孕期感染新冠病毒的母亲所生婴儿的被动免疫和主动免疫：前瞻性队列研究

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

作者信息

Song Dongli, Prahl Mary, Gaw Stephanie L, Narasimhan SudhaRani, Rai Daljeet, Huang Angela, Flores Claudia, Lin Christine Y, Jigmeddagva Unurzul, Wu Alan H B, Warrier Lakshmi, Levan Justine, Nguyen Catherine B T, Callaway Perri, Farrington Lila, Acevedo Gonzalo R, Gonzalez Veronica J, Vaaben Anna, Nguyen Phuong, Atmosfera Elda, Marleau Constance, Anderson Christina, Misra Sonya, Stemmle Monica, Cortes Maria, McAuley Jennifer, Metz Nicole, Patel Rupalee, Nudelman Matthew, Abraham Susan, Byrne James, Jegatheesan Priya

机构信息

Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA.

Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.

出版信息

medRxiv. 2021 May 3:2021.05.01.21255871. doi: 10.1101/2021.05.01.21255871.

DOI:10.1101/2021.05.01.21255871

PMID:33972953

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8109203/

Abstract

OBJECTIVE

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

DESIGN

A prospective observational study.

SETTING

A public healthcare system in Santa Clara County (CA, USA).

PARTICIPANTS

Women with SARS-CoV-2 infection during pregnancy and their infants were enrolled between April 15, 2020 and March 31, 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 eight with severe-critical symptoms. Of the 147 newborns, two infants showed seroconversion at two weeks of age with high levels of IgM and IgG, including one premature infant with confirmed intrapartum infection. The seropositivity rates of the mothers at delivery was 65% (95% CI 0.56-0.73) and the cord blood was 58% (95% CI 0.49-0.66). IgG levels significantly correlated between the maternal and cord blood (Rs= 0.93, p< 0.0001). IgG transplacental transfer ratio was significantly higher when the first maternal positive PCR was 60-180 days before delivery compared to <60 days (1.2 vs. 0.6, p=<0.0001). Infant IgG negative conversion rate over follow-up periods of 1-4, 5-12, and 13-28 weeks were 8% (4/48), 12% (3/25), and 38% (5/13), respectively. The IgG seropositivity in the infants was positively related to IgG levels in the cord blood and persisted up to six months of age.

CONCLUSIONS

Maternal SARS-CoV-2 IgG is efficiently transferred across the placenta when infections occur more than two months before delivery. Maternally-derived passive immunity may protect infants up to six months of life. Neonates mount a strong antibody response to perinatal SARS-CoV-2 infection.

摘要

目的

研究孕期母体免疫球蛋白（IgM、IgG）对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的反应以及IgG的胎盘转运情况，描述新生儿对SARS-CoV-2感染的抗体反应，并纵向追踪婴儿主动和被动获得的SARS-CoV-2抗体。

设计

一项前瞻性观察性研究。

地点

美国加利福尼亚州圣克拉拉县的一个公共医疗系统。

参与者

2020年4月15日至2021年3月31日期间纳入孕期感染SARS-CoV-2的妇女及其婴儿。

观察指标

分娩时脐带血和母体血液中的SARS-CoV-2血清学分析，以及出生至28周龄婴儿血液的纵向分析。

结果

145名孕期SARS-CoV-2检测呈阳性的母亲中，86例有症状感染：78例为轻至中度症状，8例为重症至危重症症状。147名新生儿中，2例婴儿在2周龄时出现血清转化，IgM和IgG水平较高，其中1例早产儿确诊为产时感染。母亲分娩时的血清阳性率为65%（95%可信区间0.56 - 0.73），脐带血为58%（95%可信区间0.49 - 0.66）。母体和脐带血中的IgG水平显著相关（Rs = 0.93，p < 0.0001）。与分娩前<60天相比，首次母体PCR阳性发生在分娩前60 - 180天时，IgG胎盘转运率显著更高（1.2对0.6，p = <0.0001）。在1 - 4周、5 - 12周和13 - 28周的随访期内，婴儿IgG转阴率分别为8%（4/48）、12%（3/25）和38%（5/13）。婴儿的IgG血清阳性与脐带血中的IgG水平呈正相关，并持续至6个月龄。