MATERNAL INFECTIONS

AND BREASTFEEDING

GAYLINEL BONGYAD
PERI FELLOW
“EXCLUSIVE BREASTFEEDING

“IS THE IDEAL MODE OF INFANT

FEEDING FOR THE FIRST 6MOS.,

FOR OPTIMAL GROWTH,

DEVELOPMENT

& HEALTH . . “
 HUMAN MILK

• HUMAN BREAST MILK IS NOT STERILE

• NORMAL HEALTHY BREASTFEEDING INFANTS BECOME
COLONIZED WITH THEIR MOTHER’S FLORA OVER TIME
 WHILE BREAST MILK CAN BE A
SOURCE OF MATERNALLY DERIVED
COMMENSAL AND PATHOGENIC
MICROORGANISMS, THERE ARE VERY
FEW MATERNAL INFECTIOUS
DISEASES FOR WHICH CESSATION OR
INTERRUPTION OF BREASTFEEDING
IS INDICATED

CANADIAN JOURNAL INFECTIOUS DISEASE & MEDICAL

MICROBIOLOGY VOL 17 NO 5 SEPTEMBER/OCTOBER 2006
 H
• THE NUTRITIONAL COMPONENTS OF
HUMAN MILK ARE DERIVED FROM U
THREE SOURCES: M
• SYNTHESIS IN THE LACTOCYTE A
• DIETARY IN ORIGIN
N
• MATERNAL STORES

M
• OVERALL, THE NUTRITIONAL I
QUALITY OF HUMAN MILK IS HIGHLY L
CONSERVED
K
 BREASTFEEDING AND THE ILL MOTHER

5 REASONS WHY MOTHER “STOPS” BREASTFEEDING:

~ SHE BELIEVES THAT SHE CANNOT BREASTFEED

~ SAYS THAT HER MILK “DRIED UP” WHEN SHE WAS ILL

~ THINKS THAT IT IS DANGEROUS FOR AN ILL MOTHER TO

CONTINUE
BREASTFEEDING

~ MOTHER IS ADMITTED TO THE HOSPITAL & BABY LEFT BEHIND

~ IF PROBLEM AFFECTS THE BREASTS (MASTITIS, ABSCESS)

 INFANT MORTALITY RISK FROM NOT BREASTFEEDING
(THE LANCET 2000, A POOLED ANALYSIS FROM DEVELOPING COUNTRIES)

* TO
PROMOTE, PROTECT & SUPPORT
BREASTFEEDING (BF), EVERY EFFORT MUST BE
MADE TO MINIMIZE CONTRAINDICATIONS TO BF
PARTICULARLY UNNECESSARY ONES.
(DR. NONI E. MACDONALD , 2000)
 SELECTED MATERNAL INFECTIONS & CORRESPONDING
MANAGEMENT
FOR HEALTHY TERM INFANTS
Mat. Infection/Dse.: Microbial Agent: BF recommendation:
BACTERIA : *
Mastitis & breast abscesses Staph., Strep., E.coli ~ Continue BF (unless w/ pus,

Salmonella, Candida, Cryptocc. pump & discard from

infected breast & BF
w/other breast)
TB Mycobacterium tuberculosis ~Active TB: treat mother &
delay BF x 2wks;
prophylaxis for baby
UTI Gm (-): E.coli, etc. ~ Continue BF
CS wound infection Skin microbes ~ Continue BF
Diarrhea Salmon., Shigella, E coli, Campylob. ~ Continue BF; hand hygiene

* Other infections w/c don’t compromise mother’s physical condition & general health continue BF.
PARASITE:
Malaria Plasmodium sp. ~ Continue BF

FUNGI:
Candidal vaginitis Candida ~ Continue BF; hand
hygiene
VIRUSES

HEP. A VIRUS ~ CONTINUE BF; IMMUNOGLOBULIN FOR INFANT/

GAMMA GLOBULIN FOR MOTHER ; GOOD HAND HYGIENE

HEP. B VIRUS ~ CONT.BF; ROUTINE HBIG & HBV AT BIRTH

HEP. C VIRUS ~ CONTINUE BF

HERPES: HSV-1, HSV-2 ~ CONTINUE BF; HAND HYGIENE; STOP BF IF

W/ BREAST LESIONS UNTIL HEALED (CRUSTED)

CHICKEN POX, SHINGLES VARICELLA ~ CONTINUE BF; FOR PERINATAL VZV, GIVE
VZIG (CONSIDER ALSO FOR POSTPARTUM)

OTHERS: ENTEROVIRUS ~ CONTINUE BF; HAND HYGIENE

CYTOMEGALOVIRUS ~ CONTINUE BF
TOXOPLASMOSIS ~ CONTINUE BF
EBV, LYME ~ CONTINUE BF
PARVOVIRUS, WEST NILE VIRUS ~ CONTINUE BF

HIV, HTLV- 1 & 2 ~ BF CONTRAINDICATED

MATERNAL INFECTIOUS DSES.(CANADIAN PAEDIATRIC SOCIETY):
PAEDIATRIC CHILD HEALTH , OCT. 2006
BREASTFEEDING IS ALLOWED :

PARASITIC INFECTION:

MALARIA (EVEN IF ON ANTI-MALARIAL DRUGS)

FUNGAL :

CANDIDA (VAGINITIS)

BACTERIAL :

MASTITIS; BREAST ABSCESS (STAPH. AUREUS)

TUBERCULOSIS (ANTI-TB DRUGS SAFE; GIVE PYRIDOXINE TO

NEONATE)

VIRAL:

HIV INFECTION (IN RESOURCE-LIMITED SETTINGS- AFRICA, ASIA)

CMV (FOR MOTHERS WITH LATENT INFECTION); RECENT STUDIES

SHOW A LOW RELATIVE INCIDENCE & SEVERITY OF

DISEASE IN PREMATURE INFANTS.

MATERNAL INFECTIOUS DSES.(CANADIAN PAEDIATRIC SOCIETY):
PAEDIATRIC CHILD HEALTH , OCT. 2006

• BF IS NOT RECOMMENDED: ( VERY FEW )

1. HIV : IN RESOURCE- RICH SETTINGS (CANADA, USA),

SAFE & CULTURALLY ACCEPTED REPLACEMENTS ARE
AVAILABLE.

2. HUMAN T-LYMPHOTROPIC VIRUS, TYPE 1 OR 2

INFECTION

> NEED FOR EMOTIONAL & FINANCIAL SUPPORT FOR THE

MOTHER WHO CAN’T BREASTFEED
 HIV INFECTION

 HIV INFECTED MOTHERS CAN TRANSMIT THE VIRUS TO THEIR INFANTS

 MOTHER- CHILD TRANSMISSION: 2 ND-3RD TM, DURING DELIVERY, AT
ANY POINT DURING BREASTFEEDING

 RISK OF TRANSMISSION: CUMULATIVE; 15-25 % (BEFORE OR DURING

BIRTH)
 BREASTFEEDING BY INFECTED MOTHER: RISK IS 20-40 %

• FACTS: WHO- RHR, 2004

 HIV INFECTION

 ANTIRETROVIRAL PROPHYLAXIS:
DECREASES RISK BY 2 %
 OTHER WAYS TO DECREASE RISK:
ELECTIVE CS
AVOIDANCE OF BREASTFEEDING

 MATERNAL FACTORS (INC. RISK):

 HIGH VIRAL LOAD IN PLASMA, LOW CD4+ CELL COUNT,
AIDS, VAGINAL DELIVERY, PREMATURITY
 PREVENTION OF MOTHER- TO- CHILD TRANSMISSION :

> CONSIDER INFANT FEEDING OPTIONS

* IF REPLACEMENT FEEDING IS ACCEPTABLE, FEASIBLE,AFFORDABLE, SAFE-

THEN SHOULD AVOID BF COMPLETELY.

* IF RF IS NOT FEASIBLE: BF EXCLUSIVELY X FIRST FEW MONTHS, WEAN OVER A FEW DAYS TO
WEEKS BEFORE SHIFTING RF.

(S. AFRICA: EXCLUSIVE BF X 1ST 3 MOS LOWER TRANSMISSION RATES, THAN MIXED FEEDING.)

* CURRENT/ PROSPECTIVE RESEARCH:

 MODE OF INFANT FEEDING (EXCLUSIVE OR MIXED)

 ANTIRETROVIRAL THERAPY- MOTHER & INFANT; LAMIVUDINE OR NEVIRAPINE (PROPHYLAXIS)

 EFFECTS OF DISRUPTION OF EPITHELIAL INTEGRITY OF MUCOUS MEMBRANES (INFANT),

NIPPLE FISSURES, MASTITIS
 SUMMARY:

* THERE’S AN INCREASED MORBIDITY & MORTALITY IN INFANTS NOT BREASTFED

FROM BIRTH.

* FEW “ CONTRAINDICATIONS ” TO BREASTFEEDING:

> HIV- INFECTED MOTHERS ( WHEN REPLACEMENT FEEDING IS FEASIBLE )
> HUMAN (ADULT) LYMPHOTROPIC VIRUS (HTLV), TYPES 1 & 2
> ACTIVE, UNTREATED TB
> ACTIVE HERPES SIMPLEX VIRUS INFECTION WITH LESIONS ON THE BREAST (S)

* DIFFERENT RECOMMENDATIONS MAY VARY, TAKING INTO ACCOUNT INDIVIDUAL

CIRCUMSTANCES.

* GIVE REASSURANCE, EMOTIONAL , PSYCHOLOGICAL &

FINANCIAL SUPPORT FOR MOTHERS.
THANK YOU