Maternal and Cord Anti-SARS-CoV-2-Spike IgG following COVID-19 Vaccination versus Infection during Pregnancy: A Prospective Study, Israel October 2021–March 2022

 

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Abstract

Objective Defining how pregnant women respond to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination is critical to optimize vaccination strategies that protect mother and infant at the epidemic. This study aimed to compare anti-SARS-CoV-2-spike immunoglobulin G (IgG) of vaccinated versus infected women and to determine the optimal timing of maternal vaccination during pregnancy at the time of epidemic.

Study Design We collected maternal/cord blood at delivery (October 2021–March 2022) and measured anti-SARS-CoV-2-spike IgG geometric mean concentrations (IgG-GMCs) using a quantitative immunoassay. We compared groups according to timing and number of doses and correlated maternal and fetal IgG levels. We described the proportion of women with IgG levels above the 150 AU/mL positivity threshold according to the timing of infection/vaccination and performed a subanalysis for maternal IgG-GMC levels pre- and during the Omicron wave.

Results We included 238 vaccinated women, 125 who received two doses and 113 three doses, and 48 unvaccinated infected women. All groups infected/vaccinated in the second or third trimester had an IgG-GMC above the positivity threshold. Third-trimester vaccination (second/third dose) resulted in higher maternal and cord-blood IgG-GMC compared to the second trimester (maternal-IgG: 102,32 vs. 4,325 AU/mL, p < 0.001; cord-IgG: 12,113 vs. 8,112 AU/mL, p < 0.001). Compared with infected-only women, a higher proportion of vaccinated women with ≥2 doses and their newborns had IgG levels above the positivity threshold at all time points. In vaccinated women, there were higher maternal IgG-GMC levels during the Omicron wave than pre-Omicron.

Conclusion At the time of epidemic, receiving an additional COVID-19 vaccine dose in the third trimester resulted in a higher IgG-GMC compared to the second trimester. Relatively higher levels of maternal and cord IgG-GMC were achieved following vaccination than infection. Women infected during or before the first trimester might benefit from an additional third-trimester dose to prevent peripartum infection and to passively immunize their newborn. The higher levels of maternal IgG-GMC in the Omicron period are suggestive of hybrid immunity.

Key Points

• Higher maternal anti-SARS-IgGs in vaccinated → infected.

• Higher cord anti-SARS-IgGs in vaccinated → infected.

• Third-trimester vaccine resulted in high-cord IgG levels.

Ethics Approval Statement

This study was approved by the ethics committee of Galilee Medical Center. The study was performed in accordance with the Declaration of Helsinki (approval number: 0028-21-NHR).

Patient Consent Statement

Written Informed consent was obtained from all individual participants included in the study.

Publication History

Received: 29 January 2023

Accepted: 04 May 2023

Accepted Manuscript online:
10 May 2023

Article published online:
19 June 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

• References

• 1 Coronavirus Pandemic (COVID-19) - our world in data. Accessed August 1, 2022 at: https://ourworldindata.org/coronavirus
  PubMed
• 2 Baden LR, El Sahly HM, Essink B. et al; COVE Study Group. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med 2021; 384 (05) 403-416
  CrossrefPubMedGoogle Scholar
• 3 Polack FP, Thomas SJ, Kitchin N. et al; C4591001 Clinical Trial Group. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 2020; 383 (27) 2603-2615
  CrossrefPubMedGoogle Scholar
• 4 Zeng H, Xu C, Fan J. et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA 2020; 323 (18) 1848-1849
  PubMedGoogle Scholar
• 5 Flannery DD, Gouma S, Dhudasia MB. et al. Assessment of maternal and neonatal cord blood SARS-CoV-2 antibodies and placental transfer ratios. JAMA Pediatr 2021; 175 (06) 594-600
  CrossrefPubMedGoogle Scholar
• 6 Rottenstreich A, Zarbiv G, Oiknine-Djian E. et al. Timing of SARS-CoV-2 vaccination during the third trimester of pregnancy and transplacental antibody transfer: a prospective cohort study. Clin Microbiol Infect 2022; 28 (03) 419-425
  CrossrefPubMedGoogle Scholar
• 7 Kugelman N, Nahshon C, Shaked-Mishan P. et al. Maternal and neonatal SARS-CoV-2 immunoglobulin G antibody levels at delivery after receipt of the BNT162b2 messenger RNA COVID-19 vaccine during the second trimester of pregnancy. JAMA Pediatr 2022; 176 (03) 290-295
  CrossrefPubMedGoogle Scholar
• 8 Nir O, Schwartz A, Toussia-Cohen S. et al. Maternal-neonatal transfer of SARS-CoV-2 immunoglobulin G antibodies among parturient women treated with BNT162b2 messenger RNA vaccine during pregnancy. Am J Obstet Gynecol MFM 2022; 4 (01) 100492
  CrossrefPubMedGoogle Scholar
• 9 Narasimhan M, Mahimainathan L, Araj E. et al. Clinical evaluation of the abbott alinity sars-cov-2 spike-specific quantitative igg and igm assays among infected, recovered, and vaccinated groups. J Clin Microbiol 2021; 59 (07) e0038821
  CrossrefPubMedGoogle Scholar
• 10 Reverberi R. The statistical analysis of immunohaematological data. Blood Transfus 2008; 6 (01) 37-45
  PubMedGoogle Scholar
• 11 Horne AD, Lachenbruch PA, Getson PR, Hsu HS. Analysis of studies to evaluate immune response to combination vaccines. Clin Infect Dis 2001; 33 (Suppl 4): S306-S311
  CrossrefPubMedGoogle Scholar
• 12 Wei J, Matthews PC, Stoesser N. et al; COVID-19 Infection Survey team. Anti-spike antibody response to natural SARS-CoV-2 infection in the general population. Nat Commun 2021; 12 (01) 6250
  CrossrefPubMedGoogle Scholar
• 13 Ovies C, Semmes EC, Coyne CB. Pregnancy influences immune responses to SARS-CoV-2. Sci Transl Med 2021; 13 (617) eabm2070
  CrossrefPubMedGoogle Scholar
• 14 Massalha M, Yefet E, Rozenberg O. et al. Vertical transmission and humoral immune response following maternal infection with SARS-CoV-2: a prospective multicenter cohort study. Clin Microbiol Infect 2022; 28 (09) 1258-1262
  CrossrefPubMedGoogle Scholar
• 15 Yousefi Z, Taheri N, Dargahi M. et al. Long-term persistence of anti-SARS-COV-2 IgG antibodies. Curr Microbiol 2022; 79 (04) 96
  CrossrefPubMedGoogle Scholar
• 16 Golan N, Ashkenazi S, Davidovich R. et al. Quantitative analysis of vertical transmission of maternal SARS-CoV-2 antibodies to neonates and young infants following immunization during pregnancy. J Pediatric Infect Dis Soc 2022; 11 (11) 506-509
  CrossrefPubMedGoogle Scholar
• 17 World Health Organization TAG on S-C-2 VE (TAG-V). : Classification of Omicron (B.1.1.529): SARS- CoV-2 variant of concern. Statement. 2021. Accessed May 24, 2023 at: https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern#:~:text=529%20infection%20was%20from%20a,as%20compared%20to%20other%20VOCs
  PubMed
• 18 Abu Jabal K, Edelstein M. Using SARS-CoV-2 anti-S IgG levels as a marker of previous infection: example from an Israeli healthcare worker cohort. Int J Infect Dis 2022; 120: 22-24
  CrossrefPubMedGoogle Scholar

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