The 21st Century Cures Act established PRGLAC to advise the Secretary of Health and Human Services (HHS) regarding gaps in knowledge and research on safe and effective therapies for pregnant women and lactating women. PRGLAC was tasked with identifying these gaps and reporting its findings back to the Secretary.
Objective: This study aimed to evaluate the immunogenicity and reactogenicity of coronavirus disease 2019 messenger RNA vaccination in pregnant and lactating women compared with: (1) nonpregnant controls and (2) natural coronavirus disease 2019 infection in pregnancy.
Study design: A total of 131 reproductive-age vaccine recipients (84 pregnant, 31 lactating, and 16 nonpregnant women) were enrolled in a prospective cohort study at 2 academic medical centers. Titers of severe acute respiratory syndrome coronavirus 2 spike and receptor-binding domain immunoglobulin G, immunoglobulin A, and immunoglobulin M were quantified in participant sera (n=131) and breastmilk (n=31) at baseline, at the second vaccine dose, at 2 to 6 weeks after the second vaccine, and at delivery by Luminex. Umbilical cord sera (n=10) titers were assessed at delivery. Titers were compared with those of pregnant women 4 to 12 weeks from the natural infection (n=37) by enzyme-linked immunosorbent assay. A pseudovirus neutralization assay was used to quantify neutralizing antibody titers for the subset of women who delivered during the study period. Postvaccination symptoms were assessed via questionnaire. Kruskal-Wallis tests and a mixed-effects model, with correction for multiple comparisons, were used to assess differences among groups.
Results: Vaccine-induced antibody titers were equivalent in pregnant and lactating compared with nonpregnant women (pregnant, median, 5.59; interquartile range, 4.68-5.89; lactating, median, 5.74; interquartile range, 5.06-6.22; nonpregnant, median, 5.62; interquartile range, 4.77-5.98, P=.24). All titers were significantly higher than those induced by severe acute respiratory syndrome coronavirus 2 infection during pregnancy (P
Conclusion: Coronavirus disease 2019 messenger RNA vaccines generated robust humoral immunity in pregnant and lactating women, with immunogenicity and reactogenicity similar to that observed in nonpregnant women. Vaccine-induced immune responses were statistically significantly greater than the response to natural infection. Immune transfer to neonates occurred via placenta and breastmilk.
Findings In this cohort study involving 103 women who received a COVID-19 mRNA vaccine, 30 of whom were pregnant and 16 of whom were lactating, immunogenicity was demonstrated in all, and vaccine-elicited antibodies were found in infant cord blood and breast milk. Pregnant and nonpregnant vaccinated women developed cross-reactive immune responses against SARS-CoV-2 variants of concern.
Design, Setting, and Participants An exploratory, descriptive, prospective cohort study enrolled 103 women who received a COVID-19 vaccine from December 2020 through March 2021 and 28 women who had confirmed SARS-CoV-2 infection from April 2020 through March 2021 (the last follow-up date was March 26, 2021). This study enrolled 30 pregnant, 16 lactating, and 57 neither pregnant nor lactating women who received either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) COVID-19 vaccines and 22 pregnant and 6 nonpregnant unvaccinated women with SARS-CoV-2 infection.
Results This study enrolled 103 women aged 18 to 45 years (66% non-Hispanic White) who received a COVID-19 mRNA vaccine. After the second vaccine dose, fever was reported in 4 pregnant women (14%; SD, 6%), 7 lactating women (44%; SD, 12%), and 27 nonpregnant women (52%; SD, 7%). Binding, neutralizing, and functional nonneutralizing antibody responses as well as CD4 and CD8 T-cell responses were present in pregnant, lactating, and nonpregnant women following vaccination. Binding and neutralizing antibodies were also observed in infant cord blood and breast milk. Binding and neutralizing antibody titers against the SARS-CoV-2 B.1.1.7 and B.1.351 variants of concern were reduced, but T-cell responses were preserved against viral variants.
Maybe. Continued use of a prenatal vitamin postpartum may exceed the iron and folic acid needs of a breastfeeding mother. However, some people, such as those with vegetarian and vegan diets, may not get adequate nutrients through their diet alone and may be at greater risk for nutritional deficiencies. In addition, the recommended dietary allowances (RDAs) (the average amount of a vitamin or mineral that meets the daily nutrient needs of nearly all healthy people) for some nutrients (such as iodine and choline) increase while breastfeeding; therefore, it is possible that diet alone may not be sufficient to ensure adequate nutrition for women who are breastfeeding. In these cases, breastfeeding mothers may benefit from taking a multivitamin supplement. Health care providers should work with lactating women to determine appropriate dietary supplements during lactation.
Yes. Breastfed infants of women who do not consume any animal products may have very limited amounts of vitamin B12 in their bodies. These low amounts of vitamin B12 can put their infants at risk of vitamin B12 deficiency, which can result in neurological damage. Iron may also be of concern as plant source foods only contain non-heme iron, which is less bioavailable than heme iron. The American Dietetic Association recommends vitamin B12 supplementation during pregnancy and while breastfeeding for mothers who eat vegan or vegetarian diets. Health care providers should work with lactating individuals eating a vegetarian or vegan diet to determine if they also need supplementation of iron and other nutrients such as choline, zinc, iodine, or omega-3 fats (EPA/DHA).
Ultrasound imaging has been used extensively to detect abnormalities of the non-lactating breast. In contrast, the use of ultrasound for the investigation of pathology of the lactating breast is limited. Recent studies have re-examined the anatomy of the lactating breast highlighting features unique to this phase of breast development. These features should be taken into consideration along with knowledge of common lactation pathologies in order to make an accurate diagnosis when examining the lactating breast. Scanning techniques and ultrasound appearances of the normal lactating breast will be contrasted to those of the non-lactating breast. In addition ultrasound characteristics of common pathologies encountered during lactation will be described.
The lactating breast produces milk of a complex composition that is tailored for the optimal growth and development of the term infant , yet the knowledge regarding pathology and treatment of the lactating breast is limited compared to that of the non-lactating breast. Ultrasound imaging provides a non-invasive method of investigating the breast during lactation and this paper will review ultrasound techniques used during lactation along with normal and abnormal appearances of the lactating breast.
In the last 20 years imaging modalities have become more sophisticated however research has focused extensively on the abnormal non-lactating breast and little attention has been given to the normal and abnormal lactating breast. Mammography of the lactating breast is limited due to increased glandular tissue and the secretion of breast milk  causing an increase in radio-density that makes the radiographs difficult to interpret . Galactography (the injection of radio-opaque contrast media into the duct orifice at the nipple and subsequent radiography) has illustrated only a portion of the ductal system, and few studies have examined lactating women. This procedure risks the introduction of pathogens into the breast and is therefore inappropriate for investigation of the lactating breast. To date both Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) have had little to offer in elucidating pathology in the lactating breast. A recent report using MRI illustrated a duct after its injection with contrast  and another demonstrated dilated ducts and a high proportion of glandular tissue in seven lactating women . However it is likely these modalities may provide much more useful information in the future. In the past, ultrasound investigation of the lactating breast has been limited for the same reasons as mammography; increased density of glandular tissue and the accumulation of milk . More recently, however, malignancies have been confirmed during pregnancy and lactation with both mammography and ultrasound . Ultrasound has undergone enormous technical advances that have improved the resolution of the images dramatically thus allowing imaging of very small structures within the breast. Ultrasound has the added advantage of being non-invasive thus allowing the breast to be examined without distortion. It follows that ultrasound would be the initial modality of choice for investigation of the lactating breast  however this requires a sound knowledge of breast anatomy and pathology and the development of imaging techniques unique to lactation. This paper describes the ultrasound technique used to investigate the anatomy of the lactating breast, current findings as well as breast pathologies associated with lactation.
It is widely believed that the predominant tissue in the lactating breast is glandular. Ultrasound observations made throughout pregnancy show that the proportion of glandular tissue in the breast increases, although at six to twelve weeks adipose tissue was the most prevalent tissue in 20% of women . Using a semi-quantitative ultrasound measurement of the glandular and adipose tissue in lactating Caucasian mothers it was found that there was approximately twice as much glandular tissue as adipose tissue in the lactating breast. However, the proportion of these tissues were highly variable with up to half of the breast comprised of adipose tissue in some women and conversely up to 80% of the breast composed of glandular tissue in others . In addition it was found the amount of fat situated between the glandular tissues was highly variable which has also been observed in the non-lactating breast . 041b061a72