Evaluation of immunogenicity and reactogenicity of COVID-19 vaccines in pregnant women.

OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy is associated with increased risk of adverse maternal and perinatal outcomes. Vaccines are highly effective at preventing severe coronavirus disease 2019 (COVID-19), but there are limited data on COVID-19 vaccines in pregnancy. This study aimed to investigate the reactogenicity and immunogenicity of COVID-19 vaccines in pregnant women when administered according to the 12-week-interval dosing schedule recommended in the UK. METHODS: This was a cohort study of pregnant women receiving COVID-19 vaccination between April and September 2021. The outcomes were immunogenicity and reactogenicity after COVID-19 vaccination. Pregnant women were recruited by phone, e-mail and/or text and were vaccinated according to vaccine availability at their local vaccination center. For immunogenicity assessment, blood samples were taken at specific timepoints after each dose to evaluate nucleocapsid protein (N) and spike protein (S) antibody titers. The comparator group comprised non-pregnant female healthcare workers in the same age group who were vaccinated as part of the national immunization program in a contemporaneous longitudinal cohort study. Longitudinal changes in serum antibody titers and association with pregnancy status were assessed using a two-step regression approach. Reactogenicity assessment in pregnant women was undertaken using an online questionnaire. The comparator group comprised non-pregnant women aged 18-49 years who had received two vaccine doses in primary care. The association of pregnancy status with reactogenicity was assessed using logistic regression analysis. RESULTS: Overall, 67 pregnant women, of whom 66 had received a mRNA vaccine, and 79 non-pregnant women, of whom 50 had received a mRNA vaccine, were included in the immunogenicity study. Most (61.2%) pregnant women received their first vaccine dose in the third trimester, while 3.0% received it in the first trimester and 35.8% in the second trimester. SARS-CoV-2 S-antibody geometric mean concentrations after mRNA vaccination were not significantly different at 2-6 weeks after the first dose but were significantly lower at 2-6 weeks after the second dose in infection-naïve pregnant compared with non-pregnant women. In pregnant women, prior infection was associated with higher antibody levels at 2-6 weeks after the second vaccine dose. Reactogenicity analysis included 108 pregnant women and 116 non-pregnant women. After the first dose, tiredness and chills were reported less commonly in pregnant compared with non-pregnant women (P = 0.043 and P = 0.029, respectively). After the second dose, feeling generally unwell was reported less commonly (P = 0.046) in pregnant compared with non-pregnant women. CONCLUSIONS: Using an extended 12-week interval between vaccine doses, antibody responses after two doses of mRNA COVID-19 vaccine were found to be lower in pregnant compared with non-pregnant women. Strong antibody responses were achieved after one dose in previously infected women, regardless of pregnancy status. Pregnant women reported fewer adverse events after both the first and second dose of vaccine. These findings should now be addressed in larger controlled studies. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Evaluation of immunogenicity and reactogenicity of COVID‐19 vaccines in pregnant women

Objective SARS‐CoV‐2 infection in pregnancy is associated with increased risk of adverse maternal and perinatal outcomes including preterm birth, pre‐eclampsia, stillbirth, admission to intensive care unit and death. Vaccines are highly effective in preventing severe COVID‐19, however there are limited data on COVID‐19 vaccines in pregnancy. This study aimed to investigate the reactogenicity and immunogenicity of the COVID‐19 vaccine in pregnant women when given using the UK's extended 12‐week interval schedule. Methods This was a cohort study of pregnant women receiving COVID‐19 vaccination between January and September 2021. The primary outcome was immunogenicity and reactogenicity after COVID‐19 vaccination in pregnant women. Pregnant women were recruited by phone, email and text. They were vaccinated according to vaccine availability at their local vaccination hub and blood samples were taken at specific time points after each vaccine for nucleoprotein (N) and spike protein (S) antibodies. The comparator group comprised non‐pregnant female healthcare workers in the same age‐group who were vaccinated as part of the national immunization programme in a contemporaneous longitudinal cohort study. Association of variables with antibody levels was assessed using linear regression analysis after log‐transforming antibody levels. Reactogenicity assessment in pregnant women was undertaken using an online questionnaire. The comparator group comprised non‐pregnant women aged 18‐49 years who had received two vaccine doses in primary care. The association of pregnancy status with reactogenicity was assessed using logistic regression analysis. Results Overall 67 pregnant women including 66 who had received an mRNA vaccine and 50 non‐pregnant women were included in the immunogenicity study. Most pregnant women (61.2%) received the vaccine in the third trimester, while 3.0% received it in their first and 35.8% in the second trimesters. SARS‐CoV‐2 S‐antibody GMCs after mRNA vaccination were not significantly different at 2‐6 weeks after the first dose but were significantly lower at 2‐6 weeks after the second dose of vaccine in infection‐naïve pregnant compared to non‐pregnant women. In pregnant women, prior infection was associated with higher antibody levels compared to infection‐naïve women at 2‐6 weeks after both vaccine doses. The reactogenicity analysis included 108 pregnant women and 116 non‐pregnant women. After the first dose, tiredness and chills were reported less commonly in pregnant women when compared to non‐pregnant women (P=0.043 and P=0.029, respectively). After the second dose feeling generally unwell was reported less commonly (P=0.046) in pregnant women when compared to non‐pregnant women. Conclusions Using an extended 12‐week interval between vaccine doses, antibody responses after 2 doses of mRNA vaccine were found to be lower in pregnant women than in non‐pregnant women. However, Antibody responses to mRNA vaccination were lower in pregnant women when compared to non‐pregnant women. High antibody responses were achieved after one dose in previously infected women, regardless of pregnancy status. Pregnant women had fewer adverse effects after both the first and the second dose of the vaccine. These findings should now be addressed in larger controlled studies. This article is protected by copyright. All rights reserved.