Detection of SARS-CoV-2 Antibodies in Matched Pregnant Women and Newborn Blood

Abstract

Objective The factors affecting the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies from mother to newborn and the duration of seropositivity rates in these infants have not yet been clearly demonstrated. The objectives of this study were to assess the levels of SARS-CoV-2 spike–specific immunoglobulin G (IgG) in women infected in the pregnancy period and newborns born to these women and to search the transplacental transfer ratio of spike-specific IgG.

Methods Seventy pregnant women with symptomatic SARS-CoV-2 infection and their newborns were prospectively followed. Anti–SARS-CoV-2 immunoassay was used for the detection of the in vitro quantitative determination of total antibodies to the SARS-CoV-2 spike protein.

Results Spike-specific IgG was demonstrated in 89.1% (44 of 46) of pregnant women infected more than 14 days before delivery and in 92.6% (43 of 44) of their newborns. Median transfer ratio of spike-specific Ig was 0.87 (interquartile range [IQR], 0.34–0.90), 1.0 (IQR, 0.9–0.29), and 0.81 (IQR, 0.02–1.0) in first trimester (n = 4), second trimester (n = 14), and third trimester (n = 28) pregnant women, respectively. Antibody transfer ratio was correlated with time elapsed from infection (p < 0.001). Peak antibody transfer ratio above 1 was observed at a median 60 to 120 days after the infection from delivery. Antibody transfer ratio was high in pregnant women infected more than 60 days before delivery (p < 0.001). Transfer ratio was significantly higher in the severe-critically symptomatic women (n = 15) than the mild-moderately symptomatic women (n = 55) (p = 0.001). At 3 months, 18 of 25 infants (72%) had spike-specific IgG.

Conclusion Timing from infection to delivery and severity of maternal infection are critical in assessing the antibody generation and transport. Higher antibody transfer ratio can be detected in neonates when SARS-CoV-2 infection is present for more than 60 days before birth. Maternally derived antibody can persist for 3 months after birth.

Keywords

COVID-19 - pregnancy - SARS-CoV-2 - spike-specific IgG

Publikationsverlauf

Eingereicht: 07. November 2022

Angenommen: 08. März 2023

Artikel online veröffentlicht:
11. April 2023

• References

• 1 WHO. . COVID-19 Dashboard. Geneva: World Health Organization, 2020. Accessed August 30, 2022 at: https://covid19.who.int/
• 2 Ellington S, Strid P, Tong VT. et al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (25) 769-775
• 3 Wastnedge EAN, Reynolds RM, van Boeckel SR. et al. Pregnancy and COVID-19. Physiol Rev 2021; 101 (01) 303-318
• 4 Hosono S, Isayama T, Sugiura T. et al; Neonatal Resuscitation Committee, Japan Society of Perinatal, Neonatal Medicine. Management of infants born to mothers with suspected or confirmed SARS-CoV-2 infection in the delivery room: a tentative proposal 2020. Pediatr Int 2021; 63 (03) 260-263
• 5 Iyer AS, Jones FK, Nodoushani A. et al. Persistence and decay of human antibody responses to the receptor binding domain of SARS-CoV-2 spike protein in COVID-19 patients. Sci Immunol 2020; 5 (52) eabe0367
• 6 Long QX, Liu BZ, Deng HJ. et al. Antibody responses to SARS-CoV-2 in patients with COVID-19. Nat Med 2020; 26 (06) 845-848
• 7 Liu P, Zheng J, Yang P. et al. The immunologic status of newborns born to SARS-CoV-2-infected mothers in Wuhan, China. J Allergy Clin Immunol 2020; 146 (01) 101-109.e1
• 8 Kimberlin DW, Stagno S. Can SARS-CoV-2 infection be acquired in utero?: More definitive evidence is needed. JAMA 2020; 323 (18) 1788-1789
• 9 Yu N, Li W, Kang Q, Zeng W, Feng L, Wu J. No SARS-CoV-2 detected in amniotic fluid in mid-pregnancy. Lancet Infect Dis 2020; 20 (12) 1364
• 10 Shook LL, Atyeo CG, Yonker LM. et al. Durability of anti-spike antibodies in infants after maternal COVID-19 vaccination or natural infection. JAMA 2022; 327 (11) 1087-1089
• 11 Halscott TMMS, Vaught JM. SMFM COVID-19 Task Force. Management considerations for pregnant patients with Covid-19. Accessed August 15, 2022 at: https://www.smfm.org/covidclinical
• 12 Flannery DD, Gouma S, Dhudasia MB. et al. Assessment of maternal and neonatal cord blood SARS-CoV-2 antibodies and placental transfer ratios. JAMA Pediatr 2021; 175 (06) 594-600
• 13 Wang X, Yang P, Zheng J. et al. Dynamic changes of acquired maternal SARS-CoV-2 IgG in infants. Sci Rep 2021; 11 (01) 8021
• 14 Joseph NT, Dude CM, Verkerke HP. et al. Maternal antibody response, neutralizing potency, and placental antibody transfer after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Obstet Gynecol 2021; 138 (02) 189-197
• 15 Edlow AG, Li JZ, Collier AY. et al. Assessment of maternal and neonatal SARS-CoV-2 viral load, transplacental antibody transfer, and placental pathology in pregnancies during the COVID-19 pandemic. JAMA Netw Open 2020; 3 (12) e2030455
• 16 Song D, Prahl M, Gaw SL. et al. Passive and active immunity in infants born to mothers with SARS-CoV-2 infection during pregnancy: prospective cohort study. BMJ Open 2021; 11 (07) e053036
• 17 Gonçalves G, Cutts FT, Hills M, Rebelo-Andrade H, Trigo FA, Barros H. Transplacental transfer of measles and total IgG. Epidemiol Infect 1999; 122 (02) 273-279
• 18 Heininger U, Riffelmann M, Leineweber B, Wirsing von Koenig CH. Maternally derived antibodies against Bordetella pertussis antigens pertussis toxin and filamentous hemagglutinin in preterm and full term newborns. Pediatr Infect Dis J 2009; 28 (05) 443-445
• 19 Munoz FM, Bond NH, Maccato M. et al. Safety and immunogenicity of tetanus diphtheria and acellular pertussis (Tdap) immunization during pregnancy in mothers and infants: a randomized clinical trial. JAMA 2014; 311 (17) 1760-1769
• 20 Helguera-Repetto AC, Villegas-Mota I, Arredondo-Pulido GI. et al. Cord blood SARS-CoV-2 IgG antibodies and their association with maternal immunity and neonatal outcomes. Front Pediatr 2022; 10: 883185
• 21 Kubiak JM, Murphy EA, Yee J. et al. Severe acute respiratory syndrome coronavirus 2 serology levels in pregnant women and their neonates. Am J Obstet Gynecol 2021; 225 (01) 73.e1-73.e7
• 22 Atyeo C, Pullen KM, Bordt EA. et al. Compromised SARS-CoV-2-specific placental antibody transfer. Cell 2021; 184 (03) 628-642
• 23 Chen Y, Zuiani A, Fischinger S. et al. Quick COVID-19 healers sustain anti-SARS-CoV-2 antibody production. Cell 2020; 183 (06) 1496-1507
• 24 Robbiani DF, Gaebler C, Muecksch F. et al. Convergent antibody responses to SARS-CoV-2 in convalescent individuals. Nature 2020; 584 (7821): 437-442
• 25 Ward JD, Cornaby C, Kato T. et al. The clinical impact of maternal COVID-19 on mothers, their infants, and placentas with an analysis of vertical transfer of maternal SARS-CoV-2-specific IgG antibodies. Placenta 2022; 123: 12-23
• 26 Fouda GG, Martinez DR, Swamy GK, Permar SR. The impact of IgG transplacental transfer on early life immunity. Immunohorizons 2018; 2 (01) 14-25
• 27 Dechavanne C, Cottrell G, Garcia A, Migot-Nabias F. Placental malaria: decreased transfer of maternal antibodies directed to Plasmodium falciparum and impact on the incidence of febrile infections in infants. PLoS One 2015; 10 (12) e0145464
• 28 Perlman JM, Salvatore C. Coronavirus disease 2019 infection in newborns. Clin Perinatol 2022; 49 (01) 73-92