SARS-CoV-2 specific antibodies exist in human milk expressed by lactating parents after vaccination. In the existing research, the effects of vaccine types on human milk are inconsistent.
Research Aim:
This study aims to perform a systematic review and meta-analysis of the existing observational studies to compare the positive rates of SARS-CoV-2 specific antibodies in human milk according to mRNA and adenovector-based vaccination.
Methods:
PubMed, Web of Science, Elsevier Science Direct and Cochrane Library databases were systematically searched for relevant articles published from December 30, 2019 to February 15, 2023. Observational studies were considered eligible provided they reported data on SARS-CoV-2 specific antibodies in human milk. The risk of bias in non-randomized studies of interventions (ROBINS-I) tool, the Newcastle-Ottawa Scale (NOS), and the Agency for Healthcare Research and Quality (AHRQ) were used to assess risk of bias. Seven studies, including 511 lactating participants, were included in this review and meta-analysis.
Results:
The positive rate of SARS-CoV-2 IgA is higher in mRNA vaccine groups than in adenovector-based vaccine groups (OR = 4.80, 95% CI [3.04, 7.58], p < 0.001). The positive rate of SARS-CoV-2 IgG was higher in mRNA vaccines than in adenovector-based vaccines.
Conclusions:
Compared to adenovector-based vaccines, mRNA vaccines present a higher positivity rate of IgA and IgG in human milk after vaccination. In other words, mRNA vaccinations may offer breastfed children a higher level of protection than adenovector-based vaccinations. Further high-quality data is still required to substantiate these findings.
AlbrechtM.ArckP. C. (2020). Vertically transferred immunity in neonates: Mothers, mechanisms and mediators. Frontiers in Immunology, 11, Article 555. https://doi.org/10.3389/fimmu.2020.00555
2.
ChenM. J.CheemaR.Hoyt-AustinA.AgnoliA.Kuhn-RiordonK.KairL. R. (2023). Vaccination and treatment options for SARS-CoV2 infection affecting lactation and breastfeeding. Seminars in Fetal & Neonatal Medicine, 28(1), Article 101425. https://doi.org/10.1016/j.siny.2023.101425
3.
CostaS.PrioloF.FattoreS.TedescoM.RubortoneS. A.GiordanoL.ChiomaR.NeriC.LanzoneA.BuonsensoD.ValentiniP.VentoG. (2022). Rooming-in practice during the pandemic: Results from a retrospective cohort study. Journal of Human Lactation, 38(3), 443–451. https://doi.org/10.1177/08903344221081840
4.
HenleA. M. (2023). Increase in SARS-CoV-2 RBD-Specific IgA and IgG antibodies in human milk from lactating women following the COVID-19 booster vaccination. Journal of Human Lactation, 39(1), 51–58. https://doi.org/10.1177/08903344221134631
5.
United Nations Children’s Fund, World Health Organization, & the COVID-19 Infant Feeding Working Group. (2021). Frequently asked questions: COVID-19 vaccines and breastfeeding based on WHO interim recommendations. https://www.ennonline.net/breastfeedingandcovid19vaccines
6.
JunckerH. G.MullenersS. J.RuhéE. J. M.CoenenE. R. M.BakkerS.van DoesburgM.HarinckJ. E.RoodR. D.BouhuijsJ. H.OomenM.de GrootP.PajkrtP. D.KorosiA.van GoudoeverP. J. B.van GilsM. J.van KeulenB. J. (2022). Comparing the human milk antibody response after vaccination with four COVID-19 vaccines: A prospective, longitudinal cohort study in the Netherlands. EClinicalMedicine, 47, Article 101393. https://doi.org/10.1016/j.eclinm.2022.101393
7.
KantarciogluB.IqbalO.LewisJ.CarterC. A.SinghM.LievanoF.LigockiM.JeskeW.AdiguzelC.GerotziafasG. T.FareedJ. (2022). An update on the status of vaccine development for SARS-CoV-2 including variants. Practical considerations for COVID-19 special populations. Clinical Applied Thrombosis Hemostasis, 2022 Jan-Dec;28:10760296211056648, https://doi.org/10.1177/10760296211056648
8.
Lechosa-MuñizC.Paz-ZuluetaM.Irure-VenturaJ.Mendez-LegazaJ. M.Cuesta GonzálezR.Gómez-AceboI.López-HoyosM.LlorcaJ.Cabero-PérezM. J. (2023). Development of SARS-CoV-2 specific IgG and IgA antibodies in serum and milk with different SARS-COV-2 vaccines in lactating women. International Breastfeeding Journal, 18(1), 3. https://doi.org/10.1186/s13006-022-00536-y
9.
Lechosa-MuñizC.Paz-ZuluetaM.Manuel Mendez-LegazaJ.Irure-VenturaJ.Cuesta GonzalezR.Calvo MontesJ.Lopez-HoyosM.LlorcaJ.Jesus Cabero-PerezM. (2021). Induction of SARS-CoV-2-Specific IgG and IgA in serum and milk with different SARS-CoV-2 vaccines in breastfeeding women: A cross-sectional study in Northern Spain. International Journal of Environmental Research and Public Health, 18(16), Article 8831. https://doi.org/10.3390/ijerph18168831
10.
LiberatiA.AltmanD. G.TetzlaffJ.MulrowC.GøtzscheP. C.IoannidisJ. P.ClarkeM.DevereauxP. J.KleijnenJ.MoherD. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine, 6(7), Article e1000100. https://doi.org/10.1371/journal.pmed.1000100
11.
MarkE. G.DemirciJ. R.MegliC.MartinJ. M.RickA. M. (2023). Vaccination beliefs and attitudes of lactating people during the SARS-CoV-2 pandemic. Journal of Human Lactation, 39(3), 415–425. https://doi.org/10.1177/08903344231159640
12.
MatthewJ. P.JoanneE. M.PatrickM. B.IsabelleB.TammyC. H.CynthiaD. M.LarissaS.JenniferM. T.ElieA. A.SueE. B.RogerC.JulieG.JeremyM. G.AsbjørnH.ManojM. L.TianjingL.ElizabethW. L.EvanM. W.SteveM., . . .DavidM. (2020). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. British Medical Journal, 372, Article n71. https://doi.org/10.1136/bmj.n71
13.
MullenersS. J.JunckerH. G.van GilsM. J.van GoudoeverJ. B.van KeulenB. J. (2022). Human milk antibody response after combining two different COVID-19 vaccines: Mix-and-match. Journal of Human Lactation, 38(3), 401–406. https://doi.org/10.1177/08903344221103260
14.
MuyldermansJ.De WeerdtL.De BrabandereL.MaertensK.TommeleinE. (2022). The effects of COVID-19 vaccination on lactating women: A systematic review of the literature. Frontiers in Immunology, 13, 852928. https://doi.org/10.3389/fimmu.2022.852928.
15.
OggeroM. K.WardellD. W. (2022). Changes in breastfeeding exclusivity and satisfaction during the COVID-19 pandemic. Journal of Human Lactation, 38(3), 433–442. https://doi.org/10.1177/08903344221086974
16.
PieriM.ManioriM. A.ShahabianL.KanaanE.Paphiti-DemetriouI.PipisS.FelekkisK.NicolaidouV.PapaneophytouC. (2022). Survival of vaccine-induced human milk SARS-CoV-2 IgG, IgA and SIgA immunoglobulins across simulated human infant gastrointestinal digestion. Nutrients, 14(16), Article 3368. https://doi.org/10.3390/nu14163368
17.
ScriminF.CampiscianoG.ComarM.RagazzonC.DavanzoR.QuadrifoglioM.GiangrecoM.StabileG.RicciG. (2022). IgG and IgA antibodies post SARS-CoV-2 vaccine in the breast milk and sera of breastfeeding women. Vaccines, 10(1), 125. https://doi.org/10.3390/vaccines10010125
18.
Selma-RoyoM.BauerlC.Mena-TudelaD.Aguilar-CamprubiL.Perez-CanoF. J.Parra-LlorcaA.LerinC.Martinez-CostaC.Carmen ColladoM. (2022). Anti-SARS-CoV-2 IgA and IgG in human milk after vaccination is dependent on vaccine type and previous SARS-CoV-2 exposure: A longitudinal study. Genome Medicine, 14(1), Article 42. https://doi.org/10.1186/s13073-022-01043-9
19.
SterneJ. A. C.HernánM. A.McAleenanA.ReevesB. C.HigginsJ. P. T. (2021). Assessing risk of bias in a non-randomized study. In HigginsJ. P. T.ThomasJ.ChandlerJ.CumpstonM.LiT.PageM. J.WelchV. A. (Eds.), Cochrane handbook for systematic reviews of interventions (Version 6.2; updated February 2021). Cochrane. http://www.training.cochrane.org/handbook
20.
SterneJ. A. C.HernánM. A.ReevesB. C.SavovićJ.BerkmanN. D.ViswanathanM.HenryD.AltmanD. G.AnsariM. T.BoutronI.CarpenterJ. R.ChanA. W.ChurchillR.DeeksJ. J.HróbjartssonA.KirkhamJ.JüniP.LokeY. K.PigottT. D., . . .HigginsJ. P. T. (2016). ROBINS-I: A tool for assessing risk of bias in non-randomized studies of interventions. British Medical Journal, 355, Article i4919. https://doi.org/10.1136/bmj.i4919
21.
UkoliF.LeavellJ.MayoA.MooreJ.NchamiN.BrittA. (2023). Encouraging and reinforcing safe breastfeeding practices during the COVID-19 pandemic. International Journal Environmental Research and Public Health, 20(3), Article 1756. https://doi.org/10.3390/ijerph20031756
22.
ViswanathanM.AnsariM. T.BerkmanN. D.ChangS.HartlingL.McPheetersM.SantaguidaP. L.ShamliyanT.SinghK.TsertsvadzeA.TreadwellJ. R. (2008). Assessing the risk of bias of individual studies in systematic reviews of health care interventions. In: Methods guide for effectiveness and comparative effectiveness reviews. Agency for Healthcare Research and Quality (U.S.). https://www.ncbi.nlm.nih.gov/books/NBK91433/
23.
WellsG. A.SheaB.O’ConnellD.PetersonJ.WelchV.LososM.TugwellP. (2021). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. The Ottawa Hospital. https://www.ohri.ca//programs/clinical_epidemiology/oxford.asp
24.
WhitedN.CervantesJ. (2022). Antibodies against SARS-CoV-2 in human breast milk after vaccination: A systematic review and meta-analysis. Breastfeeding Medicine, 17(6), 475–483. https://doi.org/10.1089/bfm.2021.0353
25.
World Health Organization Guidelines Approved by the Guidelines Review Committee. (2017). Guideline: Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. https://www.who.int/publications/i/item/9789241550086.
26.
World Health Organization. (2020). Frequently Asked Questions: Breastfeeding and COVID-19 for health care workers. https://www.who.int/publications/m/item/frequently-asked-questions-breastfeeding-and-covid-19
27.
World Health Organization. (2022). Coronavirus disease (COVID-19): Vaccines. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-(covid-19)-vaccines
28.
World Health Organization. (2023). China: WHO Coronavirus Disease (COVID-19) Dashboard With Vaccination Data | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data. https://covid19.who.int/region/wpro/country/cn
29.
YangX.FoxA.DeCarloC.NorrisC.GriffinS.WedekindS.FlanaganJ. M.ShenkerN.PowellR. L. (2022). Comparative profiles of SARS-CoV-2 spike-specific human milk antibodies elicited by mRNA- and adenovirus-based COVID-19 vaccines. Breastfeeding Medicine, 17(8), 638–646. https://doi.org/10.1089/bfm.2022.0019
30.
ZhengY.Correa-SilvaS.PalmeiraP.Carneiro-SampaioM. (2022). Maternal vaccination as an additional approach to improve the protection of the nursling: Anti-infective properties of breast milk. Clinics, 77, Article 100093. https://doi.org/10.1016/j.clinsp.2022.100093
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