Cornell researchers are leading a “living systematic review” on the risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through breast milk intake and breastfeeding.

Findings will inform the World Health Organization’s (WHO) international guidelines on breastfeeding during the COVID-19 pandemic.

Dr. Saurabh Mehta and Julia Finkelstein, both associate professors in Cornell’s Division of Nutritional Sciences, as well as the Department of Global Development, are leading the ongoing effort. Mehta is a physician and infectious disease epidemiologist and leads an acute febrile illness surveillance program in Ecuador. Finkelstein specializes in maternal and child health and leads a community-based surveillance program among reproductive-age women in Southern India.

Breastfeeding is the cornerstone for ensuring that children get a healthy start in life, Mehta said, but it also may be the source of transmission of some infections from mother to child.

“The ongoing pandemic is expected to lead to major global increases in childhood malnutrition due to multiple factors, including the reduction in food quality and access, and an interruption in feeding programs,” Mehta said.

“One of the World Health Organization’s critical functions is to develop guidelines for what should be done in these times,” Mehta said. “With the anticipated risk to child health and nutrition due to the pandemic, it’s important to determine the role of breast milk and breastfeeding in transmission of the virus, if any.”

When COVID-19 first appeared in January, the review team examined hundreds of papers and reports to inform WHO’s emergency guidelines for breastfeeding and COVID-19.

As of July 7, the team had screened 19,414 scientific articles and found 309 studies that reported on breastfeeding among women with suspected or confirmed COVID-19 and their infants. Among these, 38 studies included a molecular-based assessment of breast milk samples for SARS-CoV-2, the virus that causes COVID-19.

In a WHO scientific brief posted online June 23, the organization recommended that mothers with suspected or confirmed COVID-19 cases should be encouraged to initiate or continue to breastfeed. The paper, “Transmission of Novel Coronavirus (COVID-19) Through Breast Milk and Breastfeeding: A Living Systematic Review,” which informs the WHO’s recommendation, has been accepted and will be published in a forthcoming issue of the Annals of the New York Academy of Sciences.

“This highlights the need for additional studies that not only report on the presence of viral particles within breast milk, but to understand if these particles are infectious,” Finkelstein said. “As new evidence emerges, our team will continue to synthesize and report on relevant data to help inform infant feeding guidelines in the context of COVID-19.”

The Cornell review team members also include:

• Elizabeth Centeno-Tablante, doctoral student, and Melisa Medina-Rivera, postdoctoral researcher, who will both monitor international medical databases and clinical trial registries to assess evidence as the pandemic evolves;
• Dr. Pratiwi Ridwan, a doctoral student in Mehta’s laboratory; and
• Kate Ghezzi-Kopel, health sciences and evidence synthesis librarian at Mann Library and coordinator of Cornell University Library’s Evidence Synthesis Service, who helped develop the team’s search methods protocol to ensure that the resulting evidence is comprehensive, unbiased and transparent.

The WHO collaborators include: Dr. Juan Pablo Peña-Rosas, head of Cross-cutting Global Initiatives in the Department of Nutrition and Food Safety; Dr. Pura Rayco-Solon, a scientist in the Department of Maternal, Newborn, Child and Adolescent Health and Aging; Maria Nieves Garcia-Casal, nutrition scientist; and Lisa Rogers, technical officer in the Department of Nutrition and Food Safety.

Funding for this ongoing research is provided by the WHO.