Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with adverse maternal and neonatal outcomes, yet uptake of SARS-CoV-2 vaccines during pregnancy and lactation has been slow. As a result, millions of pregnant and lactating women and their infants remain susceptible to the virus.
Methods: We measured spike-specific immunoglobulin G (anti-S IgG) and immunoglobulin A (anti-S IgA) in serum and breastmilk (BM) samples from 3 prospective mother-infant cohorts recruited in 2 academic medical centers. The primary aim was to determine the impact of maternal SARS-CoV-2 immunization vs infection and their timing on systemic and mucosal immunity.
Results: The study included 28 mothers infected with SARS-CoV-2 in late pregnancy (INF), 11 uninfected mothers who received 2 doses of the BNT162b2 vaccine in the latter half of pregnancy (VAX-P), and 12 uninfected mothers who received 2 doses of BNT162b2 during lactation. VAX dyads had significantly higher serum anti-S IgG compared to INF dyads (P < .0001), whereas INF mothers had higher BM:serum anti-S IgA ratios compared to VAX mothers (P = .0001). Median IgG placental transfer ratios were significantly higher in VAX-P compared to INF mothers (P < .0001). There was a significant positive correlation between maternal and neonatal serum anti-S IgG after vaccination (r = 0.68, P = .013), but not infection.
Conclusions: BNT161b2 vaccination in late pregnancy or lactation enhances systemic immunity through serum anti-S immunoglobulin, while SARS-CoV-2 infection induces mucosal over systemic immunity more efficiently through BM immunoglobulin production. Next-generation vaccines boosting mucosal immunity could provide additional protection to the mother-infant dyad. Future studies should focus on identifying the optimal timing of primary and/or booster maternal vaccination for maximal benefit.
Keywords: COVID-19; SARS-CoV-2 vaccination; breastmilk; newborn; pregnancy.
【저자키워드】 COVID-19, Newborn, Pregnancy, breastmilk, SARS-CoV-2 vaccination, 【초록키워드】 SARS-CoV-2, IgG, Vaccine, BNT162b2 vaccine, coronavirus, vaccination, Immunity, SARS-COV-2 infection, Infection, lactation, virus, immunization, SARS-CoV-2 vaccine, Infant, outcomes, serum, Cohort, Pregnancy, Immunoglobulin, IgA, placental, immunoglobulin A, booster, anti-S IgG, mother, mucosal, pregnant, dose, Neonatal, acute respiratory syndrome, positive correlation, transfer, anti-S, uninfected, Future, susceptible, benefit, lactating women, BNT161b2, ENhance, recruited, determine, induce, significantly higher, infected with SARS-CoV-2, of BNT162b2, 【제목키워드】 coronavirus 2, Infant, Maternal, respiratory,