Immunogenicity of COVID-19 mRNA Vaccines in Pregnant and Lactating Women

Abstract

IMPORTANCE Pregnant women are at increased risk of morbidity and mortality from COVID-19 but have been excluded from the phase 3 COVID-19 vaccine trials. Data on vaccine safety and immunogenicity in these populations are therefore limited.OBJECTIVE To evaluate the immunogenicity of COVID-19 messenger RNA (mRNA) vaccines in pregnant and lactating women, including against emerging SARS-CoV-2 variants of concern. DESIGN, SETTING, AND PARTICIPANTS An exploratory, descriptive, prospective cohort study enrolled 103 women who received a COVID-19 vaccine from December 2020 through March 2021 and 28 women who had confirmed SARS-CoV-2 infection from April 2020 through March 2021 (the last follow-up date was March 26, 2021). This study enrolled 30 pregnant, 16 lactating, and 57 neither pregnant nor lactating women who received either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) COVID-19 vaccines and 22 pregnant and 6 nonpregnant unvaccinated women with SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES SARS-CoV-2 receptor binding domain binding, neutralizing, and functional nonneutralizing antibody responses from pregnant, lactating, and nonpregnant women were assessed following vaccination. Spike-specific T-cell responses were evaluated using IFN-γ enzyme-linked immunospot and multiparameter intracellular cytokine-staining assays. Humoral and cellular immune responses were determined against the original SARS-CoV-2 USA-WA1/2020 strain as well as against the B.1.1.7 and B.1.351 variants. RESULTSThis study enrolled 103 women aged 18 to 45 years (66% non-Hispanic White) who received a COVID-19 mRNA vaccine. After the second vaccine dose, fever was reported in 4 pregnant women (14%; SD, 6%), 7 lactating women (44%; SD, 12%), and 27 nonpregnant women (52%; SD, 7%). Binding, neutralizing, and functional nonneutralizing antibody responses as well as CD4 and CD8 T-cell responses were present in pregnant, lactating, and nonpregnant women following vaccination. Binding and neutralizing antibodies were also observed in infant cord blood and breast milk. Binding and neutralizing antibody titers against the SARS-CoV-2 B.1.1.7 and B.1.351 variants of concern were reduced, but T-cell responses were preserved against viral variants. CONCLUSION AND RELEVANCEIn this exploratory analysis of a convenience sample, receipt of a COVID-19 mRNA vaccine was immunogenic in pregnant women, and vaccine-elicited antibodies were transported to infant cord blood and breast milk. Pregnant and nonpregnant women who were vaccinated developed cross-reactive antibody responses and T-cell responses against SARS-CoV-2 variants of concern.

Covid-19 Vaccination in Pregnancy: A Systematic Review

“…52,53,54 It had been reported, compared to the wild type of USA-WA1/2020 SARS-CoV-2, the binding strength of neutralizing antibodies formed after Pfizer and Moderna vaccination was observed 3.5-and 6-fold lower for B.1.1.7 and B.1351, respectively. 12 Antibody resistance against B.1.1.7 and B.1351 was also reported by another study. 55 In addition, in UK, it also was reported that B.1.617.2 had overtaken B.1.1.7.…”

“…19 Maternal antibody response has been described formed following vaccination. [11][12][13][14][15]17,18,20 Through vaccination, antibody response was formed rapidly; while through vaccination it was formed gradually. 20 The number of IgG and IgM against SARS-CoV-2 were significantly increased after vaccination.…”

La incógnita del coronavirus - Lo nuevo sobre su acción en la gestante y su bebe

“…Las mujeres tuvieron una buena respuesta a las vacunas, produciendo los niveles necesarios de anticuerpos neutralizantes y células inmunitarias conocidas como células T de memoria, que pueden ofrecer una protección más duradera. La investigación también indica que las vacunas podrían ofrecer protección a los bebés nacidos de madres vacunadas (37,38) .…”

Differential pre-pandemic IgA reactivity against SARS-CoV-2 and circulating human coronaviruses measured in milk collected in Uganda and the USA

“…Second, COVID-19 vaccination has been rolled out in several countries and recent published reports indicate that vaccination induces robust IgA and IgG antibody responses with neutralizing activity in breast milk which may confer protection to breastfeeding infants [20][21][22][23].…”