Since the beginning of the pandemic, for soon-to-be and new mothers and scientists alike, COVID-19 presented several unknowns.

How does COVID-19 affect a mother and her newborn? And can the virus be transmitted from mother to baby? And if so, can COVID-19 be transmitted via breastfeeding?

New mothers have been told different things depending on what their health care provider recommended since the beginning of the pandemic.

If a mother had COVID-19, she could either be told to stay with her new baby or stay in separate rooms. Whether breastfeeding was a good idea was also left up to doctor discretion.

Even guidance from the Washington State Department of Health suggested separating a mother and baby if she had COVID-19, as well as suggesting keeping the two together, depending on a provider’s recommendations. Breastfeeding is recommended by the Department of Health, but the risks of transmitting COVID-19 via breast milk are still being researched.

Early on, the only thing that was certain about COVID-19 and pregnancy was that pregnant women were considered to be at greater risk for severe illness if they got the disease.

Several months into the pandemic, scientists are still looking for answers when it comes to infant feeding and the virus.

Researchers at Washington State University and the University of Idaho, in partnership with a handful of other universities, are hoping to answer questions about infant feeding and the virus in the coming months as they collect various samples from mothers for a new study, sponsored by the National Science Foundation. The work builds on surveys researchers are sending to new mothers diagnosed with COVID-19.

Mothers who are over the age of 18, have a baby 2 years old or younger and have tested positive for COVID-19 in the past week are eligible to participate in the study, and researchers are still enrolling women from around the country.

Courtney Meehan, an associate dean and biological anthropologist at WSU, and Michelle McGuire, director and professor of maternal and child nutrition at the University of Idaho, are two of the scientists collaborating on the project, although this is not the first time they’ve worked together.

Meehan and McGuire have collaborated on multiple projects studying the variation in human milk composition around the world.

When the pandemic hit, Meehan, McGuire and their counterparts across the country who also study milk composition and breastfeeding began sharing what they were seeing and beginning to study about the effects of COVID on breast milk. McGuire set up a Slack channel, as research pivoted and began.

So far, studies have not shown that breastfeeding when the mother has the virus is either good or bad for the baby.

“We have no evidence right now that the risks of transmitting this disease outweighs the benefits of breastfeeding,” McGuire said.

The majority of the small amount of research conducted thus far found no evidence of the virus in breast milk when COVID-19 positive mothers feed their infants, but some studies have shown the opposite, detecting the virus RNA in breast milk.

To make things more complicated, if and when the virus is detected in the breast milk, whether it’s viable is a separate question that needs further study too.

“The way we’re saying it does or doesn’t have the virus is, we’re looking for the RNA that this virus has, so we can go in and say there’s this RNA in the milk, but just because there’s RNA doesn’t mean there’s a whole virus or it’s viable,” McGuire said.

McGuire and Meehan’s study is looking for new mothers in their first week of illness with COVID-19, a detail unique to their study, McGuire said. They are also looking to enroll mothers who are breastfeeding or bottle-feeding infants 2 years old and younger, in an attempt to look broadly at the impacts of COVID-19 on maternal and infant health.

Women who participate in the study must collect their own samples at home, since researchers are not allowed to collect samples in-person. Researchers send women masks, gloves and kits to collect samples and swab around their breast and their breast milk if they are nursing their child, as well as take their own blood and fecal samples .

“We’re very interested in understanding COVID-19 in infant feeding,” Meehan said. “We’re not only focused on breastfeeding but understanding the risks and benefits of non-breastfeeding samples.”

Mothers who participate send their samples to the University of Idaho lab to be processed.

The primary research question is whether COVID-19 can be transmitted through breast milk to the baby, but Meehan and McGuire are also looking to see if antibodies can be transferred through breast milk.

“We’re looking at the risk and the benefit for the entire study,” McGuire said. “We’d like to know how maternal COVID infection impacts mother and infant health and how different feeding decisions might modify that.”

McGuire said a lot of the mothers in their study are doctors and nurses, meaning they might have experience with the virus both personally and in their workplaces. Both scientists applauded the sampling and work the mothers in their study are able to do on their own at home.

“All moms are trying to figure out what’s the best thing to do for my baby,” McGuire said, noting that participating in research is the way to help figure that out in the midst of a pandemic.

Both Meehan and McGuire emphasized the need for a more formal response in initiating research that could be facilitated by the Centers for Disease Control and Prevention or public health entities in the future.

“It was reactive and there was no plan in place, and this is not the last pandemic,” McGuire said.

That said, researchers know how to organize and rally for the next time there’s a pandemic.

“If we have to face something like this in the future, what we’ve done here sets a road map in the future of how to quickly address it and research it,” Meehan said.