ABSTRACT
On March 11, 2020, the World Health Organization declared the novel coronavirus (COVID-19) outbreak a global pandemic. In April 2020, the Pregnancy and Infant Linked Outcomes Team (PILOT) was established within the Centers for Disease Control and Prevention's (CDC) COVID-19 response structure, specifically to focus on better understanding the impact of COVID-19 in pregnancy. A total of 71 CDC staff deployed to PILOT, collectively contributing more than 99,000 hours to the response over the course of the team's 25-month activation. PILOT led or collaborated on the publication of over 40 manuscripts, managed several clinical guidance documents, and coordinated and provided subject matter expertise to three funded research studies with academic partners. The team developed six CDC webpages, a toolkit for pregnant people and new parents, and disseminated scientific findings with over 350 social media posts on Facebook, Twitter, Snapchat, LinkedIn, and Instagram with nearly 77 million total impressions. In this, we will summarize the work of PILOT, and other parts of the CDC COVID-19 response, including teams focused on vaccine effectiveness and safety, and surveillance and research activities outside of the CDC. We will review several key contributions to our understanding of COVID-19 in pregnancy: (1) pregnant people are at greater risk of severe illness from COVID-19, including hospitalization, admission to an intensive care unit, and the need for mechanical ventilation, compared with nonpregnant women of reproductive age;(2) pregnant people with COVID-19 are more likely to experience complications that can affect their pregnancy and developing baby, including stillbirth and preterm delivery, compared to pregnant people without COVID-19;(3) there are no recognized maternal or fetal adverse effects of COVID-19 vaccines in pregnancy;and (4) COVID-19 vaccine during pregnancy is effective in preventing severe illness, hospitalization and death among pregnant people, as well as preventing severe illness in infants up to age six months.
ABSTRACT
Background. Antenatal care is a unique opportunity to assess SARS-CoV-2 seroprevalence and antibody response in pregnant people, including those with previously unknown infection. Methods. Pregnant people were screened for SARS-CoV-2 IgG during antenatal care or delivery in Seattle, Washington with Abbott Architect chemiluminescent immunoassay which provides quantitative index (positive ≥1.4). Participants with IgG+ results or identified with RT-PCR+ results via medical records were invited to enroll in a longitudinal evaluation of antibody responses. We report preliminary results of an ongoing seroprevalence and longitudinal study with planned 18-month follow-up. Results. Between September 9, 2020-May 7, 2021, we screened 1304 pregnant people;62 (4.8%) tested SARS-CoV-2 IgG+, including 28 (45%) with known prior SARS-CoV-2 infection. Among participants testing IgG+, median age was 32 years (interquartile range [IQR] 26-35) and median gestational age was 21 weeks (IQR 12-38) at screening;median IgG index was 3.2 (IQR 2.1-4.9, range 1.4-9.9), including 3.9 (IQR 2.3-5.8) among those with vs. 2.7 (IQR 1.9-4.2) among those without prior RT-PCR+ results (p=0.05 by Wilcoxon rank-sum). Of 30 longitudinal study participants enrolled, 24 tested IgG+ at baseline (75% with prior RT-PCR+ result) and 6 tested IgG- on enrollment but were identified as previously RT-PCR+ via medical records;24/30 (80%) reported previous symptoms. Of 24 participants testing IgG+ at baseline, 14 (58%) had first follow-up IgG results at median of 66 days (IQR 42-104) since initial testing, with median IgG index of 2.0 (IQR 1.0-3.8). 9/14 (64%) participants with repeat IgG testing remained IgG+ at first follow-up (≤280 days after first RT-PCR+ result for those with and ≥104 days after first IgG detection for those without prior RT-PCR+ results), while 5/14 (26%) had a negative Abbott IgG test at a median of 81 days (IQR 75-112) since initial testing. Conclusion. Nearly half of pregnant people testing SARS-CoV-2 IgG+ reported no known prior SARS-CoV-2 diagnosis or symptoms. SARS-CoV-2 IgG antibody response and durability in pregnancy has implications for maternal and neonatal protection and susceptibility and highlights potential benefits of vaccination in this population.