Passive and Active Immunity in Infants Born to Mothers with SARS-CoV-2 Infection During Pregnancy: Prospective Cohort Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2021 Jul 8

PMID 34234001

Citations 41

Authors

Dongli Song

Mary Prahl

Stephanie L Gaw

Sudha Rani Narasimhan

Daljeet S Rai

Angela Huang

Claudia V Flores

Christine Y Lin

Unurzul Jigmeddagva

Alan Wu

Lakshmi Warrier

Justine Levan

Catherine B T Nguyen

Perri Callaway

Lila Farrington

Gonzalo R Acevedo

Veronica J Gonzalez

Anna Vaaben

Phuong Nguyen

Elda Atmosfera

Constance Marleau

Christina Anderson

Sonya Misra

Monica Stemmle

Maria Cortes

Jennifer McAuley

Nicole Metz

Rupalee Patel

Matthew Nudelman

Susan Abraham

James Byrne

Priya Jegatheesan

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate maternal immunoglobulins' (IgM, IgG) response to SARS-CoV-2 infection during pregnancy and IgG transplacental transfer, to characterise neonatal antibody response to SARS-CoV-2 infection, and to longitudinally follow actively and passively acquired antibodies in infants.

Design: A prospective observational study.

Setting: Public healthcare system in Santa Clara County (California, USA).

Participants: Women with symptomatic or asymptomatic SARS-CoV-2 infection during pregnancy and their infants were enrolled between 15 April 2020 and 31 March 2021.

Outcomes: SARS-CoV-2 serology analyses in the cord and maternal blood at delivery and longitudinally in infant blood between birth and 28 weeks of life.

Results: Of 145 mothers who tested positive for SARS-CoV-2 during pregnancy, 86 had symptomatic infections: 78 with mild-moderate symptoms, and 8 with severe-critical symptoms. The seropositivity rates of the mothers at delivery was 65% (95% CI 0.56% to 0.73%) and the cord blood was 58% (95% CI 0.49% to 0.66%). IgG levels significantly correlated between the maternal and cord blood (Rs=0.93, p<0.0001). IgG transplacental transfer ratio was significantly higher when the first maternal positive PCR was 60-180 days before delivery compared with <60 days (1.2 vs 0.6, p<0.0001). Infant IgG seroreversion rates over follow-up periods of 1-4, 5-12, and 13-28 weeks were 8% (4 of 48), 12% (3 of 25), and 38% (5 of 13), respectively. The IgG seropositivity in the infants was positively related to IgG levels in the cord blood and persisted up to 6 months of age. Two newborns showed seroconversion at 2 weeks of age with high levels of IgM and IgG, including one premature infant with confirmed intrapartum infection.

Conclusions: Maternal SARS-CoV-2 IgG is efficiently transferred across the placenta when infections occur more than 2 months before delivery. Maternally derived passive immunity may persist in infants up to 6 months of life. Neonates are capable of mounting a strong antibody response to perinatal SARS-CoV-2 infection.

Citing Articles

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Pregnancy enhances antiviral immunity independent of type I IFN but dependent on IL-17-producing γδ T cells in the nasal mucosa.

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