Background: SARS-CoV-2 infection triggers a significant maternal inflammatory response. There is a dearth of information regarding whether maternal SARS-CoV-2 infection at admission for delivery or SARS-CoV-2 vaccination triggers an inflammatory response in the fetus.
Objective: This study aimed to evaluate fetal inflammatory response to maternal SARS-CoV-2 infection or SARS-CoV-2 vaccination compared to control group.
Study Design: A prospective cohort study was performed with a total of 61 pregnant women who presented for delivery at a single medical center (William Beaumont Hospital, Royal Oak, MI). All mothers were tested for SARS-CoV-2 infection using polymerase chain reaction (PCR) on admission to Labor and Delivery unit. Three groups were evaluated: 22 pregnant with a positive SARS-CoV-2 test (case group), 23 pregnant women with a negative SARS-CoV-2 test (control group), and 16 pregnant women who had recent SAR-CoV-2 vaccination and a negative SARS-CoV-2 test (vaccine group). At delivery, cord blood was collected to determine the levels of IL-6, C-reactive protein (CRP), and SARS-CoV-2 Nucleocapsid IgG and IgM antibodies. In all cases, the newborn had a negative PCR test or showed no clinical findings consistent with SARS-CoV-2 infection.
Results: Mean (SD) IL-6 level was not significantly different for the three groups: case group 9.00 +/- 3.340 pg/ml, control group 5.19 +/- 0.759 pg/ml, and vaccine group 7.11 +/- 2.468 pg/ml (p-value 0.855). Pairwise comparison also revealed no statistical difference for IL-6 concentrations with p-values for case versus control, case versus vaccine, and control versus vaccine = 0.57, 0.91, and 0.74, respectively. Similarly, there were no statistically significant difference in the frequency of elevated IL-6 (> 11 pg/ml) between groups (p-value 0.89). CRP levels across the three groups were not statistically significant different (p-value 0.634). Pairwise comparison of CRP levels among the different groups were also not statistically different. SARS-CoV-2 Nucleocaspid IgG was positive in 12 out of 22 cord blood samples in the case group, 2 out of 23 of the control group (indicating old resolved maternal infection), and 0 out of 16 of the vaccine group. SARS-CoV-2 Nucleocaspid IgM was negative in all cord blood samples of the case group, control group and vaccine group.
Limitations: A total number of 61 mothers enrolled in the study which represents a relatively small number of patients. Most patients with positive SARS-CoV-2 PCR were mainly asymptomatic. In addition, our vaccine group received the mRNA-based vaccines (mRNA1273 and BNT162b2). We did not study fetal response to other SARS-CoV-2 vaccines.
Conclusion: Neither IL-6 nor CRP indicated increased inflammation in the cord blood of newborns of vaccinated or SARS-CoV-2 infected mothers when the newborn was not infected.