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COVID-19 and Women’s Health

How Efficient is Transplacental Transfer of SARS-CoV-2 Antibodies?

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BACKGROUND AND PURPOSE:

  • Flannery et al. (JAMA Pediatrics, 2021) assessed the association between maternal and neonatal SARS-CoV-2–specific antibody concentrations

METHODS:

  • Cohort study
  • Participants
    • Mother/newborn dyads who delivered between April 9 and August 8, 2020
    • Maternal and cord blood sera available
  • Study design
    • Women routinely screened for SARS-CoV-2 (1) on hospital admission to labor and delivery or (2) during pregnancy if symptomatic or exposed 
    • IgG and IgM antibodies to the receptor-binding domain of the SARS-CoV-2 spike protein were measured
    • Antibody concentrations and transplacental transfer ratios were analyzed in combination with demographic and clinical data
  • Primary outcome
    • Antibody concentrations and transplacental transfer ratios

RESULTS:

  • 1471 mother/newborn dyads
    • Median (IQR) age: 32 (28 to 35) years
    • 26.3% Black/non-Hispanic | 51.3% White/non-Hispanic | 11.8% Hispanic | 7.3% Asian, 3.3% other race/ethnicity
  • SARS-CoV-2 antibodies detected at time of delivery
    • Maternal sera: 6% (95% CI, 5% to 7%)
    • Cord sera from the pregnancies with positive maternal antibodies: 87% (95% CI, 78% to 93%)
  • In cord sera
    • When antibody present, only IgG detected
    • No antibodies detected in cord sera if mother was seronegative
  • 11 infants born to seropositive mothers were seronegative
    • Born to mother with IgM only: 45%
    • Born to mothers with significantly lower IgG concentrations: 55%
  • Cord blood IgG concentrations were positively correlated with maternal IgG concentrations (P < 0.001)
  • Placental transfer ratios of more than 1.0 were observed among women with asymptomatic SARS-CoV-2 infections as well as those with mild, moderate, and severe COVID-19
  • Transfer ratios increased with increasing time between onset of maternal infection and delivery

CONCLUSION:

  • Neonates born to seropositive mothers had IgG antibodies to SARS-CoV-2
    • Antibody positive cord sera also documented among asymptomatic pregnancies
  • Antibody concentrations in cord blood correlated with
    • Maternal antibody concentrations
    • Duration between onset of infection and delivery
  • The authors conclude

Our findings demonstrate the potential for maternally derived antibodies to provide neonatal protection from SARS-CoV-2 infection and will help inform both neonatal management guidance and design of vaccine trials during pregnancy

Learn More – Primary Sources:

Assessment of Maternal and Neonatal Cord Blood SARS-CoV-2 Antibodies and Placental Transfer Ratios

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Related ObG Topics:

Infants Born to Mothers with COVID-19 Have Detectable Levels of Antibodies
Neonatal Infection: COVID-19 and Risk for Vertical Transmission
Pregnant Women with COVID-19 at Time of Delivery: NYC Cohort Characteristics and Outcomes
Vertical Transmission in Pregnancies with Confirmed COVID-19

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