SARS-CoV-2 RNA and antibody detection in breast milk from a prospective multicentre study in Spain

Christine Bäuerl, Walter Randazzo, Gloria Sánchez, Marta Selma-Royo, Elia García Verdevio, Laura Martínez, Anna Parra-Llorca, Carles Lerin, Victoria Fumadó, Francesca Crovetto, Fatima Crispi, Francisco J Pérez-Cano, Gerardo Rodríguez, Gemma Ruiz-Redondo, Cristina Campoy, Cecilia Martínez-Costa, Maria Carmen Collado, MilkCORONA study team, Elena Crehuá-Gaudiza, Javier Estañ-Capell, Asuncion Obiol, Reyes Balanza, Álvaro Solaz-García, Inmaculada Lara-Cantón, Cristina Garcia, María Ríos Barnés, Sara Ruiz, Marta Fabre, Federico García-García, Maria José Rodríguez-Lagunas, Karla Río-Aigé, Christine Bäuerl, Walter Randazzo, Gloria Sánchez, Marta Selma-Royo, Elia García Verdevio, Laura Martínez, Anna Parra-Llorca, Carles Lerin, Victoria Fumadó, Francesca Crovetto, Fatima Crispi, Francisco J Pérez-Cano, Gerardo Rodríguez, Gemma Ruiz-Redondo, Cristina Campoy, Cecilia Martínez-Costa, Maria Carmen Collado, MilkCORONA study team, Elena Crehuá-Gaudiza, Javier Estañ-Capell, Asuncion Obiol, Reyes Balanza, Álvaro Solaz-García, Inmaculada Lara-Cantón, Cristina Garcia, María Ríos Barnés, Sara Ruiz, Marta Fabre, Federico García-García, Maria José Rodríguez-Lagunas, Karla Río-Aigé

Abstract

Objectives: To develop and validate a specific protocol for SARS-CoV-2 detection in breast milk matrix and to determine the impact of maternal SARS-CoV-2 infection on the presence, concentration and persistence of specific SARS-CoV-2 antibodies.

Design and patients: This is a prospective, multicentre longitudinal study (April-December 2020) in 60 mothers with SARS-CoV-2 infection and/or who have recovered from COVID-19. A control group of 13 women before the pandemic were also included.

Setting: Seven health centres from different provinces in Spain.

Main outcome measures: Presence of SARS-CoV-2 RNA in breast milk, targeting the N1 region of the nucleocapsid gene and the envelope (E) gene; presence and levels of SARS-CoV-2-specific immunoglobulins (Igs)-IgA, IgG and IgM-in breast milk samples from patients with COVID-19.

Results: All breast milk samples showed negative results for presence of SARS-CoV-2 RNA. We observed high intraindividual and interindividual variability in the antibody response to the receptor-binding domain of the SARS-CoV-2 spike protein for each of the three isotypes IgA, IgM and IgG. Main Protease (MPro) domain antibodies were also detected in milk. 82.9% (58 of 70) of milk samples were positive for at least one of the three antibody isotypes, with 52.9% of these positive for all three Igs. Positivity rate for IgA was relatively stable over time (65.2%-87.5%), whereas it raised continuously for IgG (from 47.8% for the first 10 days to 87.5% from day 41 up to day 206 post-PCR confirmation).

Conclusions: Our study confirms the safety of breast feeding and highlights the relevance of virus-specific SARS-CoV-2 antibody transfer. This study provides crucial data to support official breastfeeding recommendations based on scientific evidence. Trial registration number NCT04768244.

Keywords: COVID-19; global health; microbiology; neonatology.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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