk Bank<\/a>.<\/p>\n

Unger said the current pandemic is a time for extra efforts to protect the supply of donated human milk, in part because the formula was scarce and previous pandemics \u2014 notably HIV\/AIDS \u2014 created major challenges for human milk bank supply.<\/p>\n

Related:Pasteurizing Breast Milk Inactivates COVID-19<\/a><\/strong><\/p>\n

The Holder method, a technique used to pasteurize milk in all Canadian milk banks (62.5\u00b0C for 30 minutes), is effective at neutralizing viruses such as HIV, hepatitis, and others that are known to be transmitted through humans milk.<\/p>\n

In this study, researchers spiked human breast milk with a viral load of SARS-CoV-2 in U\u00a0of\u00a0T\u2019s\u00a0combined containment level 3 unit<\/a>, and tested samples that either sat at room temperature for 30 minutes or were warmed to 62.5\u00b0C for 30 minutes. The virus in the pasteurized milk was inactivated after heating.<\/p>\n

Interestingly, the virus in the unheated milk was also weakened, said\u00a0Deborah O\u2019Connor<\/strong>, the senior author on the paper who is chair of nutritional sciences at U\u00a0of\u00a0T and a researcher in the\u00a0Joannah & Brian Lawson Centre for Child Nutrition<\/a>.<\/p>\n

O\u2019Connor said this finding suggests some properties of breast milk may counteract the virus, and she recently received funding to pursue research on that topic.<\/p>\n

The impact of pasteurization on coronaviruses in human milk has not been previously reported in the scientific literature.<\/p>\n

More than 650 human breast milk banks around the world use the Holder method to ensure a safe supply of milk for vulnerable infants.<\/p>\n

The research was supported by the Canadian Institutes of Health Research and through the University of Toronto and the Temerty Foundation, which provided funding for enhanced capacity and operations of the university\u2019s combined containment level 3 facility during the COVID-19 pandemic.<\/p>\n<\/div>\n

Breastfeeding<\/b>, also called\u00a0nursing<\/b>, is the process of feeding human breast milk to a child, either directly from the breast or by expressing (pumping out) the milk from the breast and bottle-feeding it to the infant.<\/sup>\u00a0The\u00a0World Health Organization<\/a>\u00a0(WHO) recommends that breastfeeding begin within the first hour of a baby’s life and continue as often and as much as the baby wants.<\/sup><\/sup> During the first few weeks of life, babies may nurse roughly every two to three hours, and the duration of a feeding is usually ten to fifteen minutes on each breast.<\/sup>\u00a0Older children feed less often.<\/sup> Mothers may pump milk so that it can be used later when breastfeeding is not possible.\u00a0 <\/sup>Breastfeeding has a number of benefits to both mother and baby, which\u00a0i<\/a>nfant formula\u00a0lacks.<\/sup><\/sup><\/p>\n

Increased breastfeeding globally could prevent approximately 820,000 deaths of children under the age of five annually.\u00a0Breastfeeding decreases the risk of\u00a0respiratory tract infections\u00a0and\u00a0diarrhea\u00a0for the baby, both in\u00a0developing\u00a0and\u00a0developed countries. <\/sup>Other benefits include lower risks of\u00a0asthma,\u00a0food allergies, and\u00a0type 1 diabetes.\u00a0Breastfeeding may also improve cognitive development\u00a0and decrease the risk of\u00a0obesity\u00a0in adulthood.<\/sup>\u00a0Mothers may feel pressure to breastfeed, but in the developed world children generally grow up normally when\u00a0bottle-fed\u00a0with\u00a0formula.<\/sup><\/p>\n

Benefits for the mother include less\u00a0blood loss\u00a0following\u00a0delivery, better\u00a0uterus\u00a0contraction, and decreased\u00a0postpartum depression.<\/sup>\u00a0Breastfeeding delays the return of\u00a0menstruation\u00a0and\u00a0fertility, a phenomenon known as\u00a0lactational amenorrhea.<\/sup>\u00a0Long-term benefits for the mother include decreased risk of\u00a0breast cancer,\u00a0cardiovascular disease, and\u00a0rheumatoid arthritis. Breastfeeding is also less expensive than infant formula.\u00a0<\/sup><\/sup>Health organizations, including the\u00a0WHO, recommend breastfeeding exclusively for six months.<\/sup><\/sup><\/sup>\u00a0This means that no other foods or drinks, other than possibly\u00a0vitamin D, are typically given.<\/sup>\u00a0After the introduction of foods at six months of age, recommendations include continued breastfeeding until one to two years of age or more.<\/sup><\/sup>\u00a0Globally, about 38% of infants are exclusively breastfed during their first six months of life.<\/sup>\u00a0In the United States in 2015, 83% of women begin breastfeeding, but at 6 months only 58% were still breastfeeding with 25% exclusively breastfeeding.<\/sup>\u00a0Medical conditions that do not allow breastfeeding are rare.<\/sup>\u00a0Mothers who take certain\u00a0recreational drugs\u00a0and\u00a0medications<\/a>\u00a0should not breastfeed.<\/sup><\/sup>\u00a0In 2020, WHO and UNICEF announced that women should continue to breastfeed during the\u00a0COVID-19 pandemic<\/a>\u00a0even if they have confirmed or suspected COVID-19 because current evidence indicates that it is unlikely that COVID-19 can be transmitted through breast milk.<\/sup>\u00a0Smoking tobacco and consuming limited amounts of alcohol and\/or coffee are not reasons to avoid breastfeeding.https:\/\/www.diabetesasia.org\/magazine\/covid-19-and-diabetes\/<\/a><\/sup><\/sup><\/sup><\/p>\n

Lactation<\/span>\"\"<\/a><\/h2>\n
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When the baby suckles its mother’s breast, a hormone called\u00a0oxytocin\u00a0compels the milk to flow from the\u00a0alveoli\u00a0(lobules), through the ducts (milk canals), into the sacs (milk pools) behind the\u00a0areola, and then into the baby’s mouth.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

Main article:\u00a0Lactation<\/div>\n

Changes early in<\/p>\n

pregnancy prepares the breast for lactation. Before pregnancy, the breast is largely composed of adipose\u00a0(fat) tissue but under the influence of the hormones\u00a0estrogen,\u00a0progesterone,\u00a0prolactin, and other hormones, the breasts prepare for production of milk for the baby. There is an increase in blood flow to the breasts. Pigmentation of the nipples and\u00a0areola\u00a0also increases. Size increases as well, but breast size is not related to the amount of milk that the mother will be able to produce after the baby is born.<\/sup><\/p>\n

By the second trimester of pregnancy\u00a0colostrum, a thick yellowish fluid, begins to be produced in the alveoli and continues to be produced for the first few days after birth until the milk “comes in”, around 30 to 40 hours after delivery.<\/sup>\u00a0Oxytocin\u00a0contracts the\u00a0smooth muscle\u00a0of the\u00a0uterus\u00a0during birth and following delivery, called the\u00a0postpartum<\/a> period while breastfeeding. Oxytocin also contracts the smooth muscle layer of band-like cells surrounding the alveoli to squeeze the newly produced milk into the duct system. Oxytocin is necessary for the\u00a0milk ejection reflex<\/i>, or\u00a0let-down<\/i>, in response to suckling, to occur.<\/p>\n

<\/sup>Breast milk<\/span><\/h4>\n
Breast milk<\/a><\/div>\n
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Two 25\u00a0ml samples of human breast milk. The sample on the left is\u00a0foremilk<\/i>, the watery milk coming from a full breast. To the right is\u00a0hindmilk<\/i>, the creamy milk coming from a nearly empty breast.<\/sup><\/p>\n<\/div>\n<\/div>\n<\/div>\n

Not all of breast milk’s properties are understood, but its\u00a0nutrient\u00a0content is relatively consistent. Breast milk is made from nutrients in the mother’s\u00a0bloodstream\u00a0and bodily stores. It has an optimal balance of fat, sugar, water, and\u00a0protein\u00a0that is needed for a baby’s growth and development.<\/sup>\u00a0Breastfeeding triggers biochemical reactions which allow for the\u00a0enzymes,\u00a0hormones, growth factors, and immunologic substances to effectively defend against infectious diseases\u00a0for the infant. The breast milk also has long-chain\u00a0polyunsaturated fatty acids\u00a0which help with normal\u00a0retinal\u00a0and\u00a0neural\u00a0development.<\/sup><\/p>\n

If the mother is not herself deficient in vitamins breast milk normally supplies her baby’s needs, possibly with the exception of vitamin D. The CDC, the American Academy of Pediatrics, and the Mayo Clinic all advise that even if the mother is taking vitamins containing vitamin D her breast milk alone does not provide infants with an adequate amount of vitamin D, thus they advise that shortly after birth most infants will need an additional source.<\/sup>\u00a0Some research shows that delaying clamping of the cord at birth until the pulsations have stopped improves the infants’ iron status for the first six months.<\/sup><\/p>\n

The composition of breast milk changes depending on how long the baby nurses at each session, as well as on the child’s age. <\/sup>The first type, produced during the first days after childbirth, is called\u00a0colostrum<\/a><\/i>. Colostrum is easy to digest although it is more concentrated than mature milk. It has a laxative effect that helps the infant to pass early stools, aiding in the excretion of excess\u00a0bilirubin<\/a>, which helps to prevent\u00a0jaundice<\/a>. It also helps to seal the infant’s gastrointestional tract from foreign substances, which may sensitize the baby to foods that the mother has eaten. Although the baby has received some antibodies through the placenta, colostrum contains a substance that is new to the newborn, secretory immunoglobulin A<\/a>\u00a0(IgA). IgA works to attack germs in the mucous membranes of the throat, lungs, and intestines, which are most likely to come under attack from germs.<\/sup><\/p>\n

Breasts begin producing mature milk around the third or fourth day after birth. At that time the breasts begin to feel full and the milk is then said to have “come in.” As the baby suckles the milk is said to be “letting down” which the mother experiences as a tingling feeling which may be quite strong. Also, in the early days following delivery the mother may feel her uterus cramping during letting down, beneficial cramping to help prevent excessive bleeding. Letting down may also be prompted by other things than the suckling of the baby, for example, just the thought of the baby can produce let down. Mothers may use purchased disposable pads in their bra or use washable homemade pads to absorb the leaking milk.<\/sup><\/p>\n

Early in a nursing session, the breasts produce\u00a0foremilk<\/i>, thinner milk containing many proteins and vitamins. If the baby keeps nursing, then hindmilk<\/i>\u00a0is produced. Hindmilk has a more yellow color and creamier texture because it contains more fat.<\/sup><\/p>\n

Process<\/span><\/h2>\n

Commencement<\/span><\/h2>\n
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Newborn rests as a\u00a0caregiver<\/a> check its breath sounds with a\u00a0stethoscope<\/p>\n<\/div>\n<\/div>\n<\/div>\n

There is increasing evidence that suggests that early skin-to-skin contact (also called\u00a0kangaroo care) between mother and baby stimulates breastfeeding behavior in the baby.<\/sup>\u00a0Newborns who are immediately placed on their mother’s skin have a natural instinct to latch on to the breast and start nursing, typically within one hour of birth. Immediate skin-to-skin contact may provide a form of\u00a0imprinting\u00a0that makes subsequent feeding significantly easier. In addition to more successful breastfeeding and bonding, immediate skin-to-skin contact reduces crying and warms the baby.<\/p>\n

According to studies cited by UNICEF, babies naturally follow a process that leads to a first breastfeed. Initially, after birth, the baby cries with its first breaths. Shortly after, it relaxes and makes small movements of the arms, shoulders, and head. If placed on the mother’s abdomen the baby then crawls towards the breast, called the breast crawl, and begins to feed. After feeding, it is normal for a baby to remain latched to the breast while resting. This is sometimes mistaken for lack of appetite. Absent interruptions, all babies follow this process. Rushing or interrupting the process, such as removing the baby to weigh him\/her, may complicate subsequent feeding.<\/sup> Activities such as weighing, measuring, bathing, needle-sticks, and eye prophylaxis wait until after the first feeding.<\/sup><\/p>\n

Current research strongly supports immediate skin-to-skin mother-baby contact even if the baby is born by\u00a0Cesarean surgery. The baby is placed on the mother in the operating room or the recovery area. If the mother is unable to immediately hold the baby a family member can provide skin-to-skin care until the mother is able. The La Leche League suggests early skin-to-skin care following an unexpected surgical rather than vaginal delivery “may help heal any feelings of sadness or disappointment if the birth did not go as planned.”<\/sup><\/p>\n

Children who are born\u00a0preterm have difficulty initiating breastfeeds immediately after birth. By convention, such children are often fed on expressed breast milk or other supplementary feeds through tubes or bottles until they develop a satisfactory ability to suck breast milk. Tube feeding, though commonly used, is not supported by scientific evidence as of October 2016. <\/sup>It has also been reported in the same\u00a0systematic review that by avoiding bottles and using cups instead to provide supplementary feeds to preterm children, a greater extent of breastfeeding for a longer duration can subsequently be achieved.<\/sup><\/p>\n

Timing<\/span><\/h3>\n

Newborn babies typically express demand for feeding every one to three hours (8\u201312 times in 24 hours) for the first two to four weeks. <\/sup>A\u00a0newborn has a very small stomach capacity. At one day old it is 5\u20137\u00a0ml, about the size of a\u00a0large marble; at day three it is 22\u201330 ml, about the size of a ping-pong ball; and at day seven it is 45\u201360 ml, or about the size of a golf ball. The amount of breast milk that is produced is timed to meet the infant’s needs in that the first milk, colostrum, is concentrated but produced in only very small amounts, gradually increasing in volume to meet the expanding size of the infant’s stomach capacity.<\/sup><\/p>\n

According to\u00a0La Leche League International, “Experienced breastfeeding mothers learn that the sucking patterns and needs of babies vary. While some infants’ sucking needs are met primarily during feedings, other babies may need additional sucking at the breast soon after a feeding even though they are not really hungry. Babies may also nurse when they are lonely, frightened, or in pain…Comforting and meeting sucking needs at the breast is nature’s original design. Pacifiers<\/a>\u00a0(dummies, soothers) are a substitute for the mother when she cannot be available. Other reasons to pacify a baby primarily at the breast include superior oral-facial development, prolonged\u00a0lactational amenorrhea<\/a>, avoidance of\u00a0nipple confusion, and stimulation of an adequate milk supply to ensure higher rates of breastfeeding success.”<\/sup><\/p>\n

Many newborns will feed for 10 to 15 minutes on each breast.<\/sup>\u00a0If the infant wants to nurse for a much longer period\u2014say 30 minutes or longer on each breast\u2014they may not be getting enough milk.<\/sup><\/p>\n

Duration and exclusivity<\/span><\/h3>\n

Health organizations recommend breastfeeding exclusively for six months following birth, unless medically contraindicated.<\/sup><\/sup><\/sup><\/sup><\/sup><\/sup><\/sup><\/sup><\/sup><\/sup>\u00a0Exclusive breastfeeding is defined as “an infant’s consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk and no foods) except for vitamins, minerals and medications.”<\/sup>\u00a0In some countries, including the United States, UK, and Canada, daily\u00a0vitamin D<\/a> supplementation is recommended for all breastfed infants.\u00a0<\/sup><\/sup><\/sup>It seems that giving 400 IU vitamin D per day for 6 months to breastfed infants reduces vitamin D insufficiency; this result can also be achieved by providing at least 4000 IU vitamin D per day to the breastfeeding person. Note that it was not possible to determine that these vitamin D supplements were actually improving bone health.<\/sup><\/p>\n

After solids are introduced at around six months of age, continued breastfeeding is recommended. The AAP recommends that babies be breastfed at least until 12 months, or longer if both the mother and child wish.<\/sup> WHO’re guidelines recommend “continue[d] frequent, on-demand breastfeeding until two years of age or beyond.<\/sup><\/sup><\/p>\n

The vast majority of mothers can produce enough milk to fully meet the nutritional needs of their baby for six months. Breast milk supply augments in response to the baby’s demand for milk and decreases when milk is allowed to remain in the breasts.<\/sup>\u00a0Low milk supply\u00a0is usually caused by allowing milk to remain in the breasts for long periods of time, or insufficiently draining the breasts during feeds. It is usually preventable, unless caused by medical conditions that have been estimated to affect up to five percent of women.<\/sup>\u00a0There is no evidence to support increased fluid intake for breastfeeding mothers will increase their milk production.<\/sup>\u00a0“Drink when thirsty” is advised.<\/sup>\u00a0If the baby is\u00a0latching\u00a0and swallowing well, but is not gaining weight as expected or is showing signs of dehydration, low milk supply in the mother can be suspected.<\/sup><\/p>\n

Medical contraindications<\/span><\/h3>\n
Breastfeeding by HIV infected mothers<\/div>\n

Medical conditions that do not allow breastfeeding are rare.<\/sup>\u00a0Infants that are otherwise healthy uniformly benefit from breastfeeding,<\/sup>\u00a0however, extra precautions should be taken or breastfeeding avoided in circumstances including certain infectious diseases. A breastfeeding child can become infected with HIV. Factors such as the\u00a0viral load\u00a0in the mother’s milk complicate breastfeeding recommendations for HIV-positive mothers.<\/sup><\/sup><\/p>\n

In mothers who have treated with antiretroviral drugs\u00a0the risk of HIV transmission with breastfeeding is 1\u20132%.<\/sup>\u00a0Therefore, breastfeeding is still recommended in areas of the world where death from infectious diseases is common.<\/sup>\u00a0Infant formula should only be given if this can be safely done.<\/sup><\/p>\n

WHO recommends that national authorities in each country decide which infant feeding practice should be promoted by their maternal and child health services to best avoid HIV transmission from mother to child. <\/sup>Other maternal infections of concern include active untreated\u00a0tuberculosis\u00a0or\u00a0human T-lymphotropic virus. Mothers who take certain\u00a0recreational drugs\u00a0and medications should not breastfeed.<\/sup><\/p>\n

In May 2020, WHO and UNICEF stressed that the ongoing\u00a0COVID-19 pandemic\u00a0was not a reason to begin or discontinue breastfeeding. They recommend that women should continue to breastfeed during the pandemic even if they have confirmed or suspected COVID-19 because current evidence indicates that it is not likely that COVID-19 can be transmitted through breast milk.<\/sup><\/p>\n

Location<\/span><\/h3>\n
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Rooming-in bassinet<\/p>\n<\/div>\n<\/div>\n<\/div>\n

All 50 states, the District of Columbia, Puerto Rico and the Virgin Islands have laws that allow a mother to breastfeed her baby in any public or private location. In the United States, the Friendly Airports for Mothers (FAM) Act was signed into law in 2019 and the requirements went into effects in 2021. This law requires all large and medium hub airports must provide a private, non-bathroom lactation space in each terminal building.<\/p>\n

In hospitals,\u00a0rooming-in care<\/a> permits the baby to stay with the mother and simplifies the process. Some commercial establishments provide breastfeeding rooms, although laws generally specify that mothers may breastfeed anywhere, without requiring a special area. Despite these laws, many women in the United States continue to be publicly shamed or asked to refrain from breastfeeding in public.\u00a0In the\u00a0United Kingdom, the\u00a0Equality Act 2010\u00a0makes the prevention of a woman breastfeeding in any public place\u00a0discrimination under the law. In\u00a0Scotland, it is a criminal offense to try to prevent a woman feeding a child under 24 months in public.<\/p>\n

While laws in the U.S. that passed in 2010 which required that nursing mothers who had returned to work be given a non-bathroom space to express milk and a reasonable break time to do so, as of 2016 the majority of women still did not have access to both accommodations.<\/sup>\u00a0As of 2019, some establishments have placed small portable nursing “pods” with electrical outlets for nursing pumps to provide their places of business with a comfortable private area to nurse or express milk. The\u00a0Minnesota Vikings were the first (2015) NFL franchise to implement the lactation pods. In 2019 it was reported that the pod manufacturer had placed 152 of them in 57 airports.<\/sup><\/p>\n

In 2014, newly elected\u00a0Pope Francis<\/a>\u00a0drew worldwide commentary when he encouraged mothers to breastfeed babies in church. During a papal\u00a0baptism<\/a>, he said that mothers “should not stand on ceremony” if their children were hungry. “If they are hungry, mothers, feed them, without thinking twice,” he said, smiling. “Because they are the most important people here.<\/sup><\/p>\n

Position<\/span><\/h3>\n

Correct positioning and technique for latching on are necessary to prevent nipple soreness and allow the baby to obtain enough milk.<\/p>\n

Babies can successfully latch on to the breast from multiple positions. Each baby may prefer a particular position. The “football” hold places the baby’s legs next to the mother’s side with the baby facing the mother. Using the “cradle” or “cross-body” hold, the mother supports the baby’s head in the crook of her arm. The “cross-over” hold is similar to the cradle hold, except that the mother supports the baby’s head with the opposite hand. The mother may choose a reclining position on her back or side with the baby lying next to her.<\/p>\n