LAUSR

Dear Editor, Coronavirus Disease 2019 (COVID-19) is a current emerging viral disease (caused by a novel coronavirus referred as SARS-­CoV-2)­ with­ a­ rapidly­ growing­ case­ notification­ rate­ since­its­first­identification­in­Wuhan,­Hubei­Province,­China,­ in­ December­ 2019.­ Hence,­ the­ World­ Health­ Organization­ (WHO)­Emergency­Committee­declared­a­global­health­emergency based on this ongoing outbreak (Zhu et al., 2020). To date, a paucity of data is currently available regarding the association of COVID-19 with pregnancy and, especially, with breastfeeding (Rasmussen et al., 2020). No international or national guidelines have been proposed to date. Favre et al. have recommended the systematic screening of any suspected COVID-19 infections during pregnancy­ and,­ if­ COVID-19­ infection­ is­ confirmed,­ they­ have proposed an extended followup for both mothers and fetus (Favre et al., 2020).­ In­ specific­ cases­ of­ COVID-19­ infection­confirmed­before­delivery,­the­authors­did­not­recommend breastfeeding (Favre et al., 2020). However,­to­our­knowledge,­no­data­have­supported­that­ SARSCoV-2 could be transmitted through breastmilk (Rasmussen et al., 2020). Interestingly, Chen et al. did not demonstrate any presence of SARSCoV-2 in the breastmilk of six infected mothers (Chen et al., 2020). Similarly, we already know that SARSCoV-2 is closely related to two other coronaviruses that also cause severe respiratory illness, such as severe acute respiratory syndrome coronaviruses (SARSCoV) and the Middle East respiratory syndrome coronavirus (MERSCoV), with a nucleotide identity to SARSCoV and MERSCoV of 79% and 50%, respectively (Lu et al., 2020). Evidence of viral passage into breastmilk was not demonstrated for either of these viruses. Given­the­fact­that­the­health­benefits­of­breastfeeding­are­ widely acknowledged (Kramer & Kakuma, 2012), and taking into account that SARSCoV-2 was not detected in breastmilk in COVID-19infected women, it is currently questionable to dissuade breastfeeding in such cases. The temporary separation of a newborn from its symptomatic mother may be considered prudent, but the use of a breastpump may be provided during this isolation, in particular if the viral detection of SARSCoV-2 is negative. Furthermore,­based­on­the­first­available­data­(Chen et al., 2020), there is currently no evidence to suggest that the development of COVID-19 during pregnancy could lead to the occurrence of severe adverse outcomes in neonates nor intrauterine vertical transmission. Until the publication of forthcoming new data, these highly specific­situations­should­be­managed­with­a­multidisciplinary­ team,­on­a­case-­by-­case­basis,­after­explanation­of­benefits/ risks. Guidelines and management should rapidly evolve with the best understanding of the SARSCoV-2 infection.