COVID-19 booster dose induces robust antibody response in pregnant, lactating, and nonpregnant women

Atyeo, Caroline; Shook, Lydia L.; Nziza, Nadege; DeRiso, Elizabeth A.; Muir, Cordelia; Baez, Ms Arantxa Medina; Lima, Ms Rosiane S; Demidkin, Mr Stepan; Brigida, Ms Sara; Guzman, Rose M. De; Burns, Madeleine D.; Balazs, Alejandro; Fasano, Alessio; Yonker, Lael M.; Gray, Kathryn J.; Alter, Galit; Edlow, Andrea G.

doi:10.1016/j.ajog.2022.07.014

Cited by 23 publications

(23 citation statements)

References 38 publications

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“…Our results coincide with previous reports showing antibody levels among pregnant women to be significantly higher after the third dose compared to the second dose [19,20,26] and significantly higher after the second dose compared to recovered women [9,12,27]. Similar patterns were demonstrated in neonatal antibody levels [9,12,19,20,27].…”

Section: Discussionsupporting

confidence: 92%

Maternal and Neonatal Immune Responses Following COVID-19 Infection and Vaccinations in Pregnancy

et al. 2022

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The objective of the study was to compare the maternal and neonatal humoral immune responses among different groups of women, namely those vaccinated by the BNT162b2 vaccine, not vaccinated, and COVID-19-recovered parturient women at the time of delivery. This is a prospective cohort study of pregnant women, divided into four groups: Group A “Recovered”—recovered and not vaccinated. Group B “Second Vaccination”—first and second doses only. Group C “Third Vaccination”—third dose. Group D “No Third Vaccination”—women eligible for the third dose of the vaccine but did not receive it. Maternal and umbilical cord blood were sampled and tested for SARS-CoV-2 IgG antibodies on admittance to labor and immediately postpartum, respectively. Maternal serum SARS-CoV-2 IgG levels were significantly higher among Group C compared to Group B (741.6 (514.5–1069) vs. 333.5 (327–340.2), respectively). Both groups had higher antibody levels compared to Groups A and D (113.5 (61.62–209.1) and 57.99 (32.93–102.1), respectively). Similarly, umbilical cord blood SARS-CoV-2 IgG levels were also highest among Group C compared to the other three groups (1269 (953.4–1690) vs. Group B, 322.6 (305.6–340.5), Group A, 109 (49.01–242.6), and Group D, 103.9 (48.59–222), respectively). In conclusion, pregnant women who were fully vaccinated with three dosages before delivery generated the highest levels of maternal and neonatal SARS-CoV-2 IgG antibodies.

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Section: Discussionsupporting

confidence: 92%

Maternal and Neonatal Immune Responses Following COVID-19 Infection and Vaccinations in Pregnancy

et al. 2022

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“…24 Our results confirm earlier conclusions that the initial two dose vaccination series during gestation resulted in appreciable RBD-specific IgG response in maternal circulation, UCB, and breastmilk. 20, 27 Importantly, longitudinal analysis of post-partum samples indicates that the booster dose is essential for producing higher and more durable antibody levels in both maternal circulation and breastmilk, 28, 29, 42 and should be strongly encouraged for all pregnant people to increase neonatal passive immune protection against SARS-CoV-2.…”

Section: Resultsmentioning

confidence: 99%

“…23 Additionally, 46% of pregnant women recorded vaccine hesitancy 24 citing safety concerns 25 despite lack of significant adverse gestational outcomes, 26 a comparable antibody response in pregnant and nongravid females, 19 evidence of transplacental passive transfer of IgG antibodies, 16 and detectable antibody levels in breastmilk after the initial vaccination series. 20,27 Moreover, booster vaccinations led to increased levels of maternal IgG1 and IgA antibodies in umbilical cord blood 28 and breastmilk. 29 For some pregnant individuals, vaccination decisions are highly influenced by a primary goal to protect neonatal health.…”

Section: Introductionmentioning

confidence: 99%

“…To date, there are limited published data to guide these decisions. 16,[18][19][20][27][28][29][30][31][32] Previous studies investigating maternal SARS-CoV-2 vaccination include minimal longitudinal sampling that spans across the initial vaccination series and booster. In addition, the impact of gestational age at the time of vaccination on maternal and fetal/newborn antibody titers remains poorly understood.…”

Section: Introductionmentioning

confidence: 99%

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SARS-CoV-2 Vaccine Booster Elicits Robust Prolonged Maternal Antibody Responses and Passive Transfer Via The Placenta And Breastmilk

Marshall

Blanton

Doratt

et al. 2022

Preprint

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BackgroundInfection during pregnancy can result in adverse outcomes for both pregnant persons and offspring. Maternal vaccination is an effective mechanism to protect both mother and neonate into post-partum. However, our understanding of passive transfer of antibodies elicited by maternal SARS-CoV-2 mRNA vaccination during pregnancy remains incomplete.ObjectiveWe aimed to evaluate the antibody responses engendered by maternal SARS-CoV-2 vaccination following initial and booster doses in maternal circulation and breastmilk to better understand passive immunization of the newborn.Study DesignWe collected longitudinal blood samples from 121 pregnant women who received SARS-CoV-2 mRNA vaccines spanning from early gestation to delivery followed by collection of blood samples and breastmilk between delivery and 12 months post-partum. During the study, 70% of the participants also received a booster post-partum. Paired maternal plasma, breastmilk, umbilical cord plasma, and newborn plasma samples were tested via enzyme-linked immunosorbent assays (ELISA) to evaluate SARS-CoV-2 specific IgG antibody levels.ResultsVaccine-elicited maternal antibodies were detected in both cord blood and newborn blood, albeit at lower levels than maternal circulation, demonstrating transplacental passive immunization. Booster vaccination significantly increased spike specific IgG antibody titers in maternal plasma and breastmilk. Finally, SARS-CoV-2 specific IgG antibodies in newborn blood correlated negatively with days post initial maternal vaccine dose.ConclusionVaccine-induced maternal SARS-CoV-2 antibodies were passively transferred to the offspringin uterovia the placenta and after birth via breastfeeding. Maternal booster vaccination, regardless of gestational age at maternal vaccination, significantly increased antibody levels in breastmilk and maternal plasma, indicating the importance of this additional dose to maximize passive protection against SARS-CoV-2 infection for neonates and infants until vaccination eligibility.

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“…It has been shown that maternal vaccination achieves antibody titers in cord blood that far exceed titers gained from natural infection [ 18 ], and timing of vaccination in pregnancy and type of COVID-19 vaccine impact transferred antibody levels [ 5 ]. Maternal boosting in the third trimester has also been shown to produce substantial transplacental transfer of maternal IgG, with highest cord titers achieved when boosting occurred at least 60 days prior to delivery [ 21 ]. Thus, there exist strong rationale for vaccination in pregnancy beyond the primary focus of protecting pregnant individuals from severe COVID-19 [ 18 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between Anti-Spike Antibodies and Risk of SARS-CoV-2 Infection in Infants Born to COVID-19 Vaccinated Mothers

et al. 2022

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The goal of this study was to investigate the relationship between anti-SARS-CoV-2-Spike IgG titers passively transferred to the fetus from maternal vaccination during pregnancy and timing of infant SARS-CoV-2 infection. Pregnant, vaccinated individuals (n = 105) and their infants (n = 107) were enrolled in a prospective cohort study from July 2021 to June 2022, linking infant anti-Spike IgG titer at birth to risk of SARS-CoV-2 infection in the first fifteen months of life. Cord blood sera were collected at delivery and infant sera were collected at two and six months of age. Anti-SARS-CoV-2-Spike IgG levels were quantified in cord and infant sera using an enzyme-linked immunosorbent assay. Infants were followed for SARS-CoV-2 infection through fifteen months of age. Anti-SARS-CoV-2-Spike IgG titers in infants declined significantly with increased age (p < 0.001). Infants with higher anti-Spike cord blood levels had significantly longer disease-free intervals prior to infection with SARS-CoV-2 (p = 0.027). While higher anti-Spike IgG titer at two months of age was associated with a longer interval to infection through nine months of age (p = 0.073), infant anti-Spike IgG titers by six months of age had no impact on disease-free interval. This cohort study suggests that passively transferred maternal IgG is protective against infant SARS-CoV-2 infection, with higher antibody levels at birth significantly associated with longer disease-free intervals. Infant antibodies and protection from SARS-CoV-2 infection wane significantly after six months, suggesting that vaccination is needed at this stage to optimize protection against COVID-19.

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COVID-19 booster dose induces robust antibody response in pregnant, lactating, and nonpregnant women

Cited by 23 publications

References 38 publications

Maternal and Neonatal Immune Responses Following COVID-19 Infection and Vaccinations in Pregnancy

Maternal and Neonatal Immune Responses Following COVID-19 Infection and Vaccinations in Pregnancy

SARS-CoV-2 Vaccine Booster Elicits Robust Prolonged Maternal Antibody Responses and Passive Transfer Via The Placenta And Breastmilk

Relationship between Anti-Spike Antibodies and Risk of SARS-CoV-2 Infection in Infants Born to COVID-19 Vaccinated Mothers

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