Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.
Department of Pharmacology, Physiology, and Cancer Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.
Front Immunol. 2023 Sep 11;14:1216410. doi: 10.3389/fimmu.2023.1216410. eCollection 2023.
As the SARS-CoV-2 pandemic continues to evolve, we face new variants of concern with a concurrent decline in vaccine booster uptake. We aimed to evaluate the difference in immunity gained from the original SARS-CoV-2 mRNA vaccine series in pregnancy versus SARS-CoV-2 exposure during pregnancy against recent variants of concern.
This is a retrospective analysis of previously collected samples from 192 patients who delivered between February 2021 and August 2021. Participants were categorized as 1) COVID vaccine: mRNA vaccine in pregnancy, 2) COVID-exposed, and 3) controls. The primary outcome was neutralizing capacity against wild-type, Delta, and Omicron-B1 between cohorts. Secondary outcomes include a comparison of cord-blood ID50 as well as the efficiency of vertical transfer, measured by cord-blood:maternal blood ID50 for each variant.
Pregnant women with COVID-19 vaccination had a greater spike in IgG titers compared to both those with COVID-19 disease exposure and controls. Both COVID exposure and vaccination resulted in immunity against Delta, but only COVID vaccination resulted in significantly greater Omicron ID-50 versus controls. The neutralizing capacity of serum from newborns was lower than that of their mothers, with COVID-vaccination demonstrating higher cord-blood ID50 vs wildtype and Delta variants compared to control or COVID-exposed, but neither COVID-exposure nor vaccination demonstrated significantly higher Omicron ID50 in cord-blood compared to controls. There was a 0.20 (0.07-0.33, p=0.004) and 0.12 (0.0-0.24, p=0.05) increase in cord-blood:maternal blood ID50 with COVID vaccination compared to COVID-19 exposure for wild-type and Delta respectively. In pair-wise comparison, vertical transfer of neutralization capacity (cord-blood:maternal blood ID50) was greatest for wild-type and progressively reduced for Delta and Omicron ID50.
Pregnant patients with either an initial mRNA vaccination series or COVID-exposure demonstrated reduced immunity against newer variants compared to wild-type as has been reported for non-pregnant individuals; however, the COVID-vaccination series afforded greater cross-variant immunity to pregnant women, specifically against Omicron, than COVID-disease. Vertical transfer of immunity is greater in those with COVID vaccination vs COVID disease exposure but is reduced with progressive variants. Our results reinforce the importance of bivalent booster vaccination in pregnancy for both maternal and infant protection and also provide a rationale for receiving updated vaccines as they become available.
随着 SARS-CoV-2 大流行的持续演变，我们面临着新的关注变体，同时疫苗加强针的接种率也在下降。我们旨在评估与最近的关注变体相比，孕妇中最初的 SARS-CoV-2 mRNA 疫苗系列与怀孕期间的 SARS-CoV-2 暴露所获得的免疫差异。
这是对 192 名于 2021 年 2 月至 2021 年 8 月分娩的患者的先前收集样本进行的回顾性分析。参与者分为 1）COVID 疫苗：怀孕期间的 mRNA 疫苗，2）COVID 暴露，和 3）对照组。主要结局是比较野生型、Delta 和 Omicron-B1 之间各队列的中和能力。次要结局包括比较脐带血 ID50 以及每种变体的垂直转移效率，通过脐带血：母血 ID50 进行测量。
与 COVID 疾病暴露和对照组相比，COVID 疫苗接种的孕妇 IgG 滴度升高幅度更大。COVID 暴露和接种均导致对 Delta 的免疫，但只有 COVID 接种导致 Omicron ID-50 与对照组相比显著更高。新生儿血清的中和能力低于其母亲，与野生型和 Delta 变体相比，COVID 疫苗接种显示出更高的脐带血 ID50，而 COVID 暴露或接种均未显示出与对照组相比，Omicron ID50 在脐带血中显著更高。与 COVID 暴露相比，COVID 疫苗接种使脐带血：母血 ID50 分别增加 0.20（0.07-0.33，p=0.004）和 0.12（0.0-0.24，p=0.05），用于野生型和 Delta。在两两比较中，与 COVID 暴露相比，中和能力的垂直转移（脐带血：母血 ID50）对于野生型最大，对于 Delta 和 Omicron ID50 则逐渐降低。
与非孕妇相比，初始 mRNA 疫苗接种系列或 COVID 暴露的孕妇对新变体的免疫力降低，但 COVID 疫苗接种系列使孕妇对各种变体的交叉免疫力增强，特别是对 Omicron。与 COVID 疾病暴露相比，COVID 疫苗接种的垂直免疫转移更大，但随着变体的进展而降低。我们的结果强化了在孕妇中进行双价加强针接种以保护母婴的重要性，也为随着疫苗的推出而接受更新的疫苗提供了依据。
