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

Abstract

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.

Detection of SARS-CoV-2 specific IgA in the human milk of COVID-19 vaccinated, lactating health care workers

“…[10][11][12] However, these results contrast with recent studies presented at medRxiv for peer review. 13,14 The peak of SARS-CoV-2 IgA and IgG in human milk and plasma occurs 7-10 days after receiving the second dose of the COVID-19 vaccine. The peak of vaccine-induced antibody titers is but one part of antibody-mediated protection.…”

COVID-19 vaccination in pregnant and lactating diabetic women

“…In a prospective cohort study the mRNA vaccine-induced immune responses and the side effects were evaluated in 84 pregnant and in 31 lactating women. A strong humoral immune response was observed in all vaccinated women with higher levels of SARS-CoV-2 antibodies compared to pregnant women with natural infection in the previous 4e12 weeks [39]. No adverse pregnancy outcomes were observed, except the 8% of spontaneous preterm delivery [39].…”

“…A strong humoral immune response was observed in all vaccinated women with higher levels of SARS-CoV-2 antibodies compared to pregnant women with natural infection in the previous 4e12 weeks [39]. No adverse pregnancy outcomes were observed, except the 8% of spontaneous preterm delivery [39]. As for other vaccines, injection site soreness, fever, fatigue, headache, chills, together with muscle and joint pain are the most frequent systemic reactions to COVID-19 vaccines.…”

“…As for other vaccines, injection site soreness, fever, fatigue, headache, chills, together with muscle and joint pain are the most frequent systemic reactions to COVID-19 vaccines. Fever (38 C or higher) was more common after the 2 nd dose [39]. Vaccine-induced IgG pass across the placenta to the fetus and in neonates through breastmilk.…”

Human vaccines & immunotherapeutics: news

“…Both mRNA vaccines induced high antibody levels in pregnant women, and these antibodies were passed on to children through breast milk. 2,3 The third vaccine investigated for efficacy in younger populations is the non-replicating adenovirus-based vaccine Ad26. COV2.S (J&J).…”