ABSTRACT
BACKGROUND: Immune changes that occur during pregnancy may place pregnant women at an increased risk for severe disease following viral infections like SARS-CoV-2. Whether these immunologic changes modify the immune response to SARS-CoV-2 infection during pregnancy is not well understood. OBJECTIVE: This study aimed to compare the humoral immune response to SARS-CoV-2 infection in pregnant and nonpregnant women. The immune response following vaccination for SARS-CoV-2 was also explored. STUDY DESIGN: In this cohort study, 24 serum samples from 20 patients infected with SARS-CoV-2 during pregnancy were matched by number of days after a positive test with 46 samples from 40 nonpregnant women of reproductive age. Samples from 9 patients who were vaccinated during pregnancy were also examined. Immunoglobulin G and immunoglobulin M levels were measured. Trends in the log antibody levels over time and mean antibody levels were assessed using generalized estimating equations. RESULTS: The median number of days from first positive test to sampling was 6.5 in the pregnant group (range, 3-97) and 6.0 among nonpregnant participants (range, 2-97). No significant differences in demographic or sampling characteristics were noted between the groups. No differences in immunoglobulin G or immunoglobulin M levels over time or mean antibody levels were noted among pregnant and nonpregnant participants following SARS-CoV-2 infection for any of the SARS-CoV-2 antigen targets examined (spike, spike receptor-binding domain, spike N-terminal domain, and nucleocapsid). Participants who were vaccinated during pregnancy had higher immunoglobulin G levels than pregnant patients who tested positive for all SARS-CoV-2 targets except nucleocapsid antibodies (all P<.001) and had lower immunoglobulin M spike (P<.05) and receptor-binding domain (P<.01) antibody levels. CONCLUSION: This study suggests that the humoral response following SARS-CoV-2 infection does not seem to differ between pregnant women and their nonpregnant counterparts. These findings should reassure patients and healthcare providers that pregnant patients seem to mount a nondifferential immune response to SARS-CoV-2.
ABSTRACT
Background Immune changes that occur during pregnancy may place pregnant women at an increased risk for severe disease following viral infections like SARS-CoV-2. Whether these immunological changes modify immune response to SARS-CoV-2 infection during pregnancy is not well understood. Objective The objective of the present study is to compare humoral immune response to SARS-CoV-2 infection in pregnant and non-pregnant women. Immune response following vaccination for SARS-CoV-2 was also explored. Study Design In the present cohort study, 24 serum samples from 20 patients infected with SARS-CoV-2 during pregnancy were matched on number of days post positive test to 46 samples from 40 non-pregnant women of reproductive age. Samples from nine patients vaccinated during pregnancy were also examined. Immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody levels were measured. Trends in log antibody levels over time and mean antibody levels were assessed using generalized estimating equations. Results Median number of days from first positive test to sampling was 6.5 in the pregnant group (range 3-97) and 6.0 among non-pregnant participants (range 2-97). No significant differences in demographic or sampling characteristics were noted between groups. No differences in IgG or IgM levels over time or mean antibody levels were noted in pregnant and non-pregnant participants following SARS-CoV-2 infection for any of the SARS-CoV-2 antigens targets examined [Spike, Spike Receptor Binding Domain (RBD), Spike N-Terminal Domain (NTD), and Nucleocapsid]. Participants vaccinated during pregnancy had higher IgG levels than pregnant positive patients for all SARS-CoV-2 targets except Nucleocapsid (all p < 0.001), as well as lower IgM Spike (p < 0.05) and RBD (p < 0.01) antibody levels. Conclusions The present study suggests that humoral response following SARS-CoV-2 infection does not appear to differ in pregnant women compared to their non-pregnant counterparts. These findings should reassure patients and healthcare providers that pregnant patients appear to mount a non-differential immune response to SARS-CoV-2.
ABSTRACT
OBJECTIVE: We assessed the proportion of medication versus suction aspiration abortions before and after the onset of the COVID-19 pandemic in a health system that did not limit access to abortion. STUDY DESIGN: We conducted an interrupted time series analysis among patients having an abortion at 10 weeks gestation or less at Planned Parenthood health centers in San Diego, Imperial, and Riverside Counties in California. Centers required in-person follow up for medication abortion throughout the pandemic. We compared the nine months prior to the pandemic (June 2019 to February 2020) to the first nine months of the pandemic (April 2020 to December 2020), with March 2020 as a washout period. RESULTS: There was an average monthly increase of 0.78% in the proportion of medication abortions from June 2019 to February 2020 (p = 0.01, pre-pandemic trend). Immediately following the start of the pandemic, there was an estimated increase in the proportion of medication abortions of 2.58% (p = 0.23, post-level change). However, the monthly pre-pandemic trend towards medication abortions reversed by 1.07% after the start of the pandemic (p = 0.02, post-trend change), for an average monthly decrease in the proportion of medication abortions of 0.29% from April to December 2020 (p = 0.37, pandemic trend). CONCLUSIONS: The trend towards medication abortions that was present before the COVID-19 pandemic reversed after an initial increase in medication abortions at the start of the pandemic. IMPLICATIONS: Both types of abortion should remain available during public health emergencies. Further research is needed to understand how the pandemic affected abortion methods in areas with limited access and in health centers that did not require two in-person appointments for medication abortions.