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COVID-19 and Women’s Health

Infants Born to Mothers with COVID-19 Have Detectable Levels of Antibodies

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BACKGROUND AND PURPOSE:

  • Zeng et al. (JAMA, 2020) examined antibody levels in 6 women with confirmed COVID-19, as well as their infants

METHODS:

  • Retrospective study
  • Setting
    • Zhongnan Hospital of Wuhan University
  • Participants
    • 6 hospitalized pregnant women with confirmed COVID-19
    • Testing: Quantitative RT-PCR for SARS-CoV-2
    • Patients delivered February 16 to March 6, 2020
  • Study design
    • Maternal samples: Blood collected at delivery
    • Neonatal samples
      • Blood and throat swabs at birth
    • Cytokines and antibodies (IgG and IgM) also tested
    • Performance characteristics of antibody test kits: IgM: 88.2% (sensitivity) and 99.0% (specificity) | IgG: 97.8% (sensitivity) and 97.9% (specificity)

RESULTS:

  • 6 mothers tested | All had mild clinical manifestations
    • All delivered via cesarean in the third trimester in negative pressure isolation rooms
    • Infants were isolated from their mothers immediately after delivery
  • Infant characteristics
    • All had normal Apgar scores: 1-minute Apgar scores of 8 to 9 | 5-minute Apgar scores of 9 to 10
    • All RT-PCR tests were negative for SARS-CoV-2

Antibody Testing

  • All infants had antibodies detected in their serum
  • Both IgG and IgM: 2 infants had both IgG and IgM concentrations higher than the reference rage (<10 AU/mL)
    • Infant 1: IgG level = 125.5; IgM level = 39.6 AU/mL
    • Infant 2: IgG level = 113.91; IgM level = 16.25 AU/mL
    • All mothers also had elevated levels of IgG and IgM
  • IgG only: 3 infants had elevated IgG levels
    • Infant 1: 75.49 AU/mL
    • Infant 2: 73.19 AU/mL
    • Infant 3: 51.38 AU/mL)
    • All mothers had elevated IgG and 2 also had elevated IgM levels
  • Inflammatory cytokine IL-6 was significantly increased in all infants
  • Infants asymptomatic (as of March 8, 2020)

CONCLUSION:

  • None of the infants born to mothers with COVID-19 had SARS-CoV-2 detected in their serum or throat swab by RT-PCR
    • However, virus-specific antibodies were found
  • 2 infants had elevated IgM concentrations
    • “Unexpected” finding as IgG crosses placenta, but, due to size, IgM does not
    • The authors hypothesize that this finding could be due to placenta damage or the infant producing antibodies
    • Infant responding to in-utero infection with antibody production would suggest vertical transmission of SARS-CoV-2
  • Some limitations include
    • Small sample size
    • Lack of cord blood, amniotic fluid, and breast milk samples
    • Incomplete information on the outcome of the infants

Learn More – Primary Sources:

Antibodies in Infants Born to Mothers With COVID-19 Pneumonia

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Related ObG Topics:

Coronavirus and Pregnancy: CDC Guidance and Professional Recommendations
Clinical Characteristics of Pregnant Women with COVID-19 Pneumonia
Vertical Transmission in Pregnancies with Confirmed COVID-19

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