Infectious Disease

Pregnant girls with COVID-19 go few antibodies on to infants

January 14, 2021

4 min read

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Edlow, Jamieson and Rasmussen do not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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Although the risk of vertical transmission of COVID-19 seems rare, a below-expected rate of transplacental transmission of antibodies suggests that children born to infected mothers are at risk of infection, according to a study published on JAMA Network Open could.

Researchers conducted a prospective cohort study of pregnant women who presented at three Boston colleges. They recruited pregnant women who tested positive for COVID-19 using reverse transcription polymerase chain reaction (RT-PCR) tests from April 2, 2020 to June 13, 2020, and enrolled patients who tested negative for convenience have been tested.

The researchers assessed the SARS-CoV-2 viral load in plasma or respiratory fluids of pregnant women, umbilical cord plasma, anti-SARS-CoV-2 antibodies in women’s plasma and umbilical cord plasma, and SARS-CoV-2 in the placenta.

A total of 127 pregnant women – 64 who tested positive for SARS-CoV-2 and 63 who tested negative – were included in the study.

Among those who tested positive, 36% were asymptomatic, 34% had mild illness, 11% had moderate illness, 16% had severe illness, and 3% had critical illness.

Of the 107 women whose viral load was analyzed, the researchers did not identify any detectable viraemia in their blood or cord blood and found no evidence of vertical transmission. Of the 77 infants tested, in whom SARS-CoV-2 antibodies had been quantified in umbilical cord blood, only one had detectable immunoglobulin M against nucleocapsid.

The researchers were unable to detect SARS-CoV-2 RNA in any of the 88 placentas tested.

During an analysis of antibodies in 37 women with SARS-CoV-2, the researchers found that immunoglobin G of the anti-receptor binding domain was detected in 65% and anti-nucleocapsid in 70%.

In an editorial comment published alongside the study, Denise J. Jamieson, MD, MPH, Professor and Chair of the Department of Gynecology and Obstetrics at Emory University School of Medicine in Atlanta, and Sonja A. Rasmussen, MD, MS, The professor in the Department of Pediatrics and Epidemiology at the University of Florida College of Medicine wrote that while more research is needed to determine whether the observed inefficient transplacental transfer of SARS-CoV-2 antibodies from maternal to infant is due to COVID Applied to raised antibodies -19 vaccines, it shows the susceptibility of infants to infection.

“These results underscore the importance of ensuring that pregnant women are included in clinical trials of SARS-CoV-2 vaccines so that they have the opportunity to receive SARS-CoV-2 vaccines once they are found to be safe and secure are effective, “they write. “It also shows the importance of protecting pregnant women and their newborns from SARS-CoV-2 infection.”

Healio Primary Care spoke to the study’s author Andrea G. Edlow, MD, MSc, A specialist in maternal-fetal medicine at Massachusetts General Hospital and an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School to learn about the results and suggestions for COVID-19 vaccination in pregnant women.

Q: What do these results suggest to the COVID-19 vaccination efforts in pregnant women?

I think the effects on the COVID-19 vaccine in pregnant women are nuanced. In the JAMA Network Open publication, we found decreased placental antibody transfer of anti-COVID antibodies from mother to fetus when infected in the third trimester. This was an unexpected finding. In our recent article in Cell, we examined the underlying mechanism and found that it was at least partially related to various glycosylation patterns – sugar or carbohydrate attachments to the antibodies – on COVID-19-specific antibodies. Sugar groups were bound to the COVID-19 antibodies, which may have reduced the efficiency of placental transfer to the fetus, causing them to “get stuck” in the maternal circulation instead of attaching to placental receptors and passing into the umbilical cord blood. These results have implications for both rational vaccine design for pregnant women – vaccines that induce sugar-appended antibodies that are most efficiently transferred are the best protection for newborns – and when they are vaccinated during pregnancy, as infection occurs in the second Trimester resulted in a more efficient transfer of antibodies than 3rd trimester. We also don’t know whether antibodies from vaccines have the same sugar attachment profile as antibodies from a natural infection with COVID-19. So it is important to investigate this in the future. In addition, the presence of more antibodies in maternal blood is generally linked to higher transmission to the newborn, so vaccination may help increase the amount of antibodies in the mother’s system compared to a native infection – an important study area to enable increased transmission to the newborn.

Q: How does the transplacental transfer of antibodies to the fetus observed in women with COVID-19 compare to influenza?

A: The transmission of anti-COVID-19 antibodies is lower than the transmission of anti-flu antibodies or the transmission of anti-pertussis antibodies.

Q: What additional research is needed to determine the effects of COVID-19 infection in the mother on the child’s immunity?

A: Assessment of the transmission efficiency in maternal infection in the first versus the second versus the third trimester. We are also investigating the transfer of antibodies to newborns in breast milk and will be investigating the antibodies produced by the vaccine in both pregnancy and lactation.

Q: What could prevent the transmission of COVID-19 from pregnant mothers to their infants?

A: Low prevalence of maternal viraemia – the presence of a detectable virus in the bloodstream – and a protective pattern of the SARS-CoV-2 entry receptor (ACE2) and protease (TMPRSS2) in the placenta, both shown in the JAMA Network Open Paper.

Q: Should hospitals separating infants from mothers with COVID-19 continue to do so after these findings?

A: No, mothers and babies should not be separated. Our work does not contain any results that are relevant to the separation of mother and child per se. However, other studies have shown that with good hand hygiene and careful masking / precautions, newborns can be safely housed with mothers and mothers can breastfeed with a mask on and after careful hand / breast hygiene. Massachusetts General Hospital and most other hospitals across the country do not separate mothers and newborns, even if the mother is COVID-19 positive.

References:

Atyeo C et al. Cell. 2020; doi: 10.1016 / j.cell.2020.12.027.

Edlow AG et al. JAMA Netw Open. 2020; doi: 10.1001 / jamanetworkopen.2020.30455.

Jamieson DJ et al. JAMA Netw Open. 2020; doi: 10.1001 / jamanetworkopen.2020.30564.

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