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. Natural SARS-CoV-2 infection results in anti-nucleocapsid (N) and anti-spike (S) antibody (Ab) development. Anti-S Ab response (conferred by infection and/or vaccination) is more closely associated with protection. We evaluated anti-N/S Ab responses in vaccinated (> 1 dose) and unvaccinated pregnant people with prior SAR-CoV-2 infection. Methods. During January 2021-March 2022, we enrolled participants with SARS-CoV-2 infection identified in pregnancy (26 via anti-N IgG+;52 via prior RT-PCR+). Baseline, 1, 2, 3, 6, and 12 months, and delivery samples were tested for anti-N (index >= 1.4 positive) and anti-S (>= 50 AU/mL positive) IgG Ab by Abbott Architect. Kaplan-Meier methods were used to measure Ab response duration. Results. Among 78 participants, 62 (79%) enrolled in pregnancy (median 27 weeks gestation), and 16 (21%) at delivery/postpartum (median 2 weeks);34 (44%) had received >=1 vaccine prior to initial Ab testing. At baseline, 59 (75%) participants had concordant anti-N/S positive results (median anti-N index 3.58 [IQR 2.01-5.82], median anti-S 5529 AU/ml [IQR 687-25000]). Anti-S IgG was higher (25000 vs 774, p< 0.001) among participants receiving >=1 vaccine vs no vaccine, while anti-N IgG indices were similar. Among 59 participants with initial anti-N IgG+ results, median time to anti-N IgG negative results was 31 weeks after first RT-PCR+ (median 17 weeks after first anti-N IgG+ result). Only 1 (unvaccinated) participant had an anti-S IgG negative result by 22 weeks after first RT-PCR+ result. Among 30 participants with delivery samples (median 16 weeks after RT-PCR+, 12 weeks after baseline anti-N IgG+ samples), 15 (52%) remained anti-N IgG+;29 (97%) remained anti-S IgG+. Anti-S IgG was higher (25000 vs 826 AU/ml, p< 0.001) among participants receiving >= 1 vaccine vs. no vaccine prior to delivery. Conclusion. Among pregnant persons with prior SARS-CoV-2 infection, duration of anti-S IgG response was longer than anti-N IgG irrespective of vaccine status;vaccination during pregnancy was associated with higher anti-S levels at baseline and delivery. While anti-S IgG were detectable for >= 6 months, longer term follow-up is needed to assess durability of hybrid immunity vs. infection alone and has implications for maternal and infant protection.
ABSTRACT
Purpose: Quality sexual and reproductive health (SRH) care for adolescents includes implementation of youth-friendly clinical practices (e.g., practices that support minor’s rights to confidential care) and provision of recommended clinical services (e.g., access to the full range of contraceptive methods). There is limited data from providers regarding the quality of SRH care for adolescents in the United States. This analysis examines physician-reported prevalence of youth-friendly practices and SRH services overall and by physician specialty to inform focused improvement efforts. Methods: Data were from the DocStyles online panel survey administered with U.S. healthcare providers September-October 2020. The survey assessed whether the following youth-friendly practices were in place just before the COVID-19 pandemic: walk-in hours, evening/weekend hours, time alone with a provider at every visit, confidentiality policy communicated at every visit, and routine encouragement of parent-adolescent communication. SRH services assessed included long-acting reversible contraception (LARC) insertion and removal, clinic-based sexually transmitted infection (STI) testing, and counseling about STI prevention at contraception initiation. We restricted the analytic sample to family practitioners (n=364), internists (n=247), pediatricians (n=180), and obstetricians/gynecologists (n=213) primarily working in outpatient settings who reported providing family planning or STI services to at least one patient aged 15-19 years per week just before the pandemic. Descriptive statistics were calculated overall and for each physician specialty, and chi-squared tests were used to examine differences. We also explored associations between physician-report of adolescent SRH quality improvement (QI) efforts in the year just before the pandemic and each youth-friendly practice and SRH service. Generalized linear models were used to produce adjusted prevalence ratios (APR) controlling for physician specialty, individual versus group practice, and adolescent patient volume for SRH services. Results: Among physicians who provided SRH services to adolescents overall, the proportion with youth-friendly practices in place ranged from 44.7% for weekend/evening hours available to 60.5% for routine encouragement of parent-adolescent communication. Walk-in hours and evening/weekend hours available were highest for pediatricians and lowest for obstetricians/gynecologists. Nearly three-quarters of pediatricians and obstetricians/gynecologists reported always providing time alone and communicating the confidentiality policy whereas only about half of family physicians and one-third of internists reported each of these practices. Overall, 37.6% reported their practice provided LARC placement and removal, 79.3% provided clinic-based STI testing, and 66.3% always discussed STI prevention with adolescents initiating contraception. Across these services, prevalence was consistently highest for obstetricians/gynecologists and lowest for internists, although the proportion of internists and pediatricians providing LARC services was similarly low (12.2% and 13.3%, respectively). Overall, about one-quarter (28.5%) of physicians reported that adolescent SRH QI efforts were conducted in the past year, and QI was associated with increased likelihood of having youth-friendly practices in place and providing SRH services for all indicators except weekend/evening hours and LARC services (APR range: 1.10-1.55). Conclusions: Findings suggest opportunities to improve youth-friendly practices and delivery of SRH services for adolescents, which vary by physician specialty. Implementing adolescent-focused SRH QI initiatives may be one approach to strengthening certain youth-friendly practices and clinical services. Sources of Support: None.
ABSTRACT
Background: Longitudinal assessment of SARS-CoV-2 antibody (Ab) response during pregnancy after infection and transplacental transfer may inform durability of maternally derived Ab for mothers and infants. Methods: Between October 2020-September 2021, pregnant people testing SARS-CoV-2 IgG positive by Abbott Architect chemiluminescent immunoassay (CMIA) for anti-nucleocapsid (N) antibody (semi-quantitative index ≥1.4 considered IgG+) during pregnancy or delivery in a seroprevalence study, or identified with RT-PCR+ results via medical records, were invited to enroll in a longitudinal evaluation of maternal Ab responses and transplacental transfer. Maternal blood collected at 1, 2, 3, and 6 months after enrollment and maternal and cord blood collected at delivery were tested with the same assay. Results: Among 40 participants testing IgG+ for anti-N, 31 (78%) had a prior RT-PCR+ result. Median age was 32 years (IQR 29-35);27 (68%) enrolled during pregnancy at median 18 weeks gestation (IQR 13-33), while 13 (33%) enrolled at delivery or early postpartum. Median Abbott index was 3.06 (IQR 1.96-5.74) at first IgG+ result obtained at a median of 9 weeks (IQR 4-16) after RT-PCR+ result, for those with a known RT-PCR. Among 23 participants with ≥2 samples, 50% had IgG results below positivity threshold at median 17 weeks (IQR 12-28) after first IgG+ result (Figure). Seventeen mother-infant pairs had delivery samples collected at median 66 days (IQR 60-71 days) from maternal RT-PCR+ result. Six (35%) maternal samples remained IgG+ (median Abbott index 2.97 [IQR 2.35-7.01]) at delivery (gestational age 30-40 weeks) with all 6 paired cord sera testing IgG+ (median Abbott index 4.30 [IQR 2.93-7.22]). Median placental transfer ratio of maternally derived IgG Abs based on a positive Abbott index was 1.13 (95%CI 0.98-1.30) among mothers with samples remaining IgG+ at delivery. Conclusion: Within 4 months after first IgG+ result primarily in second trimester, about half of pregnant persons had SARS-CoV-2 IgG anti-N Ab levels below the Abbott CMIA positive threshold. Among evaluable mother-infant pairs, two-thirds of mothers no longer tested anti-N IgG+ at delivery. Transplacental transfer of maternal antibodies was confirmed in all infants born to mothers with samples remaining IgG+ at delivery. Durability of maternal SARS-CoV-2 Ab response and transplacental transfer following infection has implications for maternal and neonatal susceptibility to SARS-CoV-2 infection.
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.