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Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study.
Gray, Kathryn J; Bordt, Evan A; Atyeo, Caroline; Deriso, Elizabeth; Akinwunmi, Babatunde; Young, Nicola; Baez, Aranxta Medina; Shook, Lydia L; Cvrk, Dana; James, Kaitlyn; De Guzman, Rose; Brigida, Sara; Diouf, Khady; Goldfarb, Ilona; Bebell, Lisa M; Yonker, Lael M; Fasano, Alessio; Rabi, S Alireza; Elovitz, Michal A; Alter, Galit; Edlow, Andrea G.
  • Gray KJ; Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
  • Bordt EA; Lurie Center for Autism, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
  • Atyeo C; Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA; PhD Program in Virology, Division of Medical Sciences, Graduate School of Arts & Sciences, Harvard University, Boston, MA.
  • Deriso E; Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA.
  • Akinwunmi B; Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
  • Young N; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
  • Baez AM; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
  • Shook LL; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA.
  • Cvrk D; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
  • James K; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
  • De Guzman R; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
  • Brigida S; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
  • Diouf K; Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
  • Goldfarb I; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
  • Bebell LM; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; MGH Center for Global Health, and Harvard Medical School, Boston, MA.
  • Yonker LM; Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
  • Fasano A; Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
  • Rabi SA; Department of Cardiothoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
  • Elovitz MA; Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
  • Alter G; Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA. Electronic address: galter@mgh.harvard.edu.
  • Edlow AG; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA. Electronic address: aedlow@mgh.harvard.edu.
Am J Obstet Gynecol ; 225(3): 303.e1-303.e17, 2021 09.
Article in English | MEDLINE | ID: covidwho-1237586
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ABSTRACT

BACKGROUND:

Pregnant and lactating women were excluded from initial coronavirus disease 2019 vaccine trials; thus, data to guide vaccine decision making are lacking.

OBJECTIVE:

This study aimed to evaluate the immunogenicity and reactogenicity of coronavirus disease 2019 messenger RNA vaccination in pregnant and lactating women compared with (1) nonpregnant controls and (2) natural coronavirus disease 2019 infection in pregnancy. STUDY

DESIGN:

A total of 131 reproductive-age vaccine recipients (84 pregnant, 31 lactating, and 16 nonpregnant women) were enrolled in a prospective cohort study at 2 academic medical centers. Titers of severe acute respiratory syndrome coronavirus 2 spike and receptor-binding domain immunoglobulin G, immunoglobulin A, and immunoglobulin M were quantified in participant sera (n=131) and breastmilk (n=31) at baseline, at the second vaccine dose, at 2 to 6 weeks after the second vaccine, and at delivery by Luminex. Umbilical cord sera (n=10) titers were assessed at delivery. Titers were compared with those of pregnant women 4 to 12 weeks from the natural infection (n=37) by enzyme-linked immunosorbent assay. A pseudovirus neutralization assay was used to quantify neutralizing antibody titers for the subset of women who delivered during the study period. Postvaccination symptoms were assessed via questionnaire. Kruskal-Wallis tests and a mixed-effects model, with correction for multiple comparisons, were used to assess differences among groups.

RESULTS:

Vaccine-induced antibody titers were equivalent in pregnant and lactating compared with nonpregnant women (pregnant, median, 5.59; interquartile range, 4.68-5.89; lactating, median, 5.74; interquartile range, 5.06-6.22; nonpregnant, median, 5.62; interquartile range, 4.77-5.98, P=.24). All titers were significantly higher than those induced by severe acute respiratory syndrome coronavirus 2 infection during pregnancy (P<.0001). Vaccine-generated antibodies were present in all umbilical cord blood and breastmilk samples. Neutralizing antibody titers were lower in umbilical cord than maternal sera, although this finding did not achieve statistical significance (maternal sera, median, 104.7; interquartile range, 61.2-188.2; cord sera, median, 52.3; interquartile range, 11.7-69.6; P=.05). The second vaccine dose (boost dose) increased severe acute respiratory syndrome coronavirus 2-specific immunoglobulin G, but not immunoglobulin A, in maternal blood and breastmilk. No differences were noted in reactogenicity across the groups.

CONCLUSION:

Coronavirus disease 2019 messenger RNA vaccines generated robust humoral immunity in pregnant and lactating women, with immunogenicity and reactogenicity similar to that observed in nonpregnant women. Vaccine-induced immune responses were statistically significantly greater than the response to natural infection. Immune transfer to neonates occurred via placenta and breastmilk.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Qualitative research / Randomized controlled trials Topics: Vaccines Language: English Journal: Am J Obstet Gynecol Year: 2021 Document Type: Article Affiliation country: J.ajog.2021.03.023

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Qualitative research / Randomized controlled trials Topics: Vaccines Language: English Journal: Am J Obstet Gynecol Year: 2021 Document Type: Article Affiliation country: J.ajog.2021.03.023