Experts: The potential benefit far outweighs the concerns about the safety of the vaccination in breastfeeding women with an increased COVID-19 risk
To the best of our knowledge, the administration of non-live vaccines during breastfeeding is not associated with an increased risk for the breastfeeding woman or the infant . For the use of mRNA vaccines during breastfeeding, e.g. B. the influence on the breastfed infant or breast milk production / secretion, but no data are currently available.
Basic routine vaccination of all breastfeeding women is currently not recommended
A general routine vaccination of all breastfeeding women is currently not recommended by the majority of the specialist societies, also on the basis of the currently limited vaccine resources [2, 3]. The Standing Vaccination Commission (STIKO), however, considers it unlikely that vaccination of the mother during breastfeeding poses a risk to the infant [3, 4]. The Society for Maternal Fetal Medicine (SMFM) also sees no reason to believe that the vaccine poses a safety risk for the mother and / or infant during breastfeeding . A biologically traceable mechanism that could cause damage is currently not known . At this point in time, however, no conclusive studies are available on the transfer of vaccine components into breast milk .
Protection against SARS-CoV-2 infection for breastfeeding women can be assumed to be as effective as the vaccination has been shown in previous studies for non-breastfeeding women, even if detailed information is missing . Especially in the case of personal risks of severe COVID-19 disease caused by comorbidities or exposure such as pre-existing cardiovascular diseases, chronic lung diseases, autoimmune diseases and a weakened immune system as well as diabetes, hypertension and obesity, the potential benefit of the vaccination outweighs the theoretical concerns with regard to the safety of the vaccination [1,2].
Potential infection protection of the infant after vaccination of the mother
The re are individual reports of severe or critical COVID-19 cases in children under 12 months [8, 9], even if infants are not more likely to be infected per se and infections are often asymptomatic or mild [10, 11]. However, immunizing the mother can minimize the risk of a child’s infection. After secretion into breast milk, antibodies formed by vaccine immunization represent a potential protection against infection of the infant. Virus-specific IgA- , IgM and IgG [13, 14] Antibodies against SARS-CoV-2 can be detected in breast milk of women with active or past SARS-CoV-2 infection during pregnancy. Neutralizing antibodies after infection or vaccination are currently the best humoral immune correlate to protect against infection . Even if there is no reliable data, protective immunity transmitted through breast milk can be a passive prevention strategy to protect the infant .
The refore, the (potential) advantages of vaccination for mother and infant should be presented in the counseling and education and participatory decision-making should be enabled . The developmental and health benefits of breastfeeding should be taken into account along with the woman’s clinical need for immunization against COVID-19 (depending on risk factors for SARS-CoV-2 infection / severe COVID-19) and the absence safety data for the vaccine in breastfeeding women should be informed . If the breastfeeding woman has an increased need for safety, an individual determination of a breastfeeding-free period of one to three days after the vaccination can be considered. However, international recommendations do not see any need for delaying the start of breastfeeding, interruption of breastfeeding or weaning after vaccination [5,18].
1. JCVI. Advice on priority groups for covid 19 vaccination 30 dec 2020 revised. In; 2020
2. RCOG. Covid-19 vaccination and pregnancy. In; 2020
3. RKI S. Communication from the Standing Vaccination Commission at the Robert Koch Institute: Decision of the STIKO on the 1st update of the COVID-19 vaccination recommendation and the associated scientific justification, STIKO recommendation on the COVID-19 vaccination; Updated January 8, 2021. In; 2021
4. CDC. Pregnancy in Breastfeeding – vaccines reccomendations. In; 2020
5. WHO. Interim recommendations for use of the Pfizer–BioNTech COVID-19 vaccine, BNT162b2, www.who.int/publications/i/item/WHO-2019-nCoV-vaccines-SAGE_recommendation-BNT162b2-2021.1
6. experts SfMFM-H-rp. Statement: SARS-CoV-2 Vaccination in Pregnancy. In; 2020
7. Institute of Obstetricians and Gynecologists I. Statement Pregnancy Covid-19. In,releases; 2020
8. Dong Y, Mo X, Hu Y et al. Epidemiology of COVID-19 Among Children in China. Pediatrics 2020; 145. doi:10.1542/peds.2020-0702
9. CDC. Coronavirus Disease 2019 in Children — United States, February 12–April 2,2020. MMWR Morb Mortal Wkly Rep. 2020;69:422–6. doi: 10.15585/mmwr.mm6914e4
10. Mithal LB, Machut KZ, Muller WJ et al. SARS-CoV-2 Infection in Infants Less than 90Days Old. J Pediatr 2020; 224: 150-152. doi:10.1016/j.jpeds.2020.06.047
11. Raschetti R, Vivanti AJ, Vauloup-Fellous C et al. Synthesis and systematic review ofreported neonatal SARS-CoV-2 infections. Nat Commun 2020; 11: 5164. doi:10.1038/s41467-020-18982-9
12. Lebrao CW, Cruz MN, Silva MHD et al. Early Identification of IgA Anti-SARSCoV-2 in Milk of Mother With COVID-19 Infection. J Hum Lact 2020; 36: 609-613. doi:10.1177/0890334420960433
13. Gao X, Wang S, Zeng W et al. Clinical and immunologic features among COVID-19-affected mother-infant pairs: antibodies to SARS-CoV-2 detected in breast milk. New Microbes New Infect 2020; 37: 100752. doi:10.1016/j.nmni.2020.100752
14. Lackey KA, Pace RM, Williams JE et al. SARS-CoV-2 and human milk: What is the evidence? Matern Child Nutr 2020; 16: e13032. doi:10.1111/mcn.13032
15. Cimolai N. A Minimalist Strategy Towards Temporarily Defining Protection for COVID-19.SN Compr Clin Med 2020. doi:10.1007/s42399-020-00533-4: 1-8. doi:10.1007/s42399-020-00533-4
16. Cimolai N. Applying Immune Instincts and Maternal Intelligence from ComparativeMicrobiology to COVID-19. SN Compr Clin Med 2020. doi:10.1007/s42399-020-00634-0: 1-14.
17. ACOG. Vaccinating pregnant and lactating patients against covid-19. In, clinicalguidance practice advisory; 2020
18. Academy of Breastfeeding Medicine A. ABM STATEMENT Considerations for COVID-19 Vaccination in Lactation. In; 2020
A common recommendation
of the German Society for Perinatal Medicine e. V. (DGPM)
The DGPM is the oldest and by far the largest specialist society for the interdisciplinary field of “perinatal medicine” (obstetrics / neonatology and neighboring areas) in the German-speaking area. It primarily pursues the development and promotion of advances in science on pregnancy, childbirth and the neonatal period Mother and child.
of the National Breastfeeding Commission (NSK)
The main task of the National Breastfeeding Commission is to promote breastfeeding in the Federal Republic of Germany. The commission advises the federal government, issues guidelines and recommendations and supports initiatives to remove existing obstacles to breastfeeding. The aim is to recognize structural problems in breastfeeding and, where possible, to eliminate them.
of the German Society for Gynecology and Obstetrics e. V. (DGGG)
The DGGG is one of the largest scientific societies in Germany. It is committed to strengthening the specialist areas of gynecology and obstetrics and promotes the entire subject and its subdisciplines in order to further develop the unity of the specialist area gynecology and obstetrics. As a medical society, the DGGG is constantly committed to the health of women and represents the health needs of women in various political bodies.
Source and further information: PRESS RELEASE OF THE GERMAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS EV (DGGG)
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