Objectives To investigate the role of prenatal maternal SARS-CoV-2 infection and delivery during the COVID-19 pandemic on breastfeeding practices through 6 months postpartum.

Study design A cohort of mother-infant dyads who delivered at a large medical center in New York City and who had either documented history of prenatal SARS-CoV-2 infection, no history of SARS-CoV-2 infection, or who delivered in February 2020 prior to the COVID-19 pandemic were invited to participate in the COVID-19 Mother Baby Outcomes (COMBO) Initiative. These three groups of mothers completed surveys about their breastfeeding practices at 1, 2, 4, and/or 6 months postpartum, and responses were compared across enrollment group at each postpartum assessment period.

Results Data from 557 mother-infant dyads was included. The SARS-CoV-2 infected group reported significantly lower rates of mostly or exclusively breastfeeding at 1 month, 2 months, and 4 months postpartum. When analyses were separated by birth timing and maternal ethnicity, these differences between infected and uninfected mothers were only significant in the second pandemic wave delivery group and in Latina mothers.

Conclusions for practice Maternal SARS-CoV-2 infection during pregnancy was associated with lower rates of mostly or exclusively breastfeeding through 4 months postpartum. These differences may have been driven by delivery timing during the pandemic and self-reported maternal ethnicity. These results suggest a need to increase resources and support for breastfeeding during healthcare-disruptive events such as the pandemic, particularly for those belonging to groups historically underserved in healthcare.

The authors have declared no competing interest.

This research was supported by gifts from the Einhorn Collaborative to the Nurture Science Program, for which Dr. Dani Dumitriu serves as director.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Institutional Review Board of Columbia University Irving Medical Center gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present study are available upon reasonable request to the authors.