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COVID-19 vaccine response in pregnant and lactating women: a cohort study

Kathryn J. GrayDepartment of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USAEvan A. BordtDepartment of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USACaroline AtyeoPhD Program in Virology, Division of Medical Sciences, Harvard University, Boston, MA, USAElizabeth A. DeRisoRagon Institute of MGH, MIT, and Harvard, Cambridge, MA, USABabatunde AkinwunmiDepartment of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USANicola YoungDepartment of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USAAranxta Medina BaezDepartment of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USALydia L. ShookDepartment of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USADana CvrkDepartment of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USAKaitlyn E. JamesDepartment of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USARose M. De GuzmanDepartment of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USASara BrigidaDepartment of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USAKhady DioufDepartment of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USAIlona T. GoldfarbDepartment of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USALisa M. BebellDivision of Infectious Diseases, Massachusetts General Hospital, MGH Center for Global Health, and Harvard Medical School, Boston, MALael M. YonkerMucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA, USAAlessio FasanoMucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA, USAS. Alireza RabiDepartment of Cardiothoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USAMichal A. ElovitzMaternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USAGalit AlterRagon Institute of MGH, MIT, and Harvard, Cambridge, MA, USAAndrea G. EdlowDepartment of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

2021en

ABI

Аннотация

BACKGROUND: Pregnant and lactating women were excluded from initial COVID-19 vaccine trials; thus, data to guide vaccine decision-making are lacking. We sought to evaluate the immunogenicity and reactogenicity of COVID-19 mRNA vaccination in pregnant and lactating women. METHODS: 131 reproductive-age vaccine recipients (84 pregnant, 31 lactating, and 16 non-pregnant) were enrolled in a prospective cohort study at two academic medical centers. Titers of SARS-CoV-2 Spike and RBD IgG, IgA and IgM were quantified in participant sera (N=131), umbilical cord sera (N=10), and breastmilk (N=31) at baseline, 2nd vaccine dose, 2-6 weeks post 2nd vaccine, and delivery by Luminex, and confirmed by ELISA. Titers were compared to pregnant women 4-12 weeks from native infection (N=37). Post-vaccination symptoms were assessed. Kruskal-Wallis tests and a mixed effects model, with correction for multiple comparisons, were used to assess differences between groups. RESULTS: Vaccine-induced immune responses were equivalent in pregnant and lactating vs non-pregnant women. All titers were higher than those induced by SARS-CoV-2 infection during pregnancy. Vaccine-generated antibodies were present in all umbilical cord blood and breastmilk samples. SARS-CoV-2 specific IgG, but not IgA, increased in maternal blood and breastmilk with vaccine boost. No differences were noted in reactogenicity across the groups. CONCLUSIONS: COVID-19 mRNA vaccines generated robust humoral immunity in pregnant and lactating women, with immunogenicity and reactogenicity similar to that observed in non-pregnant women. Vaccine-induced immune responses were significantly greater than the response to natural infection. Immune transfer to neonates occurred via placental and breastmilk.

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Идентификаторы

DOI: 10.1101/2021.03.07.21253094

Цитирования и источники

Цитирований: 2Использованных источников: 0

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