University Department of Obstetrics and Gynecology at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany.
Department of Obstetrics and Gynecology, School of Medicine, University of Würzburg, Würzburg, Germany.
J Perinat Med. 2021 Feb 24;49(6):709-716. doi: 10.1515/jpm-2021-0001. Print 2021 Jul 27.
The Severe Acute Respiratory Distress Corona Virus 2 (SARS-CoV-2) pandemic poses special challenges for the society and especially the medical staff. Even if a rather mild course is assumed among pregnant women the measures to prevent transmission of the infection are of outstanding importance.
To screen asymptomatic pregnant women during admission to our university maternal hospital we focused on anti-SARS-CoV-2-specific IgG and IgA antibody responses. Hundred and fifty one women admitted to the hospital for childbirth or caesarean delivery were included. In case of suspicious anti-SARS-CoV-2-antibody levels an RT-PCR was performed to confirm an ongoing infection with SARS-CoV-2.
A total of 89% showed negative results for anti-SARS-CoV-2-IgA antibodies, whereas 3% were borderline and 7% positive (both labeled as suspicious). In only one patient with suspicious serology we detected SARS-CoV-2-RNA in the following RT-PCR. 2% presented anti-SARS-CoV-2-IgG antibodies, all being positive for anti-SARS-CoV-2-IgA. The observed positive rate of our study collective of 10.6% seemed much higher than the expected one (1.3%) based on the reports of the Robert Koch Institute and the specifications given by the test's manufacturer. The expected positive predictive value (PPV) was 4.3-6.7 times higher than the observed one.
To our knowledge this is the first report of anti-SARS-CoV-2-antibody levels in the peripartum period of asymptomatic women. As the positive anti-SARS-CoV-2 serology poorly correlated with the confirmatory RT-PCR and the fact that mainly the detection of the virus by PCR correlates with the patient's infectiousness we suggest to rather perform a SARS-CoV-2-PCR-based admission screening in perinatal centers to prevent the spread of the disease.
严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)大流行给社会带来了特殊挑战,尤其是对医务人员而言。即使孕妇的病情相对较轻,预防感染传播的措施也具有极其重要的意义。
为了在我们大学妇产科医院筛查无症状孕妇,我们重点关注抗 SARS-CoV-2 特异性 IgG 和 IgA 抗体反应。共纳入 151 名因分娩或剖宫产而住院的女性。如怀疑 SARS-CoV-2 抗体水平,则进行 RT-PCR 以确认是否存在 SARS-CoV-2 感染。
总共有 89%的女性抗 SARS-CoV-2-IgA 抗体检测结果为阴性,3%为临界值,7%为阳性(均标记为可疑)。仅在一名可疑血清学患者中,我们在随后的 RT-PCR 中检测到 SARS-CoV-2-RNA。2%的患者出现抗 SARS-CoV-2-IgG 抗体,均对 SARS-CoV-2-IgA 呈阳性。我们的研究群体的阳性率(10.6%)似乎远高于罗伯特科赫研究所报告的预期阳性率(1.3%),以及检测制造商给出的规范。预期阳性预测值(PPV)比观察值高 4.3-6.7 倍。
据我们所知,这是首例在无症状女性围产期检测到抗 SARS-CoV-2 抗体水平的报告。由于阳性 SARS-CoV-2 血清学与确认性 RT-PCR 的相关性较差,并且仅通过 PCR 检测病毒与患者的传染性相关,因此我们建议在围产期中心进行基于 SARS-CoV-2-PCR 的入院筛查,以预防疾病传播。