Considerations for Pregnancy, Breastfeeding, and COVID-19

Patients who are pregnant may be at an increased risk of severe illness from COVID-19 and adverse events such as preterm birth. Although patients who were pregnant or lactating were not included in the vaccine trials, these patients should not be excluded from receiving the vaccine if they choose to get immunized. There is no documented evidence of harm that would necessitate preventing these patients from being vaccinated against COVID-19. Further, the American Academy of Family Physicians (AAFP) supports ongoing efforts to include this population in future vaccine trials.

The AAFP encourages patients who are pregnant or breastfeeding to have a discussion with their physician which includes information on the level of COVID-19 community transmission, the patient’s personal risk of contracting COVID-19, the risks of COVID-19 to the patient and potential risks to the fetus, the efficacy of the vaccine, the side effects of the vaccine, and the lack of data about the vaccine during pregnancy.

In addition to counseling about the COVID-19 vaccine, breastfeeding during the COVID-19 pandemic should still be promoted. Breast milk provides protection against many acute and chronic illnesses. The AAFP recommends breastfeeding for the majority of infants except in the case of certain medical conditions. Limited evidence suggests that SARS-CoV-2, the virus that causes COVID-19, is spread via respiratory droplets, and to date, studies have not detected SARS-CoV-2 and similar coronavirus infections in breast milk. Therefore, the AAFP recommends promotion of breastfeeding and parent-infant bonding, and avoidance of parent-infant separation whenever possible. 

If a parent has been exposed to COVID-19 but is asymptomatic, breastfeeding is a reasonable choice. The parent should use a mask, gown and careful hand hygiene to reduce the risk of exposing the infant to respiratory secretions. 

If a parent has been diagnosed with COVD-19 or was exposed and has symptoms, it is still reasonable to breastfeed and/or provide expressed milk for the infant. In addition to masks and handwashing, extra mechanisms to reduce exposure are suggested such as limiting contact with the infant outside of breastfeeding and the use of expressed breast milk provided by another household member who does not have COVID-19. If expressing breast milk with a manual or electric breast pump, the parent should wash their hands before touching any pump or bottle parts and sanitize the pump after each use.  (Apr 2020 BC) (January 2022 COD)