Recommendations for breastfeeding during maternal …

1 S1811. , University of California, Los Angeles, USA. Full professor,Department of Pediatrics, School of Medicine, Universidade Federal deMinas Gerais (UFMG). Advisor of the Graduate Program in Child andAdolescent Health, UFMG, Belo Horizonte, MG, MSc. Professor, School of Medicine, Universidade Federal de MinasGerais (UFMG), Belo Horizonte, MG, , School of Medicine, USP, Ribeir o Preto. Professor, School ofMedicine, Universidade Federal de Minas Gerais (UFMG). Advisor of theGraduate Program in Child and Adolescent, UFMG, Belo Horizonte, MG, citation: Lamounier JA, Moulin ZS, Xavier for breastfeeding during maternal infections.

2 J Pediatr(Rio J). 2004;80(5 Suppl) : To make a literature review on breastfeeding and maternal infectious diseases in order to contribute withknowledge and information that can aid the pediatrician to decide upon allowing infected mothers to breastfeed theirbabies or of data: Lilacs and MEDLINE databases were searched for books, technical rules and articles on the issueof breastfeeding and infected of the findings: Infected lactating mothers can transmit pathogenic agents to their infants. Althoughbreastfeeding protects the child it can also be a dangerous source of infection. maternal diseases caused by bacteria,virus, fungi and parasites may sometimes be transmitted via human milk.

3 The literature points out that mothersinfected with HIV and T-lymphotropic human viruses (type I) should not breastfeed. With other diseases a carefulapproach should be made, but, in general, breastfeeding is : The mother who is exposed to infectious diseases may transmit pathogenic agents through thehuman milk, attention should also be made to milk from milk banks. The healthcare provider must take his/herdecision upon suspending breastfeeding - or not, what can be distressful, once he/she has a fundamental role inpromoting and stimulating Pediatr (Rio J). 2004;80(5 Suppl):S181-S188: Human milk and infection, mother s infectious illnesses, maternalbreast-feeding and for breastfeedingduring maternal infectionsJoel A.

4 Lamounier,1 Zeina S. Moulin,2 C sar C. Xavier30021-7557/04/80-05-Suppl/S181 Jornal de PediatriaCopyright 2004 by Sociedade Brasileira de PediatriaIntroductionHuman milk, in addition to its nutritional components,contains numerous cells, membranes and molecules whosefunction is to protect newborn infants. In lactating women,the enteromammary or bronchomammary immune systemis activated when pathogens (bacteria) come in contact withthe mucous membranes of the intestine or respiratory tractand are phagocytosed by macrophages. This stimulates Tlymphocytes, causing the differentiation of immunoglobulinA (IgA)-producing B lymphocytes.

5 Lymphocytes migrate tothe mammary gland and, mediated by cytokines, turn intoplasma cells that produce a glycoprotein, which binds toIgA, and eventually turns into secretory immunoglobulin A(sIgA). This is an important and specific protective functionof human milk in , given its benefits to mother and infant,is considered to be the best form of nutrition for , maternal and infant diseases may hinderbreastfeeding. Under these circumstances, the healthprofessional should be skilled, have technical knowledgeand adopt a favorable attitude so as to properly assess theviability of breastfeeding .

6 When the nursing motherpresents with the symptoms of a disease, she has alreadyexposed her infant to the pathogen and the usualrecommendation is that breastfeeding should If the mother discontinues breastfeedingafter symptom onset, infant protection against diseasesis decreased, and the chances of the infant falling ill areincreased, since he/she is not provided with specificantibodies and other protective factors from human ARTICLES182 Jornal de Pediatria - Vol. 80, (suppl), 2004No recommendation to discontinue breastfeeding , evenif temporarily, exists in cases of mothers with urinary tractinfection, bacterial infection of the abdominal wall,episiorrhaphy, mastitis or any other disease in which thenursing mother s physical conditions and general state ofhealth are not so human milk contains antibodies, mononuclearcells and other protective factors, it may be a possiblesource of infection for the infant in some maternal ,7 The mononuclear cells in human milk, albeit providingprotection.

7 May transfer infectious particles from the motherto the infant. Thus, when health professionals attend to anursing mother with active viral infection or another infectiousdisease, they may become uncomfortable about whetherthey should discontinue or not breastfeeding , as their roleis to promote and encourage infectious diseases may impede breastfeeding ,either on a temporary or permanent basis, due to maternalphysical conditions such as severe cardiac, renal, andhepatic diseases, psychosis and severe the present review, we discuss breastfeedingmanagement in the presence of common maternal diseasescaused by bacteria, viruses.

8 Parasites and infectionsIn several maternal viral diseases, such as hepatitis,herpes, measles, mumps and rubella, among others, thevirus may be excreted into human milk. However, exceptfor infections caused by retroviruses, humanimmunodeficiency virus (HIV-1), human T-lymphotropicvirus type I (HTLV I) and human T-lymphotropic virustype II (HTLV II), transmission via human milk has littleepidemiological relevance. In most maternal viraldiseases, other sources of contamination of newbornsshould be considered before ascribing the cause tobreastfeeding only. The risk of transmission may beenhanced in cases of acute infection at delivery, as themilk may contain a high concentration of viral particlesand low titers of protective antibodies able to neutralizethe infectious agent.

9 Therefore, in general, there is noformal contraindication for breastfeeding in most cases ofviral diseases, except for diseases caused by transmission of RNA retrovirus, including HIV-1,11,12 HTLV I and HTLV II13 has already beendemonstrated. HIV-2 can also be transmitted from motherto infant, but the role of breastfeeding in the transmissionvia human milk has not been clearly established yet. TheEpstein-Barr virus and herpesvirus 6 can be found inhuman milk, but so far, reports on breastfed infantsinfected by these viruses have been few and far some extent, the fact that breastmilk is not much moreinfectious is surprising, especially due to the daily volumeingested by exclusively breastfed infants.

10 Supposedly,there may be other protective factors than those 1 summarizes the most important infections,with possible transmission of the virus to the infant viabreastmilk, and the corresponding infectionHIV is excreted freely or into cells in the milk ofinfected women, who may or may not present withsymptoms of the disease. Approximately 65% of verticalHIV transmission occurs during labor and during delivery;the remaining 35% occurs in utero, mainly within the lastweeks of gestation and via breastfeeding . The viral loadin breastmilk is an important determinant for the risk ofTable 1 - maternal viral infections and the corresponding breastfeeding managementType of virusRecommendationCytomegalovirusBreast feedingHepatitis A*BreastfeedingHepatitis BBreastfeedingHepatitis C*BreastfeedingRubellaBreastfeedingMumps BreastfeedingSimple herpesBreastfeeding, except if there are lesions on the breastsVaricellaBreastfeeding.