RESULTS: The final sample consisted of 357 mothers from 31 countries, 129 of which were mothers of infants ≤30 days of age. Most respondents came from the United States, Europe, or Latin America. Of mothers of infants ≤3 days of age who tested positive for SARS-CoV2, 7.4% of their infants tested positive.  We found a non-significant decrease in risk of hospitalization among neonates who roomed-in, directly breastfeed, or experienced uninterrupted skin-to-skin care (p>0.2 for each). Infants who did not directly breastfeed, experience skin-to-skin care, or who did not room-in within arms’ reach, were less likely to be exclusively breastfed in the first 3 months, adjusting for maternal symptoms (p<0.015 for each). Nearly 60% of mothers who experienced separation reported feeling “very distressed,” and 29% who tried to breastfeed were unable to do so once reunited with their infants. Presence of maternal symptoms predicted infant transmission or symptoms among infants of all ages (aOR= 4.50, 95% Confidence Interval (CI): 1.52, 13.26, p=0.006). Infants whose births were affected by maternal COVID-19 were significantly more likely to have been born vaginally (p=0.05) and to have been taken from their mothers at birth (p=0.001), than infants whose births were not affected by COVID-19. As the study sample had very few infants who were not breastfed, we were unable to find an effect of breastfeeding (versus formula feeding) on viral transmission or hospitalization in infants >30 days of age.

CONCLUSIONS: Our research contributes to the emerging evidence that skin-to-skin care, rooming-in within arms’ reach, and direct breastfeeding may be safe for mothers infected with SARS-CoV-2.  Furthermore, we concluded that disruption of evidence-based quality standards of maternity care is associated with harm and may be unnecessary.

The study will be published in the peer-reviewed journal Breastfeeding Medicine in February 2021. Preliminary results were presented at the Academy of Breastfeeding Medicine annual international meeting in November 2021, at a seminar on COVID and women's health from the Italian Association of Epidemiology on November 3, 2020, and at the World Health Organization COVID Infant Feeding-Research Interest Group (CIF-RIG) in December 2020,

-Updated February 1, 2021