Reply With QuoteHi,
Just wanted to point out, Hep C isn't transmitted via breastmilk. And HIV amongst Australian Born women is extremely uncommon (about 1 woman infected every 2 years)
2012 BellyBelly RAK Recipient.
If it was from a donor bank I would want screening but from someone I knew or knew of I wouldnt stress too much about it. as bal said, the test is only as good as the day its done.
sent from my watzamajig so may not make sense....
Registered User
Hi,
Just wanted to point out, Hep C isn't transmitted via breastmilk. And HIV amongst Australian Born women is extremely uncommon (about 1 woman infected every 2 years)
Registered User
Yes, I would use unscreened milk if it was donated. I wouldn't buy it.
Registered User
I wouldn't hesitate to accept peer to peer shared milk.
The benefits of the milk outweigh the 'risks' for me.
The WHO has even changed their stance on hiv pos mums breastfeeding their own babies and its now encouraged as the milk is still better than formula
Sent from my Galaxy S3 so please excuse errors.
Registered User
Really? The hospital told us the opposite. How is HIV not transmitted via bm?
Registered User
What kind things can be transmitted through BM?
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Registered User
http://www.who.int/nutrition/topics/...ng_bangkok.pdf
HIV Transmission Through Breastfeeding
A Review of Available Evidence
An Update from 2001 to 2007
Executive summary
Breastfeeding is the best food for infants, and is an effective method of reducing the risk of
common childhood morbidity, particularly gastrointestinal and respiratory infections, and of
promoting child survival and maternal health through child spacing. In 2001, the World
Health Assembly endorsed the recommendation that infants should be exclusively breastfed
for the first six months of life to achieve optimal growth, development and health. Thereafter,
infants should receive nutritionally adequate and safe complementary foods while
breastfeeding continues to 24 months or beyond.
While breastfeeding carries significant health benefits to infants and young children, HIV can
be transmitted during breastfeeding from an HIV-infected mother to her infant. The reduction
of this transmission is one of the most pressing public health dilemmas confronting
researchers, health-care professionals, health policy-makers and HIV-infected women in
many areas of the world, especially in developing countries.
From the beginning of the HIV pandemic to 2006, 2.3 million children aged less than 15 years
worldwide were living with HIV and an estimated 530 000 children aged less than 15 years
were newly infected with HIV in 2006 alone, nearly always through mother-to-child
transmission (MTCT). HIV/AIDS is an increasingly important cause of mortality in those
aged less than five years in Africa. Before the highly-active antiretroviral therapy (HAART)
era, child mortality due to HIV was estimated to be 35.2% by age one year and 52.5% by two
years of age.
Mother-to-child transmission of HIV can occur during pregnancy, labour or delivery, or
through breastfeeding. Without specific interventions, HIV-infected women will pass the
virus to their infants during pregnancy or delivery in about 15–25% of cases; and an
additional 5–20% of infants may become infected postnatally during breastfeeding, for an
overall risk of 30–45%. Breastfeeding may thus be responsible for one third to one half of
HIV infections in infants in settings where interventions are not available (e.g. some countries
in Africa).
HIV has been detected in breast milk in cell-free and cell-associated compartments and there
is now evidence that both compartments are involved in transmission of HIV through breast
milk. This fact supports the idea that treatment to prevent MTCT should target the proviral
cell-associated HIV reservoir. Following ingestion of HIV infected breast milk, infant gut
mucosal surfaces are the most likely site at which transmission occurs.
The rate of late postnatal transmission (that is, after six weeks of age) can be better quantified
in 2006 than previously. Most transmission of HIV through breastfeeding occurs early in the
postnatal period, although transmission continues throughout the breastfeeding period. Data
from a meta-analysis show that the cumulative probability of late postnatal transmission at 18
months is 9.3% (95% confidence interval, CI, 3.8–14.8%). Late postnatal transmission,
therefore, could contribute as much as 42% to the overall rate of MTCT. Analysis indicates
that late postnatal transmission risk is around 1% per month of breastfeeding and is constant
over time from between four and six weeks to 18 months. Transmission can take place at any
point during breastfeeding, and the longer the duration of breastfeeding, the greater the
Literature review on HIV and Infant feeding 10
cumulative additional risk. When breastfeeding is prolonged beyond 18–24 months, the
additional cumulative postnatal HIV risk varies from 4% to 16% across studies, depending on
breastfeeding duration.
The risk of postnatal transmission through breastfeeding is associated with clinical,
immunological and virological maternal factors and infant feeding patterns. Maternal
seroconversion during breastfeeding, low maternal CD4 cell count, increased maternal RNA
viral load in plasma and breast milk and a lack of persistence of HIV-specific IgM in breastmilk
at 18 months are strongly associated with increased risk of transmission through
breastfeeding. Breast pathologies such as clinical and subclinical mastitis, nipple bleeding,
and abscesses, fissures or lesions are also associated with a higher risk of transmission
through breastfeeding. Exclusive breastfeeding for up to six months, however, is associated
with a three to fourfold decreased risk of transmission of HIV compared to non-exclusive
breastfeeding; mixed feeding, therefore, appears to be a clear risk factor for postnatal
transmission. One study found that about 4% of exclusively breastfed infants became infected
through exclusive breastfeeding from six weeks to six months. The duration of breastfeeding
is confirmed to be one of the main risk factors for HIV transmission through breastfeeding. In
Zimbabwe, among the children exposed to HIV through breastfeeding, the overall risk of
postnatal transmission was 12%, of which 68% occurred after six months.
Prevention of MTCT of HIV using available peripartum antiretroviral interventions can be
achieved leading to peripartum HIV transmission rates below 5%, even in breastfed
populations, and considerable effort is ongoing to expand these interventions to a wider
population. However, in settings where breastfeeding beyond one year is the norm, postnatal
transmission through breastfeeding reduces gains achieved by perinatal antiretroviral
interventions.
The incidence of HIV infection among women during the postpartum period is high in Africa.
The overall risk of MTCT is increased in recently-infected lactating women and estimated to
be 29% (95% Cl, 16–42%), illustrating the importance of prevention of primary infection.
HIV-prevention interventions directed at pregnant and lactating women could contribute to
reducing MTCT in several settings.
The most appropriate infant feeding option for an HIV-infected mother depends on her
individual circumstances, including her health status and the local situation. The health
services available and the counselling and support she is likely to receive should be
considered. The World Health Organization (WHO) recommends HIV-infected women
breastfeed their infants exclusively for the first six months of life, unless replacement feeding
is acceptable, feasible, affordable, sustainable and safe for them and their infants before that
time. When those conditions are met, WHO recommends avoidance of all breastfeeding by
HIV-infected women.
To help HIV-positive mothers make the best choice, they should receive appropriate
counselling that includes information about the risks and benefits of various infant feeding
options based on local assessments, and guidance in selecting the most suitable option for
their own situation. Counselling, information provision and support during the antenatal
period is key for women to make informed choices. Postnatal follow-up with repeated growth
measurements is also crucial to this support, as is nutritional counselling, particularly around
the period of breastfeeding cessation.
Literature review on HIV and Infant feeding 11
Early cessation of breastfeeding could also prevent a sizable proportion of postnatal HIV
infections but several studies in Africa have reported that it was associated with an increased
risk of infant morbidity (especially diarrhoea) and mortality in HIV-exposed children. Recent
data from Zambia and Botswana show that prolonged breastfeeding of children already
infected with HIV is associated with improved survival compared to early cessation of
breastfeeding.
It is also important to identify approaches to treating expressed breast milk to eliminate the
risk of transmission while preserving the milk’s nutritional content and protective qualities.
With this aim, expressed heat-treated breast milk and microbicides to treat HIV-infected
breast milk may have a role to play in shortening the duration of breastfeeding and allowing
for a safe transition period to other types of foods.
More research is required to provide practical tools that can be used routinely – especially
around the time of early breastfeeding cessation – to contribute to the assessment of the
nutritional adequacy of complementary feeding and guide efficiently the nutritional
counselling of children exposed to HIV.
Other possibilities for preventing HIV from being transmitted through breast milk are
emerging. These include giving HAART to women during breastfeeding (whether or not
necessary for the mother's health) and post-exposure prophylaxis to the infant. Recent studies
have sought to determine the effects of the former, and several studies on the latter are
ongoing; both are discussed in this review. Finally, passive and active immunization strategies
of breastfed newborns are increasingly being studied. Further research on their potential role
in reducing MTCT of HIV is needed and ongoing.
BellyBelly Member
A very interesting thread! My first thoughts are that would be happy with unscreened milk from someone I knew or someone that knew someone I knew and that mutual friend was happy to vouch for them.
I am considering seeking out some donor milk for DD due in December, so I am watching all this info with interest.
Registered User
I thought I might research my on question. So...hepatitis can only be transmitted if there is a lesion on the breast at the time. Chicken pox- only if donor is in active phase at the time.
TBH i thought there would be more risk but it doesn't appear to be so. I would not accept milk from a donor I didn't know but maybe...maybe i would from someone i did.
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Registered User
I didn't say its not. I said that it is now not a reason for women in developing countries to not breastfeed. Hiv is also passed on in pregnancy and labor in some cases so its possible that even without being breastfed the infant may contract it. But breastfeeding is safer than formula even for hiv pos women in these cases.
And a hiv pos mothers milk doesn't guarantee transmission.
Some people flash heat their donor milk, which you can google for info and how to's
Sent from my Galaxy S3 so please excuse errors.
Registered User
I would use it gratefully and if there was ever a need for it, DP agrees with me. I would also happily have my baby bf by someone else if I couldn't do it. Ideally, someone we know, but since I have no idea who manufactured a tin of formula or which cow the milk (not that in any way it resembles this by the time it gets to the baby) originally came from, I am happy to trust another mother kind enough to offer.
My sister and I had a conversation about this a few weeks ago. She's a new bfing Mum and to her surprise finds she wouldn't mind either of us bfing each other's babies (not that we have).
Registered User
How is a risk of transmitting HIV safer than formula? O.o
Registered User
There are heaps of groups on facebook who do just this. Try human milk 4 human babies, mothers' milk bank etc.
Registered User
I'll admit I'm something of a conservative when it comes to this - I'd prefer to access donor milk through a milk bank rather than take the chance on someone else's lifestyle. I'd have to know them extremely well to consider using donated milk from them.
Registered User
i would prefer to find a donor than go through a milk bank because of the processing of the milk that is done in a milk bank. i read an article somewhere that the processing can destroy some of the goodies in the breastmilk.
Moderator
It's on a case by case basis. In some cases access to clean water and affordability means that the the risk of transmission is preferable to the risks posed by artificial baby milk.
Can't remember who said that HIV transmission was only a couple of cases a year in Australia but this isn't correct. There are generally over 100 women a year who test positive to HIV in Australia each year. Over 50% of these women are born in Australia.The most appropriate infant feeding option for an HIV-infected mother depends on her individual circumstances, including her health status and the local situation. The health services available and the counselling and support she is likely to receive should be considered. The World Health Organization (WHO) recommends HIV-infected women breastfeed their infants exclusively for the first six months of life, unless replacement feeding is acceptable, feasible, affordable, sustainable and safe for them and their infants before that time. When those conditions are met, WHO recommends avoidance of all breastfeeding by HIV-infected women.
Last edited by Phteven; July 31st, 2012 at 11:13 AM.
Registered User
I would use milk from a friend but I don't think I'd use it from a stranger. I might if I was desperate though i.e. if I had a newborn because I would definitely not ever give a newborn formula. DH agrees with me too and if something ever happened to me he would make sure our baby got breast milk if he could.
The breastfeeding mother you get it from is obviously feeding her own baby too. So I think it's a pretty low chance of anything being 'wrong' with the milk if they're giving it to their own child iykwim.
Registered User
Wow! I guess I didn't consider clean drinking water... interesting stuff.
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