Neutralizing Antibody Responses to Messenger RNA Coronavirus Disease 2019 Vaccines Versus Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Pregnant Women and Vaccine-Induced Antibody Transfer to Infants

Fatimah S Dawood; Alan Tita; Melissa S Stockwell; Gabriella Newes-Adeyi; Kristina Wielgosz; Cynthia Gyamfi-Bannerman; Ashley Battarbee; Lawrence Reichle; Natalie Thornburg; Sascha Ellington; Romeo R Galang; Kelly Vorwaller; Celibell Y Vargas; Tyler Morrill; Mickey Parks; Emily Powers; Marie Gibson; Michael Varner

doi:10.1093/ofid/ofad204

Neutralizing Antibody Responses to Messenger RNA Coronavirus Disease 2019 Vaccines Versus Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Pregnant Women and Vaccine-Induced Antibody Transfer to Infants

Open Forum Infect Dis. 2023 Apr 19;10(5):ofad204. doi: 10.1093/ofid/ofad204. eCollection 2023 May.

Authors

Fatimah S Dawood¹, Alan Tita², Melissa S Stockwell^{3

4

5}, Gabriella Newes-Adeyi⁶, Kristina Wielgosz¹, Cynthia Gyamfi-Bannerman^{3

7

8}, Ashley Battarbee², Lawrence Reichle⁶, Natalie Thornburg¹, Sascha Ellington¹, Romeo R Galang¹, Kelly Vorwaller⁹, Celibell Y Vargas³, Tyler Morrill⁶, Mickey Parks², Emily Powers⁷, Marie Gibson⁹, Michael Varner⁹

Affiliations

¹ Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
² Center for Women's Reproductive Health and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
³ New York-Presbyterian Hospital, New York, New York, USA.
⁴ Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.
⁵ Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA.
⁶ Abt Associates, Rockville, Maryland, USA.
⁷ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA.
⁸ Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, California, USA.
⁹ Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.

Abstract

Background: Early coronavirus disease 2019 (COVID-19) vaccine trials excluded pregnant women, resulting in limited data about immunogenicity and maternal-fetal antibody transfer, particularly by gestational timing of vaccination.

Methods: In this multicenter observational immunogenicity study, pregnant and nonpregnant women receiving COVID-19 vaccines were prospectively enrolled. Participants had sera collected before vaccination, at 14-28 days after each vaccine dose, at delivery (umbilical cord and peripheral), and from their infants at 3 and 6 months. Geometric mean titers (GMTs) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ID₅₀ neutralizing antibody (nAb) against D614G-like viruses were compared by participant characteristics.

Results: Overall, 23 nonpregnant and 85 pregnant participants (trimester of first vaccine dose: 10 first, 47 second, 28 third) were enrolled. Ninety-three percent (76/82 with blood samples) of pregnant participants had detectable SARS-CoV-2 nAb after 2 vaccine doses, but GMTs (95% confidence intervals) were lower in pregnant participants than nonpregnant participants (1722 [1136-2612] vs 4419 [2012-9703]; P = .04). By 3 and 6 months, 28% and 74% of infants, respectively, of vaccinated participants had no detectable nAb to D614G-like viruses. Among the 71 pregnant participants without detectable nAb before vaccination, cord blood GMTs at delivery were 5-fold higher among participants vaccinated during the third versus first trimester, and cord blood nAb titers appeared inversely correlated with weeks since first vaccine dose (R² = 0.06, P = .06).

Conclusions: Though most pregnant women develop nAb after 2 doses of mRNA COVID-19 vaccines, this analysis suggests that infant protection from maternal vaccination varies by gestational timing of vaccination and wanes. Additional prevention strategies such as caregiver vaccination may warrant consideration to optimize infant protection.

Keywords: COVID-19 vaccine; immunogenicity; infant; pregnancy.

Published by Oxford University Press on behalf of Infectious Diseases Society of America 2023.