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Passive and active immunity in infants born to mothers with SARS-CoV-2 infection during pregnancy: prospective cohort study

Por: Song · D. · Prahl · M. · Gaw · S. L. · Narasimhan · S. R. · Rai · D. S. · Huang · A. · Flores · C. V. · Lin · C. Y. · Jigmeddagva · U. · Wu · A. · Warrier · L. · Levan · J. · Nguyen · C. B. T. · Callaway · P. · Farrington · L. · Acevedo · G. R. · Gonzalez · V. J. · Vaaben · A. · Nguyen · P.
Objective

To investigate maternal immunoglobulins’ (IgM, IgG) response to SARS-CoV-2 infection during pregnancy and IgG transplacental transfer, to characterise neonatal antibody response to SARS-CoV-2 infection, and to longitudinally follow actively and passively acquired antibodies in infants.

Design

A prospective observational study.

Setting

Public healthcare system in Santa Clara County (California, USA).

Participants

Women with symptomatic or asymptomatic SARS-CoV-2 infection during pregnancy and their infants were enrolled between 15 April 2020 and 31 March 2021.

Outcomes

SARS-CoV-2 serology analyses in the cord and maternal blood at delivery and longitudinally in infant blood between birth and 28 weeks of life.

Results

Of 145 mothers who tested positive for SARS-CoV-2 during pregnancy, 86 had symptomatic infections: 78 with mild-moderate symptoms, and 8 with severe-critical symptoms. The seropositivity rates of the mothers at delivery was 65% (95% CI 0.56% to 0.73%) and the cord blood was 58% (95% CI 0.49% to 0.66%). IgG levels significantly correlated between the maternal and cord blood (Rs=0.93, p

Conclusions

Maternal SARS-CoV-2 IgG is efficiently transferred across the placenta when infections occur more than 2 months before delivery. Maternally derived passive immunity may persist in infants up to 6 months of life. Neonates are capable of mounting a strong antibody response to perinatal SARS-CoV-2 infection.

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